March 28, 2023

😍🖼Animated Mnemonics (Picmonic):

It’s a series of lectures about bleeding and coagulation disorders in the previous video f talked about p2 y12 receptor which is a receptor on the planet and it’s a receptor for adp today i’ll talk about the p2 y12 receptor inhibitors a great video and now let’s get started platelet receptors are proteins and they are part of the glycoprotein coat on the outside

Surface of the platelets and the p2y 12 is no exception your great cell membrane is made of protein among others so membrane proteins are either integral or peripheral most receptors or peripheral proteins hemostasis has many steps temporary platelet plugs also known as primary hemostasis when we talk about the p2y twelve receptor we’re talking about the temporary

Plug or primer hemostasis when we talk about p2y twelve inhibitors we are talking about inhibiting primary hemostasis i hope this is clear if you have problems understanding the platelet plug or primer hemostasis please watch this great video about a mnemonic it’s in the playlist adhesion activation aggregation first adhesion have gp1 be it’s a receptor on the

Platelet adhere to the von willebrand factor which is bound to the sub initial collagen okay then platelet activation by secreting adp and thrown boxing into adp is a great whistleblower and it will cause adp dependent expression of gp to be 3/8 receptor but it’s more complicated than that here’s the real story atp will bind to the receptor such sp2 y12 receptor

On the planet then gp 2 then i’m sorry p2 y12 receptor well transform this vp to be 3a from inactive form into the active form via a conformational change which means a change in shape after this gp to be a 3 is active and ready to bind other plates a molecule of fibrinogen is present in between and then fibration will be converted into fibrin and this will be the

Secondary hemostasis also known as death rhombus also as the coagulation cascade p2 y 12 receptor is a receptor on the surface of play that made of protein of course because most receptors are proteins if not all receptors one of the 12 types of pure energy receptors from 1 to 14 p2 y one is gq coupled pete y 12 is gi coupled what’s the function p 2 y 12 promotes

Plays aggregation and if you have played aggregation you have a great path towards blood coagulation if you don’t have plated aggregations in cases when you use p2y twelve inhibitors such as popular grill no plated aggregation no blood coagulation it’s not going to happen if there is no platelet aggregation in vain there is blood coagulation parts of my words of

Wisdom p2y 12 is a chemoreceptor for adp so here is adp like here here is the p2 y 12 a receptor for adp okay fine then since it’s g i coupled i for inhibitory it’s gonna inhibit the level of cyclic amp ii when you have low cyclic amp ii you are ready to convert this gp to be 3a from inactive form into the active form if gp 2 b 3 is active poly that aggregation

Is gonna happen so when we talk about p 2 y 12 inhibitors they inhabit the activation of gp 2 b 3 a they inhibit plated aggregation and therefore they inhibit blood coagulation the good news is this class of medications can prevent thrombosis the bad news is you’re more likely to bleed because there are no solutions in life only trade-offs gi coupled prevents

The conversion of atp into cyclic amp you remember the enzyme adenylate cyclase when you have low cyclic amp you have more calcium more calcium more coagulation calcium coagulation so when cyclic amp is high plato aggregation is look when cyclic amp ii is low platelet aggregation is high when they go low we go high so how does that p2 y12 works it’s a gi coupled

Receptor decreasing cyclic amp ii promoting platelet aggregation how does the p2 y12 inhibitors the medication work they inhibit the p2 y 12 which is a di coupled no decrease in cyclic amp ii no increase in platelet aggregation makes perfect sense medicine is a piece of cake if explained properly which is kind of rare these days because most professors are in it

They are more concerned about who is following them on instagram than about delivering a precise nate piece of lecture adp peter why 12 which is a receptor for adp it’s jii for inhibitory it inhibits the conversion of atp to cyclic gmp low cyclic amp a more calcium you can now convert this gp to b3 from the inactive form into the active form hey we have platelet

Aggregation let’s add some medications which are p 2 y 12 inhibitors such as clopidogrel presser krell floppy dean and take a girl or now we have no gi you have no decrease in cyclic and b in fact you’ll have increase in cyclic mp okay decrease in calcium no conversion of dp to be 3 into the active for no platelet aggregation because when cyclic amp is high platelet

Aggregation is low p 2 y 12 receptor inhibitors are clopidogrel prasugrel to klaapa dean and de carril or let’s start with clopidogrel it’s used together with aspirin no kidding because aspirin is anti platelet how by inhibiting the cyclooxygenase and we were talking players we’re talking specifically about the cyclooxygenase one when you have no cyclops in each

One you have no thromboxane into okay you remember the two whistleblowers yes thromboxane a2 and agp as foreign heavies thromboxane a2 clopidogrel inhibits adp from binding to the great receptor p2 y 12 and this is the whole story morning glory as print plus clopidogrel is a powerful combo because not only mcdonald’s have combos doctors and hospitals have combos

As well except our compost are very expensive we do not charge you 595 this combo is called dual antiplatelet therapy used for heart attacks yeah because in heart attacks you have a clot in your coronary artery this is a bad coronary okay if you have a clot in your coronary artery you can have a heart attack because there’s no oxygen supply to the hole copito

Grill and aspirin can prevent that coronary arteries 10th okay sometimes your coronary artery is blocked so we introduced like a catheter or a stent into your coronary artery to poke it and open it and destroy the squad however after the surgery is done sometimes you can clot the stent which is kind of like your very unfortunate okay here comes the club peter grill

And aspirin to prevent the clogging or the clots from forming inside the stent these drugs can prevent ischemic stroke so instead of the heart if this is your brain and instead of a coronary artery you have a cerebral artery same thing here a clot can form in this artery causing an ischemic stroke because we have two types of strokes ischemic and hemorrhagic

When there is a clot in the artery we call this an ischemic stroke route of administration of this puppy degrelle / us which means oral and the us here being your mouth not any other awesome okay onset two hours it’s a perot drug which means it requires metabolism first in order for it to become active mechanism of action is a bit too y12 inhibitor and this is

A non-competitive inhibitor this is irreversible inhibition if the patient is allergic to aspirin use clopidogrel it’s a prodrug activated in the liver by the cyp2c19 member of the cytochrome p450 system adverse effects bleeding of course inhibit spoilers ttp wow rash and sensitivity drug interaction may include other drugs that are inducers or inhibitors of the

Cyp2c19 member of the p450 cytochrome system if you love mnemonics try pick monic a picture in a mnemonic or a mnemonic in a picture or whatever and they have a pic monic about clopidogrel which is today’s topic this company is awesome and see the link in description below they are not a sponsor of this video i just recommend we’re done with clopidogrel let’s go

To the next guy press a grill together with aspirin for acute coronary syndrome which is an umbrella term that includes three things unstable angina non-st elevation my core infarction or no st elevation and st-elevation myocardial infarction non-stemi and stemi percutaneous coronary intervention to keep the stent open as we have discussed with clopidogrel it’s a

Prodrug same ethical peter grill it’s more effective than clippard well however there’s more risk of bleeding because this is life if you inhibit the platelets more you’re gonna bleed more in life there are no solutions only trade-offs side-effects bleeding contraindications if you have active bleeding if i have a hemorrhagic stroke please don’t give a drug that

Will make you bleed this is known as stupid clopidogrel press a grill to clop it in take a girl or two clop it in is the evil one to cloppety and believe it or not was the first page of y12 inhibitor in history this was the first drug invented by the way there is no difference between saying a p2 y12 inhibitor and a dp receptor antagonist because as you know p2i

12 is the aedpa receptor so if you have a question on your exam and they are asking what’s the mechanism of action of clopidogrel press or grill to clop it into catgirl or or whatever and you have among the choices a dp receptor antagonists choose it if you don’t find it don’t panic choose the p2 y 12 receptor inhibitor just common sense guys why do we call to

Cloppety in the evil one because there is risk of life-threatening hematological toxicity such as a granulocyte osseous as well as thrombotic thrombocytopenic purpura what the flip is a granulocyte osis a in greek means no granulocytes osseous means condition it’s a condition when you have no granulocytes you need some etymology and terminology okay here we go

Why do we call anatomy anatomy okay tomi means to cut like a knife anna means up so literally anatomy mean to cut you up don’t forget tomi means cut how about adam a means no and tell me in scott adam is the thing that you cannot cut down into pieces it’s the building unit of matter at least at that time what’s the actual building unit of matter i’ll leave this

To the great chemistry professors back to a granulocyte oses the conditions with no granulocytes what the flip are the granulocytes they are three cells they are been basophils you know phil’s neutrophils when you’re taking this garbage drug you are risking decreasing these cells in your body those are white blood cells when you have no ipod cells you you’re more

Liable to infections what else around cytosis ttp aplastic anemia which is a wrong name the correct name should be a plastic pancytopenia because you have decreased red blood cells decrease white blood cells and decrease platelets the best name is a plastic pen side opinion therefore if you are giving a patient 8 o’clock 13 or clopidogrel or press a grill or tick

A girl or please check the complete blood count frequently to check for a granule cytosis ttp and/or aplastic anemia which is not anemia it’s a pancytopenia and that’s a great question you might have a board question your exam and you have like patient taking clopidogrel or telepathy and the question is which of the following should be done frequently and one of

The answers measure the cbc frequency and this is the correct answer why because we have a granule saito-san aplastic anemia as side effects take a girl or tradename berlinda and this is a great name by the way if i have a daughter the first daughter is gonna be malassezia because i love the great malassezia furfur fungus and the second daughter will be named

Brilinta because i love why twelve inhibitors vampires are history p2i twelve inhibitors is the new thing if you know what i mean users of take a girl or prevention of strokes and heart attacks of course adverse effects short of breath bleeding no kidding ventricular pause wow and allergy contraindications of the patient is actively bleeding and cyp3a4 inhibitors

Because this ticagrelor is metabolized by this enzyme cyp3a4 which is a member of the cytochrome p450 system in your liver so if you are taking cyp3a4 inhibitor such as like grape fruit juice for example grapefruit juice inhibits this enzyme when you inhibit this enzyme no one will metabolize to a kangaroo or tight angle or will float in the plasma freely with no

One to break it down this will increase like egg roll or toxicity increasing your risk of bleeding don’t drink and drive don’t text and drive and don’t take take a girl or while on grape fruit juice influence now let’s have some fun here are the p2y twelve receptor inhibitors also known as aedpa receptor inhibitors clopidogrel prasugrel to clop in the intake a girl

Or what’s the mechanism of action they are p2y twelve inhibitors aka adp receptor antagonist pro drug yes yes yes no ty kangaroo lore is already active if it’s a pro drug it’s not an active metabolite if it’s a pro drug it’s not an act or metabolite it’s a pro drug it’s not an item that lights but it’s not a pro drug yes it’s active at least this is how i remember

It metabolism or how does the drug become active except or carol or because it’s already active so this one needs cyp2c19 cyp3a4 cyp2c19 cyp3a4 so tuk tuk tuk tuk the alternate cyp c19 then this then cip 19 than this all of these are members of the cytochrome four-fifty system in your labor some notes copy degrelle used together with aspirin for prevention of

Thrombosis after placement of coronary stent which is part of a percutaneous coronary intervention hashtag keep the stent open slow metabolizers have no effect press a grail good for patients undergoing pci same thing possible adverse effect is life-threatening bleeding because it’s more efficient and effective than clopidogrel to cloppety is the evil one why it

Can cause life-threatening hematological toxicities such as a granulocyte osis or neutropenia aplastic anemia and ttp sorry i meant a plastic pancytopenia check the cbc plays it’s like a grill or when you give it with aspirin this is called synergy in pharmacology synergy when one plus one equals more than two in mathematics this is called stupid but in pharmacology

This is called synergy we use like a girl or for patients with acute coronary syndrome which is an umbrella term that includes unstable angina non-stemi and stemi as well as post mi as maintenance therapy all of these drugs inhibit the atp receptor they inhibit platelet aggregation but they have a side effect of bleeding if you have a patient who is scheduled for

Surgery please stop all of these drugs at least 5 days before the surgery again talk to your surgeon because everybody is different i have a great pdf note about sl salicylic acid on patreon just for a dollar basically this is free let’s be honest thank you so much guys for watching please subscribe join the tribe and hit the bell follow me on facebook i have more

Than 90 cases there and i have even more cases and all of my notes are available on slash medic osis where you can just download all of my pdf notes and they are yours forever this is médicos for fiction ellis as always be safe stay happy and study hard

Transcribed from video
P2Y12 Receptor Inhibitors By Medicosis Perfectionalis