Coagulations
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Questions and Answers

What is the target of Vorapaxar in its anti-platelet action?

  • PAR-1 receptor (correct)
  • GPIIb/IIIa receptor
  • P2Y receptor
  • Thrombin receptor
  • Which of the following medications is a fibrinolytic medication used to treat acute thrombotic events such as deep vein thrombosis?

  • Aspirin
  • Clopidogrel
  • Ticagrelor
  • Streptokinase (correct)
  • What is the primary mechanism of action of Dipyradimole in its anti-platelet action?

  • Inhibition of phosphodiesterase (correct)
  • Inhibition of COX1 enzyme
  • Antagonism of TXA2 receptors
  • Blockade of P2Y receptors
  • Which of the following is NOT an anti-platelet medication?

    <p>Tranexamic acid</p> Signup and view all the answers

    What is the end result of the fibrinolytic pathway?

    <p>Dissolution of fibrin clot</p> Signup and view all the answers

    Which of the following anti-platelet medications targets the GPIIb/IIIa receptor?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a recombinant tPA used to treat acute ischemic stroke?

    <p>Alteplase</p> Signup and view all the answers

    What is the relationship between coagulation and fibrinolysis?

    <p>Coagulation and fibrinolysis are competing pathways</p> Signup and view all the answers

    Which of the following medications is a direct inhibitor of Factor Xa, commonly used for atrial fibrillation, DVT, and pulmonary embolism?

    <p>Rivaroxaban</p> Signup and view all the answers

    Which of the following is a major concern associated with warfarin use?

    <p>Low therapeutic index requiring close monitoring</p> Signup and view all the answers

    What is the mechanism of action of heparin, a commonly used anticoagulant?

    <p>Activation of antithrombin III</p> Signup and view all the answers

    Which of the following is NOT a characteristic of fondaparinux, a type of heparin?

    <p>Available in oral form for long-term use</p> Signup and view all the answers

    Which of the following is an antidote for dabigatran, a direct thrombin inhibitor?

    <p>Idarucizumab</p> Signup and view all the answers

    Which of the following medications is NOT considered an anticoagulant?

    <p>Aspirin</p> Signup and view all the answers

    Which of these antithrombotic drugs inhibits the amplification of thrombus formation by restricting platelet activation?

    <p>Aspirin</p> Signup and view all the answers

    What is the key role of thrombin in the coagulation cascade?

    <p>Conversion of fibrinogen to fibrin</p> Signup and view all the answers

    Which of the following conditions is NOT a major cause of thrombosis?

    <p>Hypoglycemia</p> Signup and view all the answers

    Which of the following statements is TRUE regarding the extrinsic pathway of coagulation?

    <p>It is initiated by tissue damage or contact with foreign surfaces.</p> Signup and view all the answers

    Which of the following drugs would be MOST effective in dissolving an existing blood clot?

    <p>Alteplase</p> Signup and view all the answers

    What is the physiological role of glycoprotein IIb/IIIa receptors on platelets?

    <p>Binding to collagen and fibrinogen</p> Signup and view all the answers

    What is the main mechanism of action of anti-platelet drugs?

    <p>Blocking the activation of platelets</p> Signup and view all the answers

    A patient with a history of atrial fibrillation is prescribed warfarin for stroke prevention. What is the target INR range for this patient?

    <p>2 - 3</p> Signup and view all the answers

    What is the main difference between venous thrombi and arterial thrombi?

    <p>Venous thrombi are high in fibrin, while arterial thrombi are high in platelets</p> Signup and view all the answers

    Which of the following is a potential complication of using antithrombotic drugs?

    <p>Increased risk of bleeding</p> Signup and view all the answers

    Study Notes

    Thrombosis

    • Venous thrombi are characterized by high fibrin content, while arterial thrombi are high in platelets
    • Major causes of thrombosis include:
      • Myocardial infarction
      • Atherosclerosis
      • Vasculitis
      • Hypertension
      • Smoking
      • Radiation
      • Chemical irritation
      • Inflammation
      • Hypoxia
      • Infection

    Coagulation Pathway

    • Intrinsic pathway involves factors XII, XI, and IX
    • Extrinsic pathway involves tissue damage or contact with external bodies, leading to the conversion of prothrombin to thrombin (factor IIa)
    • Antithrombin III regulates the coagulation process

    Fibrin Formation

    • Thrombin cleaves fibrinogen to form insoluble fibrin
    • Fibrin strands assemble into fibrils that bind to platelets and each other

    Platelet Aggregation

    • Activated platelets express glycoprotein IIb/IIIa receptors, which bind to fibrinogen and collagen
    • Release of thromboxane A2 (TXA2) and adenosine diphosphate (ADP) promotes platelet activation

    Antithrombosis Drugs and Strategies

    • Anticoagulants inhibit initiation of thrombin formation
    • Anti-platelet drugs inhibit platelet activation
    • Fibrinolytics promote degradation of fibrin strands

    International Normalised Ratio (INR)

    • Prothrombin time measures blood clotting time (normal range: 12-13 seconds)
    • INR compares prothrombin time to a standardized norm
    • Therapeutic INR ranges:
      • Normal healthy: 0.8-1.2
      • Therapeutic: 2-3 or 2.5-3.5
      • Dose reduction: 5-9
      • Emergency: >8

    Anticoagulants - Warfarin

    • Warfarin is a vitamin K antagonist, the most commonly used anticoagulant in the UK
    • Mechanism: inhibition of vitamin K-dependent clotting factors

    Anti-Platelet Drugs

    • Examples:
      • Clopidogrel
      • Prasugrel
      • Ticagrelor
      • Aspirin
    • Mechanisms:
      • Inhibition of ADP receptors
      • Inhibition of thromboxane A2 synthesis
      • Inhibition of glycoprotein IIb/IIIa receptors

    Fibrinolytics (Thrombolytics)

    • Examples:
      • tPA ( alteplase)
      • Streptokinase
      • Tranexamic acid
    • Mechanism: degradation of fibrin strands
    • Indications:
      • Acute thrombotic or embolic events
      • Deep vein thrombosis
      • Post-myocardial infarction

    Fibrinolytics

    • Streptokinase is a bacterial plasminogen-activating enzyme
    • Recombinant tPA (alteplase) is used for acute thrombotic or embolic events
    • Tranexamic acid is used to inhibit fibrinolysis

    Anticoagulants - Warfarin Alternatives

    • Direct inhibitors of factor Xa (e.g. rivaroxaban, apixaban)
    • Direct thrombin inhibitors (e.g. dabigatran)
    • IV anticoagulants:
      • Heparins (e.g. fondaparinux)
      • Hirudins (e.g. lepirudin)

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    Description

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