Blood drugs- Cardiovascular drugs ( Chapter 5/7) | Lipincott review

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 Thrombus=A clot that adheres to vessel wall

Embolus= intravascular clot that floats in the blood

Cardiovascular drug, hypertension , screening test and interview preparation

Platelet aggregation inhibitor

Platelet Aggregation=Stimulation of Platelets by Thrombin, Collagen and ADP…

Activation of Phospholipase..liberate Arachidonic acid..Arachidonic acid convert into Prostaglandin H2(PG) by COX-1….PG H2 convert into TX A2 ..cause aggregation

Fibrinogen attach GP IIb/IIIa receptor..cross-linking..aggregation of platelets

Aspirin=inhibit COX1 by irreversible Acetylation of Serine…Arachidonic acid not

convert into TX A2…..inhibit aggregation

Also inhibit TX A2 Synthetase…activate Prostacyclin...furthur inhibition of

aggregation… Ibuprofen anatagonize platelet inhibition by Aspirin

Aspirin is only NSAID that irreversibly exhibit antithrombotic property…81mg of Aspirin

known as “Baby Aspirin”….S.E; bleeding time prolong

Pharmacist , Hypotension , blood drugs and medical students


Clopidogrel, Ticlopidine, Prasugrul= MOA= irreversibly inhibit binding of ADP to

GP IIb/IIIa…inhibit activation of receptor…inhibit aggregation

T.E=Ticlopidine used in Ischemic attacks & Stroke prior to cerebral thrombotic..

Clopidogrel prevent Atherosclerosis after M.I, Stroke & best in ischemic disease

etc..Prasugrul in patients with unstable angina, non-ST elevated M.I, ST-elevated M.I

S.E= Ticlopidine cause TTP (thrombotic thrombocytopenia purpura),

Aplastic anemia(FDA black box warning), Neutropenia/Agranulocytosis

Clopidogrel=black box warning for poor metabolizer…prodrug

Prasugrul=Black Box warning for bleeding

Abciximab=monoclonal…inhibit GP llb/llla receptor…block binding of fibrinogen &

von Willebrand factor…inhibit aggregation…i.v for 24-48hr only

Eptifibatide &Tirofiban=Eptifibatide is Cyclic peptide….Tirofiban is non-peptide…

inhibit GP llb/llla receptor...inhibit aggregation..i.v …4hr effect

Dipyridamole= Coronory Vasodilator…increases cAMP…decrease

Phosphodiesterase.. DecreaseTxA2…inhibit aggregation...treat angina...inappropriate in elderly Pt.

Cilostazol=oral antiplatelet…Vasodilating…ϴ Phosphodiesterase lll….FDA approved for Intermittant Claudication…Non-FDA use in Beurger disease, Diabetes Mellitus with vascular sclerosis, Cerebral ischemia, ……..alter lipid profile..contra in C.H.F

BLOOD CO-AGULATION

Intrinsic pathway= XII XIIa , it activate XI XIa, it activate IX I IX a

It activate X Xa , it activate Prthrombin into Thrombin which convert

Fibrinogen into Fibrin

Extrinsic Pathway= VII VIIa X Xa Prothrombin thrombin Fibrinogen Fibrin

VIIa activate X, Xa activate Prothrombin into Thrombin, thrombin convert Fibrinogen into Fibrin

Inhibitors of Co-agulation

Protein C…Protein S….Antithrombin lll……Tissue factor


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