Pharmacology Test 3 L7 Drugs Affecting Coagulation

Front 1

what does damage to blood vessels cause release of?

Back 1

this releases von Willebrand factor

Front 2

What do damage to endothelium reduce the production of?

Back 2

reduces PGI2 (prostacyclin) production

Front 3

What is Antithrombin III?

Back 3

this is a plasma protease inhibitor, that inactivates clotting factors

Front 4

What things get overwhelmed in DIC?

Back 4

the protease inhibitors AT3, Alpha1-antiprotease, and alpha2-macroglobulin

Front 5

what causes fibrinolysis?

Back 5

plasmin

Front 6

what converts plasminogen (inactive) into plasmin?

Back 6

tissue-plasminogen activator (t-PA)

Front 7

what is a white thrombus?

Back 7

this is the initial plug formed by platelets in high pressure arteries.

Front 8

what is a red thrombus?

Back 8

this is an insoluble fibrin and mesh like thrombus that includes RBCs and platelets

Front 9

What does aPTT measure?

Back 9

this measures the clotting time of the intrinsic pathway

Front 10

What does PT measure?

Back 10

this is a measure of extrinsic pathway clotting (tissue factor mediated)

Front 11

How is heparin administered?

Back 11

IV ONLY

Front 12

how is heparin cleared?

Back 12

mainly in the liver by heparinase

Front 13

What is heparin made of?

Back 13

a heterogenous mix of sulfated mucopolysacharides

Front 14

How does heparin work?

Back 14

heparin binds AT-3, and speeds up its inactivating effects by 1000X (a catalyst)

Knocks out IXa, Xa, and IIa

Front 15

What pathway dose heparin affect?

Back 15

this increases aPTT, so it must affect the intrinsic pathway.

Front 16

How long does heparin take to work?

Back 16

immediate action

Front 17

What is the trade name of heparin sodium?

Back 17

Liquaemin

Front 18

What conditions prolong the action of heparin sodium?

Back 18

Renal or hepatic dysfunction pts.
also people with low body temperature

Front 19

What is the name of LMW heparin?

Back 19

Enoxaparin
(kind close to heparin, right?)

Front 20

How is Enoxaparin BEST given?

Back 20

injected subcutaneously is the best method, requires less frequent dosing.

Front 21

What are the two main toxic effects of Enoxaprin (a LMW heparin)

Back 21

Hemorrhage (duh)

and Heparin induced thrombocytopenia

Front 22

What is the antagonist of heparin?

Back 22

Protamine sulfate

Front 23

Other than obvious pts like folks with bleeding disorders...who should NOT get heparin?

Back 23

people who have brain, spinal cord, or eye surgery

lumbar puncture pts, or regional anesthetic therapy

Front 24

What is heparin used for?

Back 24

anticoagulation during surgery
DVT prophylaxis
Maintaining catheters open
**in pregnant pts to replace warfarin, because it does not cross the palcenta**

Front 25

What does protamine sulfate do in the absence of heparin?

Back 25

this causes anticoagulation effects (ironically)

Front 26

what are the adverse effect sof protamine sulfate?

Back 26

hypotension due to histamine release

pulmonary hypertension

allergic reactions

Front 27

What is Lepirudin?

Back 27

this is recombination of hirudin, a leech anticoagulant

Front 28

What does Lepirudin do?

Back 28

this is a *direct* inhibitor of thrombin

Front 29

How does Warfarin work?

Back 29

this prevents reduction of vitamin K, and interferes with processing of clotting factors II, VII, IX, and X

Front 30

How long does Warfain take to work?

Back 30

this takes 12-16 hours to work, because it prevents the development of NEW clotting factors II,VII,IX, X

Front 31

What is the therapeutic range for Warfarin, and how is it defined?

Back 31

you use the international normalized ratio, which is a function of Prothrombin time.

You want an INR of 2-3.
(INR 3= PT of 1.6)

Front 32

Please READ Katzung about warfain interactions!

Back 32

DO it! its page 596!

Front 33

What is the main toxicity with warfain?

Back 33

hemorrhage! duh

Front 34

when is warfarin contraindicated?

Back 34

in pregnancy, it causes birth defects

Front 35

What do you give to reverse the action of warfarin

Back 35

Vitamin K1**
fresh frozen plasma,
Factor IX concentrates

Front 36

What does Dabigatran inhibit?

Back 36

this directly inhibits thrombin (like lepirudin)

Front 37

What does Rivaroxaban do?

Back 37

this is an inhibitor of Factor Xa

Front 38

What does protein C do?

Back 38

this stimulates thrombin, and increases fibrinolysis

Front 39

What do thrombolyic agents do?

Back 39

these cause the lysis of formed clots, and re-establish tissue perfusion

Front 40

What are thrombolytics useful in treating?

Back 40

heart attacks
severe pulomnary embolism
DVT
Arterial thrombosis

Front 41

What are the drug names for commercial t-PA?

Back 41

rt-PA, Alteplase, Activase

Front 42

How does Streptokinase work?

Back 42

this complexes with plasminogen, increase fibrinolytic activity

Front 43

How is Streptokinase given?

Back 43

IV

Front 44

What are the problems with streptokinase?

Back 44

allergic reactions

Front 45

Is streptokinase fibrin specific?

Back 45

No it is not, causes general fibrinolysis

Front 46

What is rt-PT selective for?

Back 46

this acts on fibrin bound plasminogen (rather than plasma plasminogen)-
called clot selective

Front 47

What is Anistreplase (eminase)

Back 47

this is a mix of plasminogen and streptokinase that has been acylated

Front 48

How clot selective is Anistreplase?

Back 48

this is more selective than streptokinase (which isnt selective at all)

Front 49

What does Aminocaproic acid do?

Back 49

this inhibits plasminogen activation

inhibiting streptokinase and urokinase activity - no plasmin formed

Front 50

What does Aminocaproic acid treat?

Back 50

hemophilia
reversal of fibrinolytic therapy

(any bleeding disorder, this helps)

Front 51

What is Tranexamic acid like?

Back 51

Aminocaproic acid- prevents bleeding by preventing fibrinolysis

Front 52

How does Aspirin work?

Back 52

this inhibits TXA2 synthesis, and decreases platelet aggregation

Front 53

What is the primary prevention for MI dose of aspirin?

Back 53

325mg/day

Front 54

How does Clopidogrel (plavix) work?

Back 54

this inhibits the ADP pathway, and affects platelet aggregation

Front 55

What does Plavix NOT affect?

Back 55

the prostaglandin pathway, unlike aspirin

Front 56

Who should take Plavix (Clopidogrel)

Back 56

people who are allergic to aspirin

Front 57

What drug is Ticlopidine like?

Back 57

this is like plavix

Front 58

what side effect does Ticlopidine have that clopidogrel does not?

Back 58

ticlopidine can cause severe bone marrow toxicity

Front 59

How does Abciximab (ReoPro) work/

Back 59

this inhibits platelet aggregation by inhibiting GP IIb/IIIa receptors.

this stops fibrinogen and vWF from binding the integrin receptor

Front 60

How is Abciximab (ReoPro) given?

Back 60

IV (it is an antibody )

Front 61

What is Argatroban (Novastan) used for?

Back 61

this directly inhibits thrombin, and is used for pts with heparin induced thrombocytopenia