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what does prostacyclin do?
inhibits platelet aggregation.
released from endothelial cells
what does thromboxane do?
stimulates platelet aggregation and vasoconstriction.
released from platelets.
diagram of how PGs and thromboxane are produced
when are antiplatelet drugs used?
used to prevent MI in patients who have previously had an MI.
reduces stroke incidence.
what do antiplatelet drugs do?
inhibits cyclo-oxygenase (irreversible)
example of antiplatelet drugs?
low dose aspirin
aspirins effects diagram
how is aspirin selective?
it only effects the platelets due to them not having a nucleus and therefore not being able to produce new COX.
why is aspirin only a small dose?
if it was a larger dose there would be spare aspirin that would affect the new COX as well, the inhibition would not be able to be overcome.
what is clopidogrel?
a P2Y12 receptor antagonist.
what does plasmin do?
digests the fibrin of the clot (and some of the clotting factors)
what is altered to create plasmin?
plasminogen.
via streptokinase.
what is the issue with streptokinase?
it is a protein so the body can create antibodies against it.
means cant really be used more than once.
what is alteplase?
recombinant human tissue type plasminogen activator.
when is alteplase given?
immediate after myocardial infarction (MI)
what drugs are used to prevent coagulation?
heparins
oral anti-coags = warfarin
direct oral anti-coags (DOACs) = rivaroxaban.
heparin
first extracted from the liver.
family of mucopolysaccharides.
it is unfractionated.
use the low molecular weight fractions.
what do heparins activate?
anti thrombin III
how is heparin administered?
injected.
What does warfarin do?
blocks unwanted coagulation.
vitamin K reductase inhibitor.
does warfarin interact with other drugs?
yes, with most others.
what is reducing vitamin K essential for?
production of prothrombin and factors VII, IX and X
what is warfarin's TW?
narrow - risk of bleeding.
Note 
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