26 topics with concise breakdowns: definitions, key facts, and seminar questions.
In this section, we analyze drugs that regulate the blood coagulation system. You will study the basics of hemostasis and thrombus formation, as well as the pharmacology of agents capable of stopping bleeding or dissolving dangerous blood clots. Please note that diuretics are also included in the list of topics — during the classes, we will discuss how changes in plasma volume affect blood rheology.
The material covers key pharmacological groups. You will study antiplatelet agents (P2Y12 receptor antagonists such as clopidogrel and ticagrelor, phosphodiesterase inhibitors, prostacyclin receptor agonists, and glycoprotein receptor blockers — abciximab, eptifibatide). Anticoagulants are discussed in detail: direct (from standard heparin and LMWHs to fondaparinux and direct oral anticoagulants) and indirect. Also presented are fibrinolytics for thrombus lysis and agents that increase coagulation (antifibrinolytics).
Exams and colloquia most frequently test the exact sites of drug action in the coagulation cascade. Pay special attention to the differences between unfractionated and low-molecular-weight heparins, the differences in the mechanisms of action of clopidogrel and ticagrelor, and the principles of monitoring therapy with indirect anticoagulants.
What is the main difference between indobufen and acetylsalicylic acid?
Indobufen blocks cyclooxygenase reversibly, whereas ASA binds to the enzyme irreversibly. In addition, indobufen additionally inhibits thromboxane synthase.
What type of antibodies does abciximab belong to?
The drug represents "chimeric" monoclonal antibodies. It consists of a murine antibody Fab fragment and a human immunoglobulin Fc fragment.
How quickly does the antiplatelet effect occur after eptifibatide administration?
The drug's action begins rapidly. Just 5 minutes after the start of intravenous infusion, platelets lose their ability to aggregate, which is critically important in acute conditions.
What is the difference between arterial and venous thrombosis?
In arteries, due to high blood flow velocity, platelet aggregation predominates. In veins, blood flow is slow, so coagulation with the formation of fibrin thrombi dominates there.
What type of inhibition is characteristic of acetylsalicylic acid regarding COX?
Acetylsalicylic acid causes irreversible inhibition of the cyclooxygenase (COX-1) enzyme by acetylating its active site.
Why is epoprostenol not prescribed in pill form for the prevention of thrombosis?
The drug is destroyed extremely rapidly in the blood, with a half-life of only about 2 minutes. To maintain the effect, continuous infusion is required, which makes oral administration impossible.
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