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HEMATOLOGY > Anti-coagulants > Flashcards

Anti-coagulants Flashcards

1
Q

Which is a vit K antagonist ?

A

Warfarin

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2
Q

What is the problem of anti-coagulants having NARROW therapeutic windows?

A
  • over anticoagulation==> bleeding problems

- under: reduced efficacy

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3
Q

When are anti-coagulants given?

A

venous thrombosis

ATRIAL fibrillation

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4
Q

Why are anti-coagulants given for atrial fibrillation?

A
  • d.t irregular contraction of the atrium
  • results in stasis in the atrium> BLOOD CLOT formed
  • —-like venous thrombosis
  • risk of STROKE (through common carotid > internal carotid arteries> brain)
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5
Q

What are two types of thromboembolic strokes?

A
  • atheroma (platelet rich thrombus)

- embolic stroke if pt HAS Atrial fibrillation —give anticoagulants, check ECG

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6
Q

Thrombin role?

A
  • converts fibrinogen to fibrin

- —switching it off; stops coagulation!

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7
Q

Why is warfarin effective against PC AND PS?

A

-they’re also VITK dependant blood clotting factors.

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8
Q

How does heparin work?

A
  • causes the blood clot to disappear over a LONG period of time
  • —-potentiates anti-thrombin
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9
Q

What are the 2 forms of heparin?

A
  • unfractionated (alot of MONITORING) — shorter Half T1/2
  • LMWH
  • –given as IV / s.c : parentral ! (inpatient)
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10
Q

What is the MOA of heparin?

A
  • heparin keeps the anti-thrombin BOUND to thrombin and Xa to potentiate anti-thrombin axn
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11
Q

What is the diff between unfractionated and LMWH?

A
  • —–unfractionated keeps anti-thrombin and thrombin together
  • —-LMWH - keeps both bound together (Xa and Thrombin) —affect stays for 12-24 hrs
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12
Q

How to monitor heparin?

Why does LMWH not require as much monitoring?

A

PT and APTT is prolonged
—-APTT is much more sensitive

  • anti-Xa assay; MORE PREDICTABLE!
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13
Q

What is monitored in a pt who takes warfarin?

A
  • INR

- PT

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14
Q

What is the risk of monitoring PT with heparin?

A
  • may lead to OVER-COAGULATION
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15
Q

What are the risks of heparin?

A
  • abs to platelets!—-(heparin induced thrombocytopenia)
  • BLEEDING
  • OSTEOPOROSIS
  • s/c injections EVERYDAY
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16
Q

What to monitor if the pt has been on unfractionated heparin?

A
  • monitor FBC

- check for the platelet Abs

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17
Q

How to reverse heparinn drug action?

A
  • STOP the heparin (STOPS bioavailability of unfractionated heparin)
  • –ANTIDote: PROTAMINE SULPHATE (reverses anti-thrombin effect)
18
Q

How effective is PROTAMIN SULPHATE for reversing heparin axn?

A
  • PARTIAL reversal for LMWH

- —complete reversal for unfractionated

19
Q

Name coumarin anit-coagulants.

A

—INHIBIT vitamin K
warfarin. phenindione. acenocoumarin
phenprocoumon

20
Q

What is affected with warfarin administration?

A
  • PROTEIN C,S (reduces FIRST FEW DAYS)
    2, 7, 9, 10 (3-5DAYS)
    —–no longer have a negative charge (does not form a blood clot)
21
Q

What should be noted when administering warfarin and heparin?

A
  • ALWAYS GIVEN WARFARIN AND HEPARIN TOGETHER (KICK IN HEPARIN IN A WEEK)
22
Q

What is an issue with Warfarin?

A
  • NARROW therapeutic window

- –metabolised in the liver (need to personalise the dose to the individual; some need 1 mg or 15 mg)

23
Q

What is recommended with warfarin administration?

A

dose to be taken at the SAME time every day

24
Q

What is the INR?

A

normalizes the PT ratio by adjusting the variability in the sensitivity of the diff. thromboplastins.
—-standardizes reagents

25
Q

What are the MAJOR adverse effects of haemorrhage?

A
  • intensity of t anti-coagulation
  • concomitant clinical d.o
  • concomitant use of OTHER meds
  • BEWARE drug interactions
  • quality of management
26
Q

What are some bleeding s.es of warfarin?

A

MILD: bruising/ epistaxis/ haematuria

SEVERE: GI/ intracerebral/ sign. DROP in Hb

27
Q

What to do if INR is HIGH?

A

-DROP 1-2 doses
( 2-3 days of INR to drop)
- give VITAMIN K
—if MASSIVE hemorrhage (ADMINISTER clotting factors )
- clinical and lab assessment of response

28
Q

Why is clotting factors reserved for life-threatening conditions?

A
  • $$$
  • risk of infection!
  • in the 50s: Hep.C and HIV
29
Q

How long does it take for vit K and clotting factors to act?

A
  • Vit. K: 6 HRS

- CLOTTING FACTORS: immediate

30
Q

DABIGATRAN

A
  • targets THROMBIN (prevents fibrin clot forming)
31
Q

In whom is dabigatran inhibited?

A
32
Q

Name Xa inhibitors,

A
  • EDOXABAN
  • RIVAROXABAN
  • APIXABAN
33
Q

Why are anti-coagulants given for DVT/ PE and atrial fibrillation?

A
  • don’t affect PC AND PS
34
Q

What is warfarin used for?

A
  • those on heart valves and phospholipid diseases

- —great for preventing arterial events

35
Q

Why are new anti-coagulants preferred nowadays>

A
  • oral
  • NO monitoring needed
  • LESS drug interactions
36
Q

What are new anticoagulants used for?

A
  • prophylaxis in hip and knee replacement surgery
37
Q

What do the anti-coagulant drugs target?

A
  • formation of fibrin clot
38
Q

If pt comes in with a suspected stroke, an his ecg shows atrial fibrillation, what medication is he given?

A
  • anti-coagulants (to dissolve the FIBRIN-rich clot)

—-not given anti-platelets (unless ecg is -ve and the pt has HIGH BP/ is a smoker/ has DM/ high cholestrol)

39
Q

What does prolonged PT with normal APTT suggest?

A

Factor VII deficiency

40
Q

WHat does prolonged APTT with NORMAL PT suggest?

A

Factor VIII, IX, XI, XII

vWF (resp. to transport VIII)

HEMATOLOGY (20 decks)

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