anti-thrombolytics

Question 1

Aspirin / ASA

Answer 1

antiplatelet agent: Salicylate with anti-inflammatory, analgesic, and antipyretic properties.

for: Reduces risk of MI in patients with unstable angina or hx infarction. Reduces risk of TIA and stroke.

MOA; “Irreversibly inhibits COX pathway –> TX A2 and PGs inhibition –> decrease in platelet aggregation.

SE: “GI ulceration and bleeding. Salicylism: hyperventiolation, tinnitus. Dizziness, nausea, vomiting. Risk of Reye’s syndrome in children with fevers due to viral infections –> encephalopathy, liver complications.

Must be off of ASA for at least a week before surgery.

Question 2

Clopidogrel / Plavix

Answer 2

ADP Receptor Antagonist / Platelet Aggregation Inhibitor

for: Reduces risk of thrombotic event (DVT, embolism), MI, and stroke. Aspirin alternative, or can be used concurrently
moa: Block ADP receptor sites on platelets –> diminished platelet aggregation
se: Nausea, headache. Neutropenia. Bleeding.

Question 3

Abciximab / Reopro

Answer 3

Glycoprotein IIB / IIIA Inhibitor

for: “Reduces risk of MI. Emergent percutaneous coronary intervention. Addition to aspirin and heparine –> improves both early and late outcomes, including decreased mortality from Q-wave MI. “

MOA: Prevent binding of fibrinogen –> block platelet aggregation

SE: Increased bleeding.

Question 4

Heparin

Answer 4

Anticoagulant
for: Unstable angina, acute MI, atrial fibrillation, post pulmonary embolism due to DVT.

MOA:Binds to antithrombin II –> binds to and inactivated factors X (Xa) and II (thrombin). Ultimate effect: prevents conversion of fibrinogen to fibrin.

SE: Bleeding

Question 5

Enoxaparin / Lovenox

Answer 5

Low Molecular Weight Heparin (Anticoagulant)

for: Unstable angina, acute MI, prophylaxis and treatment of pulmonary embolism and DVT

MOA:Directly inactivating factor X (Xa) in the clotting cascade

SE: Hemorrhage. Heparin induced thrombocytopenia (HIT) syndrome - first symptom is bruising. [LMW Heparin has fewer side effects than regular heparin.]

Question 6

Rivoxaroxaban/ Xarelto

Answer 6

Anticoagulatnt

for: “Prophylaxis of deep vein thrombosis which may lead to pulmonary embolism in adults undergoing hip and knee replacement surgery as well as stroke prophylaxis in patients with non-valvular disease induced atrial fibrillation.

MOA:”Direct inhibition of factor Xa

SE:Bleeding.

Question 7

Warfarin / Coumadin

Answer 7

ORAL anticoagulant

for: Prophylaxis and treatment of: DVT, PE, thromboembolic event assoc with atrial fibrillation and/or cardiac valve replacement

MOA:Antagonizes vitamin K –> interferes with synthesis of clotting factors 2, 7, 9, and 10.

SE:”Bleeding. Contraindicated in pregnancy,

Category X drug.”

Question 8

Streptokinase

Answer 8

Thrombolytics=clot busters

for:Acute MI, ischemia (non-hemorrhagic) stroke, acute DVT, acute PE. Best when administered within 4 hours of the onset of a heart attack/stroke.

MOA: Activates plasminogen to plasmin. Plasmin digests fibrin and fibrinogen.

SE:Bleeding. Enhances bleeding caused by asprin, NSAIDS, heparin, coumadin, and anti-platelets.