Podcast
Questions and Answers
What is the main purpose of thrombin in the coagulation cascade?
What is the main purpose of thrombin in the coagulation cascade?
Which of the following is an irreversible inhibitor of COX-1?
Which of the following is an irreversible inhibitor of COX-1?
What role does Protein C play in hemostasis?
What role does Protein C play in hemostasis?
What initiates the coagulation cascade in the extrinsic pathway?
What initiates the coagulation cascade in the extrinsic pathway?
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Which of the following drugs is NOT classified as a thrombolytic agent?
Which of the following drugs is NOT classified as a thrombolytic agent?
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What is one of the main functions of Glycoprotein IIb/IIIa inhibitors?
What is one of the main functions of Glycoprotein IIb/IIIa inhibitors?
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Which medication primarily targets the TXA2 synthesis pathway?
Which medication primarily targets the TXA2 synthesis pathway?
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What is the main component in platelet adhesion to exposed collagen?
What is the main component in platelet adhesion to exposed collagen?
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What is the common starting dose for Warfarin?
What is the common starting dose for Warfarin?
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Which of the following drug combinations is considered dangerous with Warfarin?
Which of the following drug combinations is considered dangerous with Warfarin?
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What is the target INR range for most indications while using Warfarin?
What is the target INR range for most indications while using Warfarin?
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What is the primary reason for the longer time blood takes to clot in patients taking Warfarin?
What is the primary reason for the longer time blood takes to clot in patients taking Warfarin?
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What must be monitored regularly in patients taking Warfarin?
What must be monitored regularly in patients taking Warfarin?
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Which of the following drugs is NOT classified as a Direct Thrombin Inhibitor?
Which of the following drugs is NOT classified as a Direct Thrombin Inhibitor?
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What is a common complication associated with high doses or incorrect use of Warfarin?
What is a common complication associated with high doses or incorrect use of Warfarin?
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What is the primary characteristic of Novel Oral Anticoagulants compared to Warfarin?
What is the primary characteristic of Novel Oral Anticoagulants compared to Warfarin?
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What is the primary function of ADP inhibitors in platelet aggregation?
What is the primary function of ADP inhibitors in platelet aggregation?
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What is a common side effect associated with the use of Ticlopidine?
What is a common side effect associated with the use of Ticlopidine?
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Which indication requires a loading dose of Clopidogrel?
Which indication requires a loading dose of Clopidogrel?
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What is a major concern when using Heparin for anticoagulation?
What is a major concern when using Heparin for anticoagulation?
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What is one advantage of Low Molecular Weight Heparin (LMWH) over unfractionated Heparin?
What is one advantage of Low Molecular Weight Heparin (LMWH) over unfractionated Heparin?
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What is a significant concern when administering Abciximab?
What is a significant concern when administering Abciximab?
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What is the typical length of treatment with Clopidogrel after a PCI with Drug-Eluting Stents (DES)?
What is the typical length of treatment with Clopidogrel after a PCI with Drug-Eluting Stents (DES)?
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What is the mechanism of action for GpIIb/IIIa receptor antagonists?
What is the mechanism of action for GpIIb/IIIa receptor antagonists?
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Study Notes
Anticoagulation
- Anticoagulation is a key area in cardiovascular pharmacology (CRD 203).
- The lecture covers coagulation cascade, platelet activation, aggregation, receptor function, and various pharmacological classes of anticoagulants.
- It also includes cholesterol and lipid-lowering medications like statins, bile acid sequestrants, niacin, fibrates, and ezetimibe.
- The lecture discusses opposing forces in blood clotting (anti-aggregation and pro-aggregation), and the role of endothelial cells in blood flow.
- Platelet activation and adhesion in response to vascular injury initiate the coagulation cascade, locally strengthening the platelet plug.
- The intrinsic and extrinsic pathways of the coagulation cascade are detailed, including the role of specific factors like tissue factor, factor VII, and thrombin. These pathways work together to create a clot.
- Positive feedback loops in the coagulation cascade accelerate thrombin formation.
- Several key pharmacological classes of anticoagulants are mentioned, including aspirin, ADP inhibitors, GP IIb/IIIa inhibitors, heparin and low molecular weight heparins, thrombin inhibitors, warfarin, novel oral anticoagulants, and fibrinolytics. The specific actions of these classes are explored.
- Platelet inhibition involves various receptors and metabolic processes, acting as drug targets. Key targets include ADP, GPIIb/IIIa, TXA2 synthesis, discussed along with their inhibitory effects.
- Aspirin is a COX-1 inhibitor and irreversibly inhibits thromboxane A2 production, inhibiting platelet activity for the lifespan of the platelet (8-10 days).
- ADP inhibitors prevent ADP activation of the P2Y12 receptor, inhibiting platelet aggregation. Medications like Ticlopidine, Clopidogrel, and Prasugrel are detailed.
- GpIIb/IIIa receptor antagonists prevent the final step in platelet aggregation. Examples include Abciximab.
Acute Anticoagulation
- Heparin and LMWH are indirect thrombin inhibitors that must be closely monitored (unpredictable dose/effect).
- Heparin is given intravenously, and LMWH is given subcutaneously.
- Monitoring parameters like aPTT are essential for heparin adjustments. LMWH is generally more predictable, and kidney function monitoring is necessary.
Oral Anticoagulation
- Warfarin (Coumadin) is a vitamin K antagonist. It inhibits vitamin K-dependent clotting factors; response takes 2-7 days.
- Warfarin dosing is individualized, with a starting dose of 5 mg. INR monitoring is crucial. Different INR ranges exist for various medical conditions.
- Warfarin has many drug interactions, both pharmacodynamically and pharmacokinetically, through CYP 450 interactions.
- It has significant interactions with some food items, especially green leafy vegetables rich in vitamin K.
- Warfarin has complications, like bruising and bleeding; vitamin K administration is the antidote. The route of administration (oral or intravenous) depends on severity.
- Warfarin can induce skin necrosis.
- Novel oral anticoagulants (NOACs) are a newer class of anticoagulants. These include Dabigatran, Rivaroxaban, and Apixaban. They are alternative to warfarin for long-term anticoagulation, with predictable dose responses and no monitoring.
- Many NOACs are indicated for stroke prevention in atrial fibrillation and prevention of venous thromboembolism (VTE) after orthopedic surgery and treatment of deep vein thrombosis (DVT).
- Specific dosages and usage considerations exist for these drugs.
- NOACs, however have less severe bleeding complications but more minor ones.
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Description
This quiz explores anticoagulation within the context of cardiovascular pharmacology, focusing on the coagulation cascade, platelet activation, and various anticoagulants. It also covers cholesterol-lowering medications and the dynamics of blood clotting. Test your understanding of these crucial concepts in CRD 203.
