Pharm Block 2 (Antithrombotc Drugs)

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Pharm Block 2 (Antithrombotc Drugs)
2010-11-20 09:14:26
Pharm Block Antithrombotc Drugs

Pharm Block 2 (Antithrombotc Drugs)
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  1. How do Vitamin K antagonist work?

    name them.
    -inhibition of the synthesis of vitamin K dependent functional clotting factors II, VII, IX and X as well as anticoagulant protein C in the liver.

    žWarfarin, Dicumoral, Phenindione
  2. Warfarin (Coumadin)
    What is it?
    How is it taken?
    How long before it works?
    It is a Anti-coagulant that works through inhibiting the synthesis of Vitamin K depentents factors.

    • taken orally
    • Effect is delayed 3-5 days. (4-5 half lives for the proteins to ne excreted from the plasma)

    may cause an initial Coagulation so you might want to use with Heparin.
  3. What are the Adverse effects of Warfarin (coumadin)?
    • -Bleeding is Common--- Monitor via PT or INR
    • -Skin Necrosis, purple toes and alopecia
    • Fetal Warfarin syndrome
    • - Some other Antibiotics can exagerate the effects of Warfarin (inhibit Vit K reductase).
  4. What do you do in a Warfarin Overdose?
    • -Stop Warfarin
    • -The Antidote is Vitamin K (K1 phytonadione)

    If the hemorrhage is serious you can give Plasma Clotting factors II,VII,IX and x
  5. In the clotting cascade, what is used to block the intrinsic and what monitors it? what about extrinsic?
    Intrinsic- heparin is used to block it, monitor with PTT.

    Extrinsic- Warfarin is used to block it and PT is used to monitor.
  6. What are Fibrinolytic drugs?

    Name them.
    When would you use them?
    These are plasminogen activators which convert plasminogen into plasmin that catalyzes the degradation of fibrin. Used to lyse preformed clots.

    Streptokinase, Urokinase, t-PA

    Use them in Pulmonary Emboli and MI
  7. Fibrinolytic drugs
    Which are non-selective?
    Which are selective?
    • žNon-selective plasmin production:
    • 1.Streptokinase
    • 2.Urokinase

    • žClot (fibrin) selective;
    • 1.Recombinant tpa (Alteplase)
  8. Streptokinase facts.
    Where is it from?
    is it antigenic?
    Is it specific?
    long or short half life?
    • Where is it from? Hemolytic Stretococci
    • is it antigenic? Yes
    • Is it specific? No
    • long or short half life? Longer (30 min)
  9. Urokinase facts:
    Where is it from?
    is it antigenic?
    Is it specific?\
    long or short half life?
    • Where is it from? Renal cells
    • is it antigenic? NO
    • Is it specific? NO
    • long or short half life? Short
  10. t-PA (what are the three kinds)?
    Where is it from?
    is it antigenic?
    Is it specific?
    long or short half life?
    Alteplase, Teteplase and Tenecteplase

    • Where is it from? Recombinant DNA
    • is it antigenic? NO
    • Is it specific? YES
    • long or short half life? Short
  11. Name the inhibitors of Fibrinolysis

    How do act?
    When would you use them clinically?
    Aminocaproic acid, Tranexamic acid

    - they acts by binding plasminogen and inhibiting its activation to plasmin

    - Excessive or abnormal menstral Bleeding and Post Delivery bleeding.
  12. Name some Anti-platelet drugs.
  13. 1. Cox inhibitors: Aspirin
    • 2. Phosphdiesterase Inhibitors: Dipyridamole, Cilastazol.
    • 3. ADP pathway Inhibitors:Ticlopidine, Clopidogrel.
    • 4.GLYCOPROTEIN II b / III a RECEPTORS INHIBITORS Abciximab, Eptifibatide, Tirofiban
  14. What are some things that can active the platelets?
    5HT, Epinephrine, PAF, Collagen, ADP, TXA2, Vasopressin, thrombin
  15. What is Aspirin?
    How does it work?
    Low dose, what is the Effect?

    What is a disadvantage?
    it is an anti-platelet drug

    • -works through Irreversible inactivation of TXA2 synthetase in the platelets.
    • -žLow dose spares endothelial synthesis of PGI-2 and thus better anti-platelet activity.

    žGastric bleeding is a disadvantage.
  16. What is Dyridamole?
    • It is an a very weak anti-platelet drug.
    • Usually is used in Combination with other anti-platelet drugs. Example: it is used with aspirin in prevention of thromboembolism in prosthetic heart valves and stroke

    What are they?
    How do they work?
    What is good about it?
    What are some Adverse effects?
    They are Anti-platelet Drugs

    • - blocks purinergic (ADP) receptors on the platelets
    • - It causes less G bleeding then Aspirin.
    • - Ticlopidine is associated with neutropenia and thrombocytopenia.
  18. What are the GLYCOPROTEIN II b / III a inhibitors (Fibrinogen receptors on platelets)?
    How do they work?
    What are they used for?
    What can be given with it?

    - Binds to IIb / IIIa receptors on platelets and block the binding of fibrinogen and thus inhibits aggregation of platelets.

    • - Used in acute coronary syndrome and coronary angioplasty.
    • - Heparin / aspirin can be given with it.