Venous Thromboembolism Flashcards

1
Q

virchow’s triad

A

venous stasis
venous endothelial injury
hyper-coagulability

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2
Q

gold standard for diagnosis VTE. Only test that can detect proximal and distal

A

venography

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3
Q

this test is only sensitive for proximal DVT. It is non-invasive and measures blood flow following occlusion

A

impedance plethysmography

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4
Q

this test is non-invasive and measures the rate of blood flow from the reflection of sound waves off RBCs

A

doppler U/S

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5
Q

combines doppler with real time B-mode U/S to give better sensitivity and specificity of detecting proximal DVTs

A

duplex U/S

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6
Q

this test has high sensitivity but low specificity. You can rule out DVT if normal, but cant rule-in if elevated

A

d-dimer

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7
Q

If non-invasive tests are negative and you suspect a PE, what should you do?

A

V/Q scan

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8
Q

objectives for DVT treatment

A

prevent development of PE
prevent postphlebitic syndrome
reduce mortality
minimize adverse events and costs

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9
Q

this drug blocks the synthesis of thromboxane A2 from arachidonic acid by inhibiting cyclooxygenase

A

aspirin

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10
Q

ADRs include bronchospasm and GI hemorrhage

A

aspirin

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11
Q

contraindications include children under 12, breast feeding, hemophilia, PUD, and known hypersensitivity rxn

A

aspirin

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12
Q

this drug is combined with aspirin to make aggrenox

A

dipyrdamole

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13
Q

this drug causes inhibition of phosphodiesterase that hydrolyzes cAMP. Increase in cAMP causes decreases tA2 synthesis and thus platelet aggregation

A

dipyrdamole

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14
Q

used to prevent thrombosis

A

aggrenox

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15
Q

used with prosthetic mechanical valves in combo with warfarin and is an alternative to exercise in thallium myocardial perfusion imaging

A

dipyrdamole

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16
Q

ADRs- HA, GI bleed, hypotension

A

dipyrdamole

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17
Q

caution in pts with hypotension and in pts with serious CAD

A

dipyrdamole

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18
Q

this drug block ADP-induced platelet-fibrinogen and platelet-platelet binding

A

ticlopidine

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19
Q

indicated for prevention of repeat stroke or TIA and in coronary artery stinting

A

ticlopidine

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20
Q

contraindicated in pts with severe liver dysfunction, thrombocytopenia, neutropenia, PUD, and internal bleeding

A

ticlopidine

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21
Q

interacts with cimetidine, digoxin, theophylline, and red clover

A

ticlopidine

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22
Q

ADRs include bleeding, N/V/D, thrombocytopenia, neutropenia, pancytopenia, nephrotic syndrome, and dark colored urine

A

ticlopidine

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23
Q

this drug inhibits activation of glycoprotein IIb/IIIa receptor on the surface of platelets, which is required for aggregation to occur

A

clopidogrel

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24
Q

indicated for secondary prevention of CV and cerebrovascular events and in patients allergic to aspirin

A

clopidogrel

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25
Q

ADRs include hemorrhage, abdominal discomfort, and N/V

A

clopidogrel

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26
Q

this drug is safer than ticlopidine and is often added to ASA to obtain better platelet inhibition

A

clopidogrel

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27
Q

an antibody fragment directed toward the GP IIb/IIIa receptor of platelets. Binding and blocking the receptor prevents platelet aggregation

A

abciximab

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28
Q

indicated to prevent ischemic cardiac complications in patients undergoing percutaneous coronary intervention. Short term prevention of MI in patients with unstable angina

A

abciximab

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29
Q

these two drugs work like abciximab but are peptide fragments. They are potentially antigenic and should only be used once

A

tirofiban and eptifbatide

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30
Q

work by inhibiting the action of coagulation factors or interfere with the synthesis of coagulation factors

A

anticoagulants

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31
Q

binds to antithrombin III and accelerates inactivation of coag factors. AT III is an anticoagulant (inhibits binding of fibrinogen to thrombin)

A

heparin

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32
Q

binds to thrombin, inactivating its activity

A

heparin

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33
Q

binds and inhibits factor Xa (which converts prothrombin to thrombin)

A

heparin

34
Q

this drug complexes with antithrombin III and inactivates factor Xa but does not bind as well to thrombin

A

LMWH

35
Q

indicated for DVT, PE. Coronary artery pr-thrombosis after thrombolytic therapy

A

heparin

36
Q

can be used in pregnancy- does not cross placenta

A

heparin

37
Q

indicated for DVT/PE, unstable angina, and MI

A

LMWH

38
Q

in order to treat someone with this, make sure they have a stable proximal DVT or PE, normal vital signs, low bleeding risk, no renal insufficiency, and monitoring system

A

heparin and LMWH

39
Q

contraindicated in hemophilia, thrombocytopenia, PUD

A

heparin/LMWH

40
Q

ADRs: bleeding (esp in those >70, recent surgery or trauma, use of ASA or NSAIDs, and renal failure)

A

heparin/LMWH

41
Q

antidote for heparin (and sort of for LMWH)

A

protamine

42
Q

this can occur in 3% of UFH treated patients. It is associated with arterial or venous thrombosis and causes a drop in platelet count >50%

A

heparin induced thrombocytopenia (HIT)

43
Q

complications of this include DVT, PE, MI, stroke, TIA, and end organ damage

A

HIT

44
Q

treat HIT

A

D/C UFH
use DTIs (argotroban or lepirudin)
initiate warfarin once platelets are okay

45
Q

ADR includes osteoporosis

A

heparin (less with LMWH)

46
Q

monitor: baseline aPTT, PT/INR, and CBC along with signs and symptoms of bleeding

A

heparin

47
Q

monitor: aPTT, PT/INR, CBC, and SrCr along with anti factor Xa activity

A

LMWH

48
Q

this drug prevents DVT following orthopedic surgery. It requires cofactor of antithrombin III for activity

A

fondaparinux

49
Q

this drug is indicated in prevention of DVT in patients undergoing knee or hip replacement. Also used in stroke and systemic embolism prophylaxis in patients with non-valvular afib

A

rivaroxaban

50
Q

indicated for DVT prophylaxis in patients post hip and knee replacement- dont give if CrCl <15 or severe liver failure

A

apixaban

51
Q

reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fib. Can inhibit both free and clot-bound thrombin

A

dabigatran

52
Q

binds selectively and reversibly to the catalytic site of thrombin as a competitive inhibitor- can inhibit clot-bound thrombin

A

argatroban

53
Q

short half life. Used in heparin induced thrombocytopenia with and without thrombosis, ischemic stroke, hemodialysis, PCI. NO antidote

A

argatroban

54
Q

derived from the leech, these two drugs inactivate thrombin

A

desirudin and lepirudin

55
Q

indicated in patients with heparin induced thrombocytopenia. Prophylaxis of DVT in patients undergoing hip and knee replacement

A

hirudins

56
Q

contraindicated in active bleeding and renal or hepatic impairment

A

hirudins

57
Q

ADRs hemorrhage and hypersensitivity

A

hirudins

58
Q

vitamin K antagonist. Blocks the reduction of vitamin K epoxide (necessary for clotting factors II, VII, IX, X)

A

warfain

59
Q

half life for clotting factors

A

II- 60 hours
VII- 6 hours
IX- 24 hours
X- 40 hours

60
Q

used in acute MI, DVT, PE, afib, rheumatic disease, prosthetic heart valves, hip or knee replacement patients

A

warfarin

61
Q

contraindicated in central thrombosis, peptic ulcer, pregnancy

A

warfarin

62
Q

ADRs- bleeding and skin necrosis

A

warfarin

63
Q

treat bleeding induced by warfarin

A

vitamin K

64
Q

monitor PT/INR, aPTT, CBC, LFTs
UA and fecal occult
signs and symptoms of bleeding

A

warfarin

65
Q

this class turns plasminogen into plasmin, which cleaves fibrin and lyses thrombi

A

thrombolytic agents

66
Q

someone had an MI how do you administer throbolytic agent

A

intracoronary

67
Q

used in acute MI, massive or submassive PE, heparin tx failures, extensive proximal DVT

A

thrombolytic agents

68
Q

ADRs include hemorrhage and reperfusion arrhythmias

A

thrombolytic agents

69
Q

contraindicated in recent surgery, CVA within 2 months, recent needle puncture, active bleeding, uncontrolled HTN, malignancy, pregnancy, CPR

A

thrombolytic

70
Q

enzyme that catalyzes the conversion of tissue plasminogen to plasmin in the presence of fibrin. Fibrin specifically produces local fibrinolysis in the area of a recent clot with limited systemic proteolysis

A

alteplase

71
Q

indicated for acute MI, PE, acute ischemic stroke

A

alteplase

72
Q

ADRs include bleeding, arrhythmias, N/V, cardiac arrest, stroke, thromboembolism

A

alteplase

73
Q

this drug forms a complex with plasminogen to convert the active enzyme plasmin, hydrolyzes fibrin plugs, and catalyzes the degradation of fibrinogen 7 clotting factors V and VII

A

streptokinase

74
Q

indicated for life threatening DVT, PE, arterial thromboembolism, and acute MI

A

streptokinase

75
Q

ADRs include N/V, bleeding, and antigenic reactions (allergic)

A

streptokinase

76
Q

DVT/PE prevention: total hip replacement

A

LMWH, warfarin, factor Xa inh

77
Q

DVT/PE prevention: total knee replacement

A

LMWH, warfarin, factor Xa inh, +/-IPC

78
Q

DVT/PE prevention: hip fracture surgery

A

factor Xa inh, LMWH, warfarin, LDUH

79
Q

DVT/PE prevention: trauma

A

LMWH, IPC or ES in LMWH C/I

80
Q

DVT/PE prevention: general med (CHF, COPD) or bedrest and >1 RF

A

LDUH, LMWH, fondaparinux