Anticoagulants Flashcards Preview

D&T 1 Exam 1 > Anticoagulants > Flashcards

Flashcards in Anticoagulants Deck (48):
1

Vit K Dependent Coag Factors

2,7,9,10

2

Heparin MOA

Accelerates inactivation by Antithrombin 3 (reversible binding)

3

Can you use heparin in pregnancy?

YES

4

How do you monitor heparin?

Activated partial thromboplastin (aPTT) -- monitors common and intrinsic pathway

5

Can you give heparin intramuscular?

NO. Contraindicated (painful hematoma)

6

Side effects of heparin

Bleeding -- thrombocytopenia
Osteoporosis (long term)

7

How do you treat excess hemorrhage (with heparin)

Plasma
Whole blood with coag factors
PROTAMINE SULFATE (NOT with protamine allergy -- FISH; also no NPH insulin)

8

Low MW Heparin (3 types)

Enoxaprin
Dalteparin
Tinzaparin

9

Benefits of low MW heparin

Higher specificity for Enhanced Antithrombin 3 inactivation of Xa
Longer intervals between dosing (ONCE A DAY!)
Does not require monitoring
Better predictability
Less Thrombocytopenia

10

Can you use low MW heparin in pregnant women?

YES

11

When to use Low MW heparin

Prophylaxis and acute DVT
Surgery

12

How do you administer low MW heparin?

Subcutaneous Injection

13

How do you administer Heparin?

Injection (IV)

14

Fondaparinux (pentasaccharide) MOA

Binds to AT2 to accelerate ONLY factor Xa inactivation

15

How do you give Fondaparinux?

IV, SC

16

What is Fondaparinux used for?

DVT
PE

17

Can you use Fondaparinux in pregnancy?

YES

18

Warfarin MOA

Inhibits hepatic synthesis of biologically active Vit K Dependent clotting factors, Protein C, and S

-- inhibits conversion of Vit K Epoxide to Hydroquinone

19

Warfarin is the DOC for what?

ORAL ANTICOAGULANT

20

Warfarin is effective as an anticoag ONLY when what?

administered in vivo

21

How do you monitor warfarin?

INR - laboratory standardized quick-one stage prothrombin time

Monitor extrinsic pathway with prothrombin time

22

Ideal INR?

2.0-3.0
When prophylactic for heart valves: 2.5-3.0

23

Adverse Rxns are more likely to occur with Warfarin if:

Changes in warfarin or Vit K
Alteration of coag factors
Change in fibrin degradation
Change in platelet number or fxn

24

What genes cause the need to use LESS warfarin?

CYP2CP and VKORC1

25

Warfarin metabolism is mediated by what?

CYP450

26

Drugs which INCREASE warfarin's response

Ibu
Sulfamethoxazole/Trimethoprim
Cephalosporins
Erythromycin

27

Drugs which DECREASE warfarin response

Rifampin
Oral contraceptives

28

Can you give Warfarin to a pregnant woman?

NO NO NO
-congenital abnormalities
-neonatal and fetal hemorrhage

29

Treatment of overdose of warfarin

Whole blood
plasma
VIT K1 - Phytonadione

30

Direct Thrombin Inhibitors

Argatroban
Dabigatran Etexilate

31

How do you administer Argatroban?

IV

32

How do you give Dabigatran?

ORAL

33

Use of Argatroban

Thrombosis with heparin induced thrombocytopenia (treat and prophy)

34

Use of Dabigatran

Prodrug
NOT a p450 substrate
Substrate for P-glycoprotein transport
Converted to 4 diff glucuronides

35

Antiplatelet Drugs

Aspirin
Dipyridamole
Clopidogrel, Ticlopidine, Cangelor
Abciximab, Eptifibatide

36

Aspirin MOA

Inhibit platelet aggregation
Irreversible inhibitor of cycloox
TXA2

37

Dipyridamole

Inhibits phosphodiesterase (inc platelet cAMP)
Little benefit alone
Given with warfarin

38

MOA for Ticlopidine and Clopidogrel

Block ADP binding at the P2Y12 Receptor
Impairs ADP action on platelets
BOTH ARE PRODRUGS

39

Cangrelor

Reversible inhibitor or P2Y12 Receptor
GIVEN IV
Quickly reversible

40

Benefits of Clopidogrel

Better safety profile and shorter duration of action

41

Ticlopidine

Peak action takes 5 days and residual action lasts 72 hours after treatment
Can cause life threatening agranulocytosis

42

MOA for Abciximab and Eptifibatide

Platelet gyp 2b3a receptor antagonists
competitive reversible inhibitors
inhibit platelet cross linking with fibrinogen
IV
CANNOT USE WITH WARFARIN
Ab = 24-48 hours
Ep = shorter

43

Fibrinolytic MOA

restricts clot expansion and degrades fibrin during wound healing

44

Streptokinase

From Streptococci
IV
Complexes with Plasminogen
HIGH ANTIGENIC ACTIVITY
FEVER
Bleeding

45

Anistreplase

FEVER
More specific binding to thrombi

46

Alteplase

tPA
activates fibrin bound plasminogen more selectively than circulating plasminogen
Lytic state less marked

47

Tenecteplase

Derivative of Alteplase
longer half life
greater fibrin specificity
slower inactivation

48

Aminocaproic Acid

Inhibitor of plasminogen activation
Lysine analop
Used with excessive bleeding