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Clinical > 3 Anticoag HH > Flashcards

3 Anticoag HH Flashcards

1
Q

Complications of UFH use

A

Osteoperosis Heparin induced thrombocytopenia (HIT)

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2
Q

What are the two types of HIT

A

type 1 - platelet aggregation type 1 - platelet activating - a more rapid drop in platelet count, paradoxically causes THROMBOSIS. Seen 5-7days after initiation.

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3
Q

Action of coumarins?

A

Vit k epoxide reductase inhibitor - LEARN THE CYCLE

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4
Q

What is vit K used for?

A

gamma-carboxylation of Gla residues essential to activate clotting factors.
This converts vit K into vit K epoxide (and this is transformed back using vit K epoxide reductase)

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5
Q

How are platelets activated?

A

when unactivated there is an asymmerical distribution of phospholipids in hte membrane, this scrambles when activated. Becomes anionic allowing Ca binding

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6
Q

PT time tests the extrinsic or intrinsic pathway

A

exctrinsic

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7
Q

S/e warfarin

A 
BLEED
alopecia
skin rash
skin necrosis
teratogenic
agranulacytosis
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8
Q

Why do we give vit K as well as clotting factors in high INR?

A

short half life of clotting factors

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9
Q

Name the NOACs

A

rivaroxiban
apixiban
dabigatran

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10
Q

Mechanism of action of dabigatran

A

anti-IIa inhibitor

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11
Q

Mechanism of action of riv and apixaban

A

anti-Xa inihibitor

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12
Q

Warfarin: why is time in therapeutic range important?

A

under 50% of the time in therapeutic range actually shows worse survival than no warfarin

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13
Q

Look at the diagram of where anticoagulants work!

A

ssdfsdfjsdlkfjsldfj

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14
Q

Major advantages of NOACs? 4

A

Reproducible PK
No monitoring

Rapid onset
Oral

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15
Q

All NOACs are licensed for… (4)

A

VTW prophylaxis in hip/knee surgery
SPAF
treatment and secondary prevention of VTE

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16
Q

Disadvantages of NOACs

A
  • Cost
  • Extra care in some circumstances (see other card)
  • unlicensed in preg and kids
  • not reversible
  • difficulty measuring effect
  • drug interactions still possible
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17
Q

Care using NOACs with (4)

A

peri-op
epidural anesthesia
renal impairmen
wight 12kg

18
Q

Reversal agents for NOACs are being investigated such as

A

MAB fragments and modified antifXa vairent

19
Q

Which NOAC has OD dosing

A

Rivarox

20
Q

NOAC to choose in high risk of stroke/bleed/renal impairment

A

Riv or Apix

21
Q

NOAC to choose in previous MI or ACS

A

Riv

22
Q

NOAC to choose for high GI bleed risk

A

Apix

23
Q

NOAC to choose for high tisk of ischemic stroke

A

Dabigatran

24
Q

Choice of anticoagulant:

Cr

A

Warfarin

25
Q

Choice of anticoagulant:

Cr 15-30

A

riv 15mg od
or
apix 2.5mg bd

26
Q

Choice of anticoagulant:

extremes of weight

A

Warfarin

27
Q

Choice of anticoagulant:

children

A

Warfarin

28
Q

Choice of anticoagulant:

heart valve prosthesis

A

Warfarin

29
Q

Choice of anticoagulant:

cancer associated thromosis

A

LMWH

30
Q

Choice of anticoagulant:

high GI bleed risk

A

warfarin or apixiban

31
Q

Choice of anticoagulant: previous MI

A

warfarin or riv (maybe apix)

32
Q

Thrombolytic agents

A
  • Streptokinase (Kabikinase®, Streptase®)
  • rt-PA, Alteplase (Actilyse®)
  • Reteplase (Rapilysin®)
  • Tenecteplase (Metalyse®)
33
Q

Contraindications to fibriolysis in acute MI

A 
Recent haemorrhage
Trauma
Surgery
Coagulation defects
Peptic ulceration
Severe hypertension
Acute pulmonary disease esp cavitation
Acute pancreatitis
Severe liver disease
Previous allergic reaction
34
Q

You can put a creepy spider device itno your …. to prevent PE

A

vena cava

35
Q

There is evidence suggesting ….. and … should be used in combo for PE/DVT

A

anticoagulants and thrombolytics

36
Q

Pharmacists role in anticoagulation

A
  • Patient decision re-anticoagulation of choice?
  • VTE risk assessment / management
  • Initiation and dosing of anticoagulant drugs
  • Monitoring and managing results
  • Drug interactions
  • Counselling patients
37
Q

Non-pharmacological ways of avoiding VTE?

A

mobility and hydration
stockings
foot pumps

38
Q

APTT measure intrinsic or extrinsic clotting time?

A

Intrinsic

39
Q

APTT is normall

A

27-35 sec

don’t confuse APTT ratio with INR. APTT raio is APTT/control

40
Q

LMHW doses are ….. adusted

UFH doses are …. adjusted

A

LMWH - weight

UFH - APTT

41
Q

Name some LMWH

A

Dalteparine
Enoxaparin
Tinzaparin

42
Q

How do you reverse heparin?

A

Protamine (it’s uncommonly needed) - more effective on UFH that LMW

Clinical (32 decks)

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