Platelet Aggregation Inhibitors and Aspirin
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Questions and Answers

What is the primary mechanism by which aspirin functions as an antiplatelet agent?

  • Inhibits the synthesis of thromboxane A2 (correct)
  • Increases platelet aggregation
  • Blocks glycoprotein receptors
  • Reduces calcium levels in platelets
  • Which receptor does vorapaxar primarily antagonize to inhibit platelet aggregation?

  • GP-1b
  • P2Y12
  • PAR-1 (correct)
  • GP-2b/3a
  • What effect does clopidogrel have in the context of platelet aggregation?

  • Enhances thromboxane A2 synthesis
  • Blocks the purine P2Y12 receptor (correct)
  • Increases adenosine levels
  • Inhibits cyclooxygenase activity
  • Which of the following does not contribute to increased platelet aggregation?

    <p>Prostacyclin (A)</p> Signup and view all the answers

    What is the role of dipyridamole in platelet aggregation?

    <p>Increases levels of adenosine A2 receptors (B)</p> Signup and view all the answers

    What is the primary mechanism of action of cilostazol?

    <p>Inhibition of type 3 phosphodiesterase (D)</p> Signup and view all the answers

    Which of the following side effects is most commonly associated with cilostazol?

    <p>Headache (C)</p> Signup and view all the answers

    Which statement about prasugrel compared to clopidogrel is accurate?

    <p>Prasugrel is an irreversible P2Y12 antagonist (C)</p> Signup and view all the answers

    What is the main therapeutic use of abciximab?

    <p>To prevent platelet aggregation during percutaneous coronary interventions (C)</p> Signup and view all the answers

    Which of the following antiplatelet agents does not require activation to exert its effect?

    <p>Ticagrelor (D)</p> Signup and view all the answers

    What potential adverse effect is specifically associated with ticagrelor?

    <p>Dyspnea (A)</p> Signup and view all the answers

    How quickly does peak platelet inhibition occur after the administration of abciximab?

    <p>Within 30 minutes (C)</p> Signup and view all the answers

    What effect does low-dose aspirin have on TXA2 synthesis?

    <p>It selectively inhibits TXA2 synthesis. (A)</p> Signup and view all the answers

    Why does aspirin have a prolonged effect on platelet aggregation?

    <p>It irreversibly inhibits cyclooxygenase. (C)</p> Signup and view all the answers

    What is the primary role of dipyridamole in treatment?

    <p>It serves as a coronary vasodilator. (A)</p> Signup and view all the answers

    What adverse effect is commonly associated with aspirin use?

    <p>Bleeding, particularly in the gastrointestinal tract. (D)</p> Signup and view all the answers

    What is Aggrenox composed of?

    <p>Dipyridamole and aspirin. (B)</p> Signup and view all the answers

    In which situation is aspirin contraindicated?

    <p>Pregnancy, particularly in the 3rd trimester. (A)</p> Signup and view all the answers

    How does dipyridamole increase cAMP levels in platelets?

    <p>By blocking platelet uptake of adenosine. (C)</p> Signup and view all the answers

    What is the major limitation of dipyridamole in thromboembolic disorder treatment?

    <p>It has a limited role and is a relatively weak antiplatelet drug. (C)</p> Signup and view all the answers

    Flashcards

    What are platelet aggregation inhibitors?

    Platelet aggregation inhibitors are medications that reduce the tendency of platelets to clump together and form clots.

    How do platelets initiate clotting?

    Platelets stick to damaged endothelium via glycoprotein receptors, leading to the release of clotting factors like thromboxane A2, ADP, and serotonin.

    How does aspirin affect platelet aggregation?

    Aspirin inhibits the enzyme cyclooxygenase (COX), thereby preventing the synthesis of thromboxane A2, a potent platelet activator.

    What is the general mechanism of action for aspirin and NSAIDs?

    Aspirin and other NSAIDs inhibit the production of prostaglandins, which are involved in inflammation and platelet aggregation.

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    What are the opposing roles of prostacyclin and thromboxane A2 in platelet aggregation?

    Prostacyclin, produced by endothelial cells, inhibits platelet aggregation. Thromboxane A2, produced by platelets, promotes platelet aggregation.

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    Antiplatelet drug

    A substance that prevents blood clots from forming by inhibiting platelet aggregation.

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    Aspirin

    A type of antiplatelet drug that inhibits the synthesis of thromboxane A2 (TXA2), a potent platelet aggregator.

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    Aspirin's Mechanism of Action

    Aspirin irreversibly inhibits cyclooxygenase (COX), an enzyme involved in the synthesis of TXA2.

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    Aspirin Dosage

    Lower doses of aspirin specifically target TXA2, while higher doses inhibit both TXA2 and prostacyclin.

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    Prostacyclin

    Prostacyclin, a substance produced by blood vessel walls, prevents platelet aggregation and thrombosis.

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    Thromboxane A2 (TXA2)

    Thromboxane A2 (TXA2) promotes platelet aggregation and thrombosis.

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    Dipyridamole

    Dipyridamole inhibits platelet aggregation by blocking platelet uptake of adenosine, leading to increased cAMP levels.

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    Aggrenox

    A combination of dipyridamole and aspirin, shown to be more effective for stroke prevention than either drug alone, but with greater risk of bleeding.

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    What does Cilostazol do?

    Cilostazol is a drug that helps improve blood flow in the legs by stopping a chemical called PDE3 from breaking down another chemical called cAMP. More cAMP leads to less blood vessel constriction and improved blood flow.

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    What do ADP inhibitors do?

    Clopidogrel, Prasugrel, Cangrelor, and Ticagrelor are drugs that prevent platelets from sticking together by blocking a receptor on the platelet called P2Y12.

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    How do Clopidogrel and Prasugrel work?

    Clopidogrel and Prasugrel are irreversible P2Y12 antagonists, meaning they block P2Y12 for the entire lifespan of the platelet.

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    How do Cangrelor and Ticagrelor work?

    Cangrelor and Ticagrelor are reversible P2Y12 antagonists, meaning their blocking effect is temporary and can be reversed.

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    How does Abciximab work?

    Abciximab is a drug that prevents platelets from sticking together by binding to a receptor called GPIIb/IIIa on the platelet.

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    How does Vorapaxar work?

    Vorapaxar is a new drug that prevents platelet aggregation by a different mechanism than other antiplatelet drugs.

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    Study Notes

    Platelet Aggregation Inhibitors

    • Platelets adhere to damaged endothelium via GP-1a and GP-1b receptors, leading to synthesis and release of aggregation mediators like TXA2, ADP, and 5-HT.
    • These mediators increase GP receptor expression, promoting platelet aggregation via fibrinogen binding to GP2b/3a receptors.
    • Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit thromboxane A2 synthesis by blocking cyclooxygenase (COX).
    • Clopidogrel, prasugrel, and ticagrelor block ADP receptors (P2Y12).
    • Agents like eptifibatide, tirofiban, and abciximab bind to GP2b/3a proteins, inhibiting fibrinogen cross-linking.
    • Vorapaxar is an antagonist at PAR-1 receptors, targeting thrombin.
    • Dipyridamole inhibits adenosine reuptake, increasing cAMP, decreasing calcium and platelet aggregation.
    • Cilostazol inhibits PDE3, elevating cAMP levels.

    Aspirin

    • Aspirin is a non-steroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, and anti-inflammatory effects.
    • It inhibits prostaglandin synthesis, notably thromboxane A2 (TXA2) synthesis more than prostacyclin (PGI2) synthesis at low doses.
    • Aspirin irreversibly inhibits cyclooxygenase, the enzyme responsible for TXA2 synthesis, thus reducing platelet aggregation for the lifespan of the platelet.
    • It is used to prevent arterial thrombosis in patients with ischemic heart disease and stroke.
    • Adverse effects include bleeding, particularly gastrointestinal bleeding due to reduced bicarbonate secretion.
    • Pregnancy, especially in the third trimester, and hypersensitivity are contraindications.

    Dipyridamole

    • Dipyridamole is a coronary vasodilator and relatively weak antiplatelet drug.
    • It inhibits platelet aggregation by blocking adenosine uptake, leading to increased cAMP levels and reduced calcium release.
    • Lowers platelet aggregation.
    • It is used in combination with aspirin, potentially improving stroke prevention.

    Cilostazol

    • Cilostazol is a vasodilator and antiplatelet drug that inhibits type 3 phosphodiesterase (PDE3).
    • Increases cAMP levels in platelets and blood vessels, reducing platelet aggregation
    • Often indicated for intermittent claudication, a peripheral vascular disease.

    Adenosine Diphosphate Inhibitors (ADP)

    • Clopidogrel, prasugrel, cangrelor, and ticagrelor inhibit ADP binding to its platelet receptors, hindering GPIIb/IIIa activation and subsequent fibrinogen binding.
    • Clopidogrel and prasugrel are irreversible inhibitors.
    • Cangrelor and ticagrelor are reversible inhibitors, used in situations like surgery.

    Glycoprotein IIb/IIIa Antagonists

    • Abciximab is a monoclonal antibody that blocks GP IIb/IIIa receptors, preventing platelet aggregation by hindering fibrinogen binding. Its IV management achieves peak inhibition rapidly but is short-lived.

    Vorapaxar

    • Vorapaxar is a protease-activated receptor-1 (PAR-1) antagonist, preventing platelet aggregation via thrombin's influence on platelets.
    • Approved for patients with MI history or peripheral arterial disease.

    Thrombolytic Drugs

    • Thrombolytic drugs convert plasminogen to plasmin, which breaks down fibrin and fibrinogen in blood clots.
    • First-generation includes streptokinase and urokinase.
    • Second-generation includes reteplase and alteplase ,which are fibrin-selective.
    • Used to treat acute myocardial infarction, pulmonary embolism, deep vein thrombosis, and acute ischemic stroke.
    • Hemorrhage is a major side effect due to their non-discriminating action on fibrin.

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    Description

    Explore the mechanisms and effects of platelet aggregation inhibitors, including the role of various mediators and specific drugs like aspirin and clopidogrel. This quiz covers important pharmacological aspects and interactions relevant to thrombus formation and prevention.

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