3 Anticoag HH

Question 1

Complications of UFH use

Answer 1

Osteoperosis Heparin induced thrombocytopenia (HIT)

Question 2

What are the two types of HIT

Answer 2

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

Question 3

Action of coumarins?

Answer 3

Vit k epoxide reductase inhibitor - LEARN THE CYCLE

Question 4

What is vit K used for?

Answer 4

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)

Question 5

How are platelets activated?

Answer 5

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

Question 6

PT time tests the extrinsic or intrinsic pathway

Answer 6

exctrinsic

Question 7

S/e warfarin

Answer 7

BLEED
alopecia
skin rash
skin necrosis
teratogenic
agranulacytosis

Question 8

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

Answer 8

short half life of clotting factors

Question 9

Name the NOACs

Answer 9

rivaroxiban
apixiban
dabigatran

Question 10

Mechanism of action of dabigatran

Answer 10

anti-IIa inhibitor

Question 11

Mechanism of action of riv and apixaban

Answer 11

anti-Xa inihibitor

Question 12

Warfarin: why is time in therapeutic range important?

Answer 12

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

Question 13

Look at the diagram of where anticoagulants work!

Answer 13

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Question 14

Major advantages of NOACs? 4

Answer 14

Reproducible PK
No monitoring

Rapid onset
Oral

Question 15

All NOACs are licensed for… (4)

Answer 15

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

Question 16

Disadvantages of NOACs

Answer 16

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

Question 17

Care using NOACs with (4)

Answer 17

peri-op
epidural anesthesia
renal impairmen
wight 12kg

Question 18

Reversal agents for NOACs are being investigated such as

Answer 18

MAB fragments and modified antifXa vairent

Question 19

Which NOAC has OD dosing

Answer 19

Rivarox

Question 20

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

Answer 20

Riv or Apix

Question 21

NOAC to choose in previous MI or ACS

Answer 21

Riv

Question 22

NOAC to choose for high GI bleed risk

Answer 22

Apix

Question 23

NOAC to choose for high tisk of ischemic stroke

Answer 23

Dabigatran

Question 24

Choice of anticoagulant:

Cr

Answer 24

Warfarin

Question 25

Choice of anticoagulant: | Cr 15-30

Answer 25

riv 15mg od or apix 2.5mg bd

Question 26

Choice of anticoagulant: | extremes of weight

Answer 26

Warfarin

Question 27

Choice of anticoagulant: | children

Answer 27

Warfarin

Question 28

Choice of anticoagulant: | heart valve prosthesis

Answer 28

Warfarin

Question 29

Choice of anticoagulant: | cancer associated thromosis

Answer 29

LMWH

Question 30

Choice of anticoagulant: | high GI bleed risk

Answer 30

warfarin or apixiban

Question 31

Choice of anticoagulant: previous MI

Answer 31

warfarin or riv (maybe apix)

Question 32

Thrombolytic agents

Answer 32

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

Question 33

Contraindications to fibriolysis in acute MI

Answer 33

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

Question 34

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

Answer 34

vena cava

Question 35

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

Answer 35

anticoagulants and thrombolytics

Question 36

Pharmacists role in anticoagulation

Answer 36

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

Question 37

Non-pharmacological ways of avoiding VTE?

Answer 37

mobility and hydration stockings foot pumps

Question 38

APTT measure intrinsic or extrinsic clotting time?

Answer 38

Intrinsic

Question 39

APTT is normall

Answer 39

27-35 sec | don't confuse APTT ratio with INR. APTT raio is APTT/control

Question 40

LMHW doses are ..... adusted | UFH doses are .... adjusted

Answer 40

LMWH - weight | UFH - APTT

Question 41

Name some LMWH

Answer 41

Dalteparine Enoxaparin Tinzaparin

Question 42

How do you reverse heparin?

Answer 42

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