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CV II Exam 2 > Anti-Coagulants I > Flashcards

Anti-Coagulants I Flashcards

1
Q

warfarin

A

given oral only
-inhibit K dependent factors
II, VII, IX, X, protein C and S

without the two carboxy residues - cannot bind calcium or phospholipid

inhibits vitamin K epoxide reductase

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2
Q

heparin

A

only IV or subQ
-aka unfractionated

activates antithrombin III
-inactivates IIa, IXa, Xa, XIa, XIIa

prolongs aPTT and thrombin time

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3
Q

low MW heparin

A

give subQ
-prophylaxis/treatment of MI, DVT, PE

acts only on Xa
-no binding site for IIa

longer half life than heparin
no monitoring required
less protein binding than heparin
no endo cell binding
no dose-dependent clearance
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4
Q

fondaparinux

A

factor Xa inhibitor

  • subQ injection
  • analog of heparin
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5
Q

dabigatran

A

oral anticoag

  • binds to thrombin
  • inhibits clot-bound and circulating thrombin
  • rapid onset

Re-ly and Re-cover trials - non-inferior and similar safety to warfarin**

no monitoring required

no antidote
expensive

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6
Q

aspirin

A

inhibits TXA2 formation (blocks COX-1)
-inhibits platelet aggregation

for prophylaxis tx of MI, stroke, and PAD

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7
Q

clopidogrel

A

blocks P2Y12 - ADP receptor on platelets - IRREVERSIBLE
-no aggregation

inactive prodrug

prophylaxis of stroke, MI, PAD, acute coronary syndrome

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8
Q

dipyridamole

A

blocks platelet aggreagation
-inhibits adenosine uptake and is cAMP phosphodiesterase inhibitor

prophylaxis of arterial thromboembolism

prosthetics and bypass grafts

angioplasty phophylaxis

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9
Q

abciximab

A

monoclonal antibody for GpIIbIIIa complex

-no platelet aggregation

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10
Q

aletplase

A

plasminogen activator

acute MI

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11
Q

reteplase

A

plasminogen activator

acute MI

diffuses through clot more freely

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12
Q

tenecteplase

A

plasminogen activator

single bolus given over 5-10sec

acute MI

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13
Q

streptokinase

A

non-enzyme plasminogen activator

acute MI

from beta hemolytic strep

  • many have antibodies
  • must saturate with loading dose
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14
Q

5HT

A

serotonin

-activator of platelet aggregation

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15
Q

PGI2

A

prostacyclin

-inhibitor of platelet aggregation

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16
Q

arterial thrombus

A

white clot

  • not many RBCs - sheared off
  • high blood flow
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17
Q

venous thrombus

A

red clot

  • lots of RBCs - stasis
  • can be very long tali
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18
Q

enoxaparin

A

low MW heparin

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19
Q

heparin monitoring

A

aPTT 1.5 - 2.5x control

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20
Q

warfarin monitoring

A

PT - normalized with INR

2-3

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21
Q

subQ minidose of heparin

A

post-surgery prophylaxis

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22
Q

low MW heparin monitoring

A

not necessary

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23
Q

rivaroxaban

A

oral anticoag
inhibits factor Xa

no monitoring
no antidote
expensive

24
Q

apixaban

A

oral anticoag
inhibit factor Xa

no monitoring
no antidote
expensive

25
Q

eptifibatide

A

blocks fibrinogen binding to GpIIbIIIa

26
Q

tirofiban

A

blocks fibrinogen binding to GpIIbIIIa

27
Q

lepirudin

A

binds thrombin

28
Q

bivalirudin

A

binds to thrombin

29
Q

argatroban

A

binds to thrombin

Tx for HIT

30
Q

rapid anticoag

A

heparin
low MW heparin
fondaparinux

31
Q

slow anticoag

A

warfarin

32
Q

heparin

A

antithrombin III activation

most important - effect on IIa and Xa inhibition

33
Q

HIT

A

heparin induce thrombocytopenia

type II - severe - antibodies against platelet factor 4

34
Q

Tx of acute MI

A

aspirin therapy, O2, nitro, morphine

then thrombolytics/ procedure

then IV heparin

35
Q

DIC

A

Tx heparin

36
Q

heparin antidote

A

protamine sulfate

  • strongly basic protein
  • given IV - binds up heparin

need to give slow

37
Q

surgery of abdomen, hip, knee

A

prophylaxis for DVT - enoxaparin

38
Q

Q wave MI

A

enoxaparin with asprin

39
Q

acute DVT

A

enoxaparin with warfarin

40
Q

IV direct thrombin inhibitors

A

IV only

hirudin, lepirudin, bivalirudin, argatroban

41
Q

vit K epoxide reductase

A

inhibited by warfarin

42
Q

t-1/2 for warfarin

A

40 hours

5 half lifes for plateau

43
Q

contraindicated in pregant

A

warfarin - congenital anomalies

44
Q

warfarin overdose

A

treatment with vit K1

infusion of fresh-frozen plasma

45
Q

oral direct thrombin inhibitors

A

dabigatran
rivaroxaban
apixaban

for prevention of thromboembolic stroke, PE, DVT

46
Q

high dose of aspirin

A

COX-2 blocker
-prostacyclin blocked

prostacyclin is an inhibitor of platelet aggregation and vasodilator

47
Q

aspirin and acute MI

A

loading dose - 162mg

continue 160mg daily for 30 days

48
Q

antiplatelet effect of aspirin

A

80mg daily

49
Q

ticlopidine

A

inhibits ADP receptor on platelets

can cause TTP, aplastic anemia, agranulocytosis

50
Q

cilostazol

A

inhibit phosphodiesterase III

  • results in increased cyclic AMP
  • and decreased platelet aggreagation
  • also stimulates vasodilation

Tx of intermittent claudication

51
Q

pentoxifylline

A

decrease blood viscosity
improve erythrocyte felxibility

for intermittent claudication

52
Q

normal platelet levels

A

130,000 - 400,000

53
Q

aPTT

A

for intrinsic pathway

monitor unfractionated heparin

54
Q

PT

A

measure extrinsic factors

monitor warfarin - normalized to INR

55
Q

thrombin time

A

no Ca added

-clotting time independent on thrombin formation

56
Q

warfarin drug interactions

A

INCREASE WARFARIN RESPONSE
inhibit hepatic metabolism
displacement from plasma binding sites
interfere with vit K

DECREASE WARFARIN RESPONSE
induce enzymes for warfarin metabolism
-reduced absorption, increased synthesis of clotting factors, hemoconcenration of clotting factors

CV II Exam 2 (18 decks)

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