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43 Cards in this Set

  • Front
  • Back
Misc Antiarrythmics
Digoxin
Adenosine
Class IA
Quinidine
Procainamide
Class IB
Lidocaine
Class IC
Flecainide
Propafenone
Class II
Propanolol
Esmolol
Class III
AS I DD
Amioderone
Sotalol
Ibutilide
Dofetilide
Dronedarone
Class IV
Verapamil
Diltiazem
Treatment of HIT
Argatroban
binds to ATIII complex and prevents II, IX, X, XII
Heparin
X prothrombin to thrombin (thrombosis)
II fibrinogen to fibrin (clot extension)
antidote for LMWH induced bleeding
protamine
Enhancement of Warfarin action
due to inhibition of the P450 system:
Cimedtidine and amiodarone

Additive effects from aspirin

inhibition from Vitamin K
Warfarin interferes with
action of vitamin K on activation of II, VII, IX, and X
Direct Thrombin Inhibitors
pharm actions of hirudin (binds directly to thrombin)

irreversible binding, potent thrombin inhibitor, but associated bleeding probs (not app in the US)
DTIs
Bivalirudin (UA undergoing PTCA)-lower affinity and reversible with less side effects... immediate anticoag

Dabigatran (first orally active DTI) reduce stroke and systemic embolism risk with nonvalvular AF... take twice daily. requires no assessment or monitor and has no antidote for bleeding
DTI Side effects
Dyspepsia
how are DTIs eliminated?
renally, not affected by P450 system
Factor Xa Inhibs
fondaparinux (indirect inhibitor) causes irreversible change in the ATIII and irreversible binding of Xa to ATIII (Prophy for DVT that may lead to PE from surgeries)

Rivaroxaban (first oral) no need for monitoring... same indications as above.
Best Anticoag?
Dabigatrain>Warfarin... Rivaroxaban and warf are similar
Bleeding from anticoags?
Warfarin-IC bleeds
Dabigatran and Rivaroxaban-GI bleeds
Antifibrinolytics do what?
Which is strongest?
inhibit plasminogen activator
Tranexamic Acid>Aminocaproic Acid
Tranexamic Acid is for what?
short term in hemophilia patients following tooth extraction
Thrombolytic/Fibrinolytics do what?
activate plasminogen to converts plasminogen to plasmin and degrades the fibrin clots...
Use prophy aspiran or heparin to prevent rethrombosis from the thrombin being released from the lysed clot
Antifibrinolytics do what?
they block plasminogen and don't allow for clot breakdown
Thrombolytics produce what from lysis of the clot?
fibrinogen is depleted and I, II, V, and VII are degraded. Lytic state inhibits further clotting but impairs hemostasis
ADR for Thrombolytics
Hemorrhage... bc the plasmin can't tell bt pathologic thrombus and hemostatic blud that prevents bleeding from a vascular injury... Plasminogen activators also work on circulating plasminogen producing a plasmin generated systemic fibrinolysis (lytic state)
Who gets thrombolytics?
within 12 hr of chest pain
12-24 hr after ongoing ischemia
STEMI in 2 leads or new LBBB
no contraind for thrombo therapy
**can't use after 24 hours! so give ASAP
Alteplase dose of 150 is associated with what?
intracranial bleeding
Reteleplase has longer/shorter half life than alteplase?
Longer and slightly lower affinity... use IV dose 10 over 2 mins. Major advantage is that its faster (30 compared to 90 with alteplase)
Tenecteplase
long half life allows single bolus dose over 5 seconds....highest specificity for pathologic fibrin clots....lowest antigenic potential...
TXA2 inhibitor
Aspirin
enzyme aspirin uses
COX-1
Ticlopidine and Clopidogel work how?
inhibit ADP induced platelet agg via ADP P2Y12 antag... inhibs prim and sec platelet agregation by ADP and fibrinogen
Eptifibatide and Tirofiban work how?
Prevent acti of BPIIb/IIIa receptor complex
Abciximab work how?
antibody to GPIIb/IIIa complex
Dipyridamole does what?
inhibits platelet PDE, increases cyclic AMP, inhibs platelet adhesion and aggregation... use with coumadin antcoags to prevent postop thromboembolic comps or cardiac valve replacement
ADR to Ticlopidine?
life threatening blood dyscrasias... use only in pts allergic to or who have failed aspirin treatment
Causes: TTP and Neutropenia
Clopidogrel
3 times more potent than Ticlo. is a prodrug... about as effective as ASA but safer than Ticlopidine.
Bare metal stents therapy
antiplatelets... Aspirin plus clopidogrel, prasurgel, or ticagrelor for 1 month... continue aspirin forever
Drug eluting stent therapy
aspirin plus clopid, prasurg, or ticagrelor for 1 year!... continue aspirin forever
Prasugrel
produg... conversion by hepatic P450. inhibitors of 2C19 should not cause suboptimal response. Don't use if bleeding or >75
Ticagrelor
faster onset than clopid and prasugrel bc its not a prodrug... reversibly binds and shorter effects. Advantage in Acute Surgery! May cause dyspnea... Use in ACS works via P2Y12 inhibitor (active metaolite)
Platelet GP IIb/IIIa antags
Eptifibatide for ACS and PCI (use with heparin)
Tirofiban for ACS and PTCA or arthectomy (use with heparin)
Ab to GPIIb/a receptor
Abciximab...inhibs platelet agg by binding of blocking binding of fibrinogen, vWF, and other factors. Use in PTCA for high risk pts to abrupt closure of treated coronary vessels... Use with asprin and heparin