N4.i · Anticoagulants, Antiplatelets & Fibrinolytics

Compare and contrast the mechanism of action, pharmacokinetics, adverse effects and monitoring of effect of dabigatran and warfarin.

Describe the following pharmacology of both unfractionated heparin and bivalirudin: (a) indications for use (10% of marks) (b) mechanism of action (30% of marks) (c) monitoring and reversal (10% of marks) (d) important pharmacokinetic differences and considerations when using in the intensive care unit (ICU) (30% of marks) (e) adverse effects (20% of marks).

Outline the important similarities and differences between unfractionated heparin and enoxaparin using the following headings (20% of marks each): (i) Mechanism of action (ii) Pharmacokinetics (iii) Adverse effects (iv) Dosing (v) Monitoring and reversal

Describe the pharmacology of heparin highlighting important differences between unfractionated and fractionated (low molecular weight) heparin.

Compare and contrast unfractionated heparin with low molecular weight heparin

Compare and contrast the pharmacology of heparin and enoxaparin.

Describe the pharmacology of low molecular weight heparin (70% marks). Outline the pharmacology of hirudin (30% marks).

How does warfarin exert its pharmacological effect (40% marks)? Write brief notes on the pharmacology of the agents that can be used to reverse the effects of warfarin (60% marks).

Outline the pharmacology of warfarin.

How does warfarin exert its anti-coagulant effect (50% of marks)? Outline the pharmacology of the agents that can be used to reverse the effects of warfarin, giving examples (50% of marks).

Compare and contrast aspirin and clopidogrel

Compare and contrast the pharmacology of aspirin and clopidogrel

Outline the mechanisms of action of anti-platelet drugs. (50% of marks) Briefly describe the mechanism of action, and pharmacokinetics of aspirin, in relation to its use as an anti-platelet drug. (50% of marks).

List the antiplatelet agents and outline their mechanisms of action, adverse effects, mode of elimination and duration of action.

Outline the process of fibrinolysis (40% marks). Write short notes on the indications, mechanism of action, pharmacokinetics and side effects of tranexamic acid (60% marks).

Describe the pharmacology of tranexamic acid.

Outline the mechanism of action of drugs used to promote haemostasis.

Outline the differences between heparin and enoxaparin with respect to: a. Phamacokinetics b. Monitoring of effect c. Adverse effects d. Reversal of effect

Outline the physiological processes that occur in a blood vessel after venipuncture (80% of marks). How are these altered by the administration of aspirin (20% of marks)?

Outline the major clotting factors and steps in the haemostasis pathway (70% marks). Outline the mechanism of action of thrombolytics (30% marks).

Describe the fibrinolytic pathway and identify areas of interaction with the coagulation pathway (80% of marks). List two anti-fibrinolytic agents and state their specific mechanism of action (20% of marks).

(a) Outline the process of fibrinolysis including how it interacts with the coagulation system (80% of marks). (b) Describe the mechanism of action and adverse effects of alteplase (20% of marks).

Describe the structure and function of platelets (50% marks). Outline the pharmacology of clopidogrel (50% marks).

With respect to viscoelastic assays, describe the expected alterations and the underlying mechanisms resulting from the following: a) platelet dysfunction (40% of marks), b) therapeutic heparin use (40% of marks), c) hyperfibrinolysis (20% of marks). Either TEG or ROTEM is acceptable for your answer.