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Pharm Exam 5 > Anticoag's > Flashcards

Anticoag's Flashcards

1
Q

take home points for coag cascade 1

A

coag factors are enzymes
each step amplifies the initial signal
made in the liver

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2
Q

take home points for coag cascade 2

A

final pathway results in prothrombin –> thrombin which catalyzes the conversion of fibrinogen –> fibrin
fibrin activates the fibrinolytic system (plasmin and t-PA)

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3
Q

vitamin K dependent factors

A

II, VII, IX and X

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4
Q

homeostasis is maintained by the balance of:

A 
procoagulants 
endogenous anticoags (protein C&S important for warfarin dosing and antithrombin III important for heparin dosing)
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5
Q

fibrinolytic system

A

degrades fibrin

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6
Q

fibrinolytic system results in:

A

fibrin split pdts (FSP), fibrin depredation pdts (FDPs), fibrin Dimers (D-Dimer)
inc levels suggest presence of thrombin (think DVT!)

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7
Q

venous thrombi

A 
DVT
"red thrombus"
AKA: venous stasis thrombi
VTE 
complications: PE
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8
Q

arterial thrombi

A

platelet driven
“white thrombus”
complications: stroke, MI

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9
Q

thrombi RF’s

A

sx, CA, immobility, varicose veins and preg

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10
Q

potential complication of anticoag’s

A

BLEEDING, not an allergy!! extension of MOA

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11
Q

Heparin MOA

A

binds to antithrombin III

binding requires specific pentasaccharide sequence

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12
Q

Heparin limitations

A

directly activates platelets –>
HIT (true allergy!)
inc dose does not cause linear response
can only bind thrombin that is free in circulation (so doesn’t tx initial clot, prevents further clots)

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13
Q

Unfractionated Heparin

A

heterogeneous mix of sulfated glycosaminoglycans
only ~1/3 of molecules have the pentasaccharide
only effective on soluble fibrin (not clot-bound fibrin)
prevents the grow/propagation of the thrombus

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14
Q

Unfractionated Heparin cont

A

UFH-antithrombin complex is 100-1000 x > anticoagulant than antithrombin alone
allows the pt’s fibrinolytic system to degrade the clot
measured by aPTT

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15
Q

`Adv of UFH

A

immediate anticoag
effects reversed by protamine
may be given subQ for prophylaxis
usually done by PDS

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16
Q

Disadv of UFH

A

non-linear kinetics
frequent lab test required
minimal effect on interior of clot

17
Q

HIT - I (non immune)

A

okay, occurs in more pt’s than II
transient due to clumping of platelets (actually artifact, platelet value lower than what it actually is)
happens immediately
do manual platelet count

18
Q

HIT - II (immune)

A

very bad
seen after 5-10 days of heparin
platelet count falls > 50% from baseline
immune mediated by anti platelet factor 4 (test for PF4)

19
Q

Low molecular weight Heparin

A

more favorable benefit/risk ratio

more predictable dose response

20
Q

LMWH adv

A 
no IV access required
no routine testing required
pre-filled syringes
dec monitoring costs
less risk of HIT
may be less costly overall
21
Q

LMWH disadv

A 
require subQ route
testing requires anti-Xa (not routinely available)
requires dose-rounding
inc unit coses
no reversal by protamine if overdose
22
Q

Warfarin/Vit K Antagonist MOA

A

inhibits post-translational carboxylation of coag factors II (prothrombin), VII, IX and X
inhibits 2 vit-K sensitive synthetic enzymes

23
Q

warfarin drug-drug interactions

A

drugs that inhibit CYP2C9 increase INR and risk of bleeding –> Bactrim, flagyl
drugs that induce CYP2C9 decrease INR and inc the risk of thrombosis –> contraceptives

24
Q

sources of high dietary folate

A

beef, pork liver, green teas, leafy green veggies, spinach

25
Q

anti platelet drugs

A

glycoprotein IIb/IIIa inhibitors
ADP rec antagonists
others

26
Q

Prasugrel

A

ADP/P2Y12 antagonist
more effective than clopidogrel or ticlopidine
less inhibition by PPIs

27
Q

Aspirin

A

platelet antagonist
inhibits platelet aggregation by acetylation of ADP rec
acetylation lasts the life of the platelet
benefits are weighed against adverse effects: GI bleed and tinnitus (minimal at low doses)
chew 2-4 low dose (not baby!!)

28
Q

Dipyridamole

A

platelet antagonist
platelet aggregation inhibitor and vasodilator
dx agent in CAD (persantine stress test) - frequent use

29
Q

Alteplase

A

tPA
used for lysis of coronary artery thrombi in acute MI
management of ischemic stroke (more common)
lysis of occluded ports and catheters

30
Q

other tx of immune mediated HIT

A

danaparoid and lepirudin

31
Q

complications of warfarin

A

start at 10 mg daily

warfarin-induced skin necrosis

32
Q

bivalent DTIs

A

lepirudin, bivalrudin and desirudin

can be used in pt with hx of HIT-II

33
Q

univalent DTIs

A

argatroban and dabigatran

can be used in pt with hx of HIT-II

34
Q

andexanet alfa

A

factor Xa reversal agent
“decoy protein”
corrects apixaban, rivaroxaben, edoxaban, enoxaparin or fondaparinux

Pharm Exam 5 (3 decks)

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