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Questions and Answers
What is the mechanism underlying the antiplatelet effect of low-dose aspirin?
What is the mechanism underlying the antiplatelet effect of low-dose aspirin?
- Inhibition of cyclooxygenase-1 (COX-1) enzyme, which prevents the formation of thromboxane A2 (correct)
- Activation of glycoprotein IIb/IIIa receptors, inhibiting platelet activation
- Inhibition of phosphodiesterase, leading to decreased platelet aggregation
- Inhibition of adenosine diphosphate (ADP) receptors, preventing platelet activation
What is a factor that can influence the effects of warfarin, especially in terms of patient compliance and drug-drug interactions?
What is a factor that can influence the effects of warfarin, especially in terms of patient compliance and drug-drug interactions?
- Excessive physical exercise
- Consumption of green leafy vegetables high in vitamin K (correct)
- Increased intake of vitamin C-rich foods
- Consumption of grapefruit juice
What is the clinical indication and mechanism of action of new factor Xa inhibitors such as rivaroxaban, apixaban, and edoxaban?
What is the clinical indication and mechanism of action of new factor Xa inhibitors such as rivaroxaban, apixaban, and edoxaban?
- Clinical indication: Prevention of stroke in patients with nonvalvular atrial fibrillation; Mechanism: Directly inhibits factor Xa (correct)
- Clinical indication: Prophylaxis of deep vein thrombosis; Mechanism: Inhibits platelet aggregation
- Clinical indication: Treatment of acute coronary syndrome; Mechanism: Inhibits thromboxane A2 synthesis
- Clinical indication: Management of heparin-induced thrombocytopenia; Mechanism: Activates protein C
What is the mechanism of action of fibrinolytic agents such as alteplase, reteplase, and tenecteplase?
What is the mechanism of action of fibrinolytic agents such as alteplase, reteplase, and tenecteplase?
Which anticoagulant has a delayed onset and prolonged duration due to delayed termination through liver and kidney metabolism?
Which anticoagulant has a delayed onset and prolonged duration due to delayed termination through liver and kidney metabolism?
What is the primary method for monitoring heparin therapy?
What is the primary method for monitoring heparin therapy?
Which condition is a contraindication for heparin therapy?
Which condition is a contraindication for heparin therapy?
What is the primary method for adjusting warfarin therapy?
What is the primary method for adjusting warfarin therapy?
Which anticoagulant is used for rapid onset anticoagulation?
Which anticoagulant is used for rapid onset anticoagulation?
What is the primary method for overdose treatment of heparin therapy?
What is the primary method for overdose treatment of heparin therapy?
Which type of heparin has greater anti-Xa activity and is used for DVT prophylaxis?
Which type of heparin has greater anti-Xa activity and is used for DVT prophylaxis?
What is a potential side effect of heparin toxicity?
What is a potential side effect of heparin toxicity?
What is a potential side effect of warfarin toxicity?
What is a potential side effect of warfarin toxicity?
Which anticoagulant is used for prolonged anticoagulation, overlapping with and then replaced by warfarin?
Which anticoagulant is used for prolonged anticoagulation, overlapping with and then replaced by warfarin?
Which condition is a contraindication for warfarin therapy?
Which condition is a contraindication for warfarin therapy?
Which anticoagulant has high patient variability and numerous potential drug-drug interactions, requiring careful monitoring and dose adjustments?
Which anticoagulant has high patient variability and numerous potential drug-drug interactions, requiring careful monitoring and dose adjustments?
Which drug irreversibly inhibits cyclooxygenase, preventing thromboxane A2 (TXA2) formation and platelet aggregation for the lifespan of the platelet?
Which drug irreversibly inhibits cyclooxygenase, preventing thromboxane A2 (TXA2) formation and platelet aggregation for the lifespan of the platelet?
Which drug is administered to patients with myocardial infarction, for secondary prevention of MI and stroke, primary prevention of cardiovascular disease, and reducing thromboembolic complications in specific patients?
Which drug is administered to patients with myocardial infarction, for secondary prevention of MI and stroke, primary prevention of cardiovascular disease, and reducing thromboembolic complications in specific patients?
Which drug is used for the prophylaxis of stroke, MI, peripheral arterial disease, and acute coronary syndrome?
Which drug is used for the prophylaxis of stroke, MI, peripheral arterial disease, and acute coronary syndrome?
Which drug is indicated for intermittent claudication and chronic occlusive arterial disease of the limbs?
Which drug is indicated for intermittent claudication and chronic occlusive arterial disease of the limbs?
Which drug is the drug of choice for parenteral anticoagulant therapy, binds to antithrombin III, and inactivates coagulation factors of common and intrinsic pathways?
Which drug is the drug of choice for parenteral anticoagulant therapy, binds to antithrombin III, and inactivates coagulation factors of common and intrinsic pathways?
Which anticoagulant reversing agent is used to reverse the effects of heparin?
Which anticoagulant reversing agent is used to reverse the effects of heparin?
Which anticoagulant reversing agent is used to reverse the effects of dabigatran?
Which anticoagulant reversing agent is used to reverse the effects of dabigatran?
Which drug is used to destroy preformed pathological thrombus in special situations?
Which drug is used to destroy preformed pathological thrombus in special situations?
Which anticoagulant drug has immediate anticoagulant onset with IV administration?
Which anticoagulant drug has immediate anticoagulant onset with IV administration?
Which antiplatelet drug stimulates vasodilation for the reduction of symptoms of intermittent claudication?
Which antiplatelet drug stimulates vasodilation for the reduction of symptoms of intermittent claudication?
Which antiplatelet drug irreversibly inhibits the P2Y12 ADP receptor?
Which antiplatelet drug irreversibly inhibits the P2Y12 ADP receptor?
Which antiplatelet drug is approved for acute coronary syndromes?
Which antiplatelet drug is approved for acute coronary syndromes?
Which anticoagulant is highly selective for thrombin, does not require other proteins for activity, and is used in patients with thrombosis related to heparin-induced thrombocytopenia?
Which anticoagulant is highly selective for thrombin, does not require other proteins for activity, and is used in patients with thrombosis related to heparin-induced thrombocytopenia?
Which drug is an antibody fragment that binds free and thrombin-bound dabigatran, neutralizing its activity?
Which drug is an antibody fragment that binds free and thrombin-bound dabigatran, neutralizing its activity?
Which drug is a nonenzymatic activator of plasminogen extracted from hemolytic streptococci, and is used in thrombolytic therapy?
Which drug is a nonenzymatic activator of plasminogen extracted from hemolytic streptococci, and is used in thrombolytic therapy?
Which drug has a shorter half-life than alteplase, diffuses more freely into clot, and is a genetically engineered form of r-TPA?
Which drug has a shorter half-life than alteplase, diffuses more freely into clot, and is a genetically engineered form of r-TPA?
Which drug is an activator of endogenous fibrinolysis, used to dissolve pathological blood clots without causing uncontrolled bleeding?
Which drug is an activator of endogenous fibrinolysis, used to dissolve pathological blood clots without causing uncontrolled bleeding?
Which drug is used to destroy preformed pathological thrombus in special situations and is produced by genetic engineering?
Which drug is used to destroy preformed pathological thrombus in special situations and is produced by genetic engineering?
Which anticoagulant is metabolized by the CYP450 system in the liver and excreted by renal and GI system?
Which anticoagulant is metabolized by the CYP450 system in the liver and excreted by renal and GI system?
Which anticoagulant is eliminated 66% via metabolism in the liver and 33% unchanged drug in the urine?
Which anticoagulant is eliminated 66% via metabolism in the liver and 33% unchanged drug in the urine?
Which anticoagulant binds to the active site of factor Xa and inhibits its enzymatic action?
Which anticoagulant binds to the active site of factor Xa and inhibits its enzymatic action?
Which anticoagulant is used in patients with thrombosis related to heparin-induced thrombocytopenia and during coronary angioplasty?
Which anticoagulant is used in patients with thrombosis related to heparin-induced thrombocytopenia and during coronary angioplasty?
Which anticoagulant is used for the treatment of venous thrombosis, pulmonary embolism, prevention of stroke with atrial fibrillation, and acute coronary syndrome?
Which anticoagulant is used for the treatment of venous thrombosis, pulmonary embolism, prevention of stroke with atrial fibrillation, and acute coronary syndrome?
Which anticoagulant prevents thrombin generation, prolonging both aPTT and PT times, and does not require routine monitoring of these laboratory parameters?
Which anticoagulant prevents thrombin generation, prolonging both aPTT and PT times, and does not require routine monitoring of these laboratory parameters?
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Study Notes
Anticoagulant Reversing Agents and Antiplatelet Drugs Summary
- Anticoagulant reversing agents include Vitamin K, KCENTRA® (prothrombin complex concentrate-human), protamine sulfate, idarucizumab (PraxBind), and Andexxa®.
- Antiplatelet drugs such as aspirin, prasugrel, clopidogrel, ticagrelor, abciximab, eptifibatide, tirofiban, cilostazol, and dipyridamole are used to prevent pathological thrombus formation.
- Aspirin irreversibly inhibits cyclooxygenase, preventing thromboxane A2 (TXA2) formation and platelet aggregation for the lifespan of the platelet.
- Aspirin is administered to patients with myocardial infarction, for secondary prevention of MI and stroke, primary prevention of cardiovascular disease, and reducing thromboembolic complications in specific patients.
- Other antiplatelet drugs like cilostazol and dipyridamole inhibit platelet aggregation and stimulate vasodilation for the reduction of symptoms of intermittent claudication.
- Abciximab, eptifibatide, and tirofiban are approved for acute coronary syndromes, while clopidogrel, prasugrel, and ticagrelor are used for the prophylaxis of stroke, MI, peripheral arterial disease, and acute coronary syndrome.
- Ticlopidine is approved for the prevention of thrombotic stroke, while pentoxifylline is indicated for intermittent claudication and chronic occlusive arterial disease of the limbs.
- Therapeutic objectives involving anticoagulant drugs like heparin and warfarin aim to prevent the formation of pathological thrombus and arterial damage, as well as inhibit platelet aggregation.
- Fibrinolytic drugs like rtPA, reteplase, streptokinase, and urokinase are used to destroy preformed pathological thrombus in special situations.
- Heparin, the drug of choice for parenteral anticoagulant therapy, binds to antithrombin III and inactivates coagulation factors of common and intrinsic pathways.
- Heparin is administered through continuous IV, intermittent IV (not recommended), and subcutaneous routes for post-surgery prophylaxis.
- Heparin pharmacokinetics involve immediate anticoagulant onset with IV administration, while subcutaneous administration begins in 20-30 minutes with a duration of 12-24 hours.
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