2012 Drugs that promote or inhibit coagulation

Lecture Objectives

  1. Be able to diagram the coagulation and fibrinolytic pathways and the interaction of protein C with those pathways.  Define how pro- and anti-coagulant drugs (including thrombolytics and anti-platelet drugs) interact with specific clotting factors and naturally occurring molecules in the context of these pathways. In broad terms, be able to distinguish among thrombolytics, anticoagulants and anti-platelet drugs with respect to therapeutic uses.

  2. Be able to identify both the common and the distinguishing characteristics of thrombolytic agents.  Describe the similarities and differences between streptokinase and urokinase vs. tPAs.

  3. Compare and contrast:
  4. a.  heparin and low molecular weight heparins
    b.  heparin and direct thrombin inhibitors
    c.  heparin and warfarin

with respect to mechanism of action, pharmacokinetics (esp. time to onset of activity), method of monitoring, antidotes, use during pregnancy and side effects.  Know the properties of agents that can reverse the actions of heparin and the oral anticoagulants.

  1. Understand how particular disease states and/or co-administration of other drugs alter the efficacy and side effects of warfarin (esp. why it is the metabolism of S‑warfarin that is critical).  Be able to describe specific pharmacokinetic and pharmacodynamic principles governing warfarin interactions, and be able to interpret specific examples.

  2. Be able to use cytochrome P450 interaction tables to define drug-drug interactions.

  3. Be able to describe with the biochemical mechanisms of action and adverse effects of anti-platelet agents.  Know the specific instances where anti-platelet drugs are used in conjunction with other anti-clotting agents.

  4. Know the drugs and plasma fractions that are used specifically in the treatment of vitamin K deficiency, factor VIII deficiencies [classic hemophilia (hemophilia A); and von Willebrand’s disease] and factor IX deficiency (Christmas disease, hemophilia B).

  5. Understand the mechanisms of action of the fibrinolytic inhibitors aminocaproic acid and aprotinin.
Email: Dr. Janet Fitzakerley | ©2012 University of Minnesota Medical School Duluth | Last modified: 31-may-12 7:38 PM