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Therapeutics 2 - Exam 4 > anticoagulant > Flashcards

anticoagulant Flashcards

hockerman

1
Q

what are the anti-coagulants that cleave factors Va and VIIIa to inactivate them?

A

protein C

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1
Q

what are the pro-coagulants that cleave down-stream factors to activate them?

A

XII, XI, X, IX, VII, II
12, 11, 10, 9, 7, 2

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2
Q

what are the cofactors that activate proteases?

A

VIII, V, III (Tissue factor), protein S
8, 5, 3

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3
Q

what factor bings to and inhibits thrombin?

A

anti-thrombin III

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4
Q

what is the function of fibrinogen?

A

substrate protein for factor IIa (thrombin) that polymerizes to form a clot

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5
Q

how does the liver affect coagulation?

A

all clotting factors beside vWF is made in the liver
liver disease can unpredictable effects as a result

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6
Q

when does convergence occur with the intrinsic pathway?

A

factor IXa binds to factor VIIIa on the surface of platelets and activates factor X

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7
Q

what does thrombin do?

A

activates factor V and VIII
enhances platelet activation
increases coag

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8
Q

what does antithrombin do?

A

neutralizes procoagulant serine proteases
reaction is accelerated by heparin
decreases coag

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9
Q

what does the protein c system do?

A

activate by thrombin binding to thrombomodulin
decreases coag

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10
Q

what does factor Xa do?

A

activates tissue factor pathway inhibitor (TFPI) to block initial activations of factor VII
decrease coag

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11
Q

what are common hemostatic function tests?

A

platelet count
prothrombin (PT/INR)
aPTT
fibrinogen
D-dimer

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12
Q

what does too low platelet count signal?

A

thrombocytopenia
bone marrow malfunction, nutritional deficiency

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13
Q

what is too high platelet count called?

A

thrombocytosis

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14
Q

what does prothrombin time measure?

A

time is takes to clot

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15
Q

what is a fibrinogen test?

A

less common test of hemostatic function
ranges from 200-400 mg/dL

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16
Q

what is a D-dimer test?

A

measures the product of fibrin breakdown

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17
Q

what is a DIC panel?

A

assortment of test in a coagulation profile

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18
Q

what does aPPT monitor?

A

heparin therapy

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19
Q

what is the average prothrombin time?

A

12-14 seconds

20
Q

what is the average aPPT?

A

26-33 seconds

21
Q

what is a normal INR?

A

0.8 to 1.2

22
Q

what is the therapeutic INR?

A

2 to 3
>3 risk of hemorrhage

23
Q

how is UFH administered?

A

via IV
effective immediately
adjust dosing according to coagulation test (aPPT)

24
Q

what is protamine sulfate?

A

polycationic protein that is the reversal agent of heparin
binds tightly to heparin to neutralize the anticoagulant action

25
Q

what are some adverse effects of heparin?

A

thrombocytopenia (HIT/HAT)
osteoporosis
iatrogenic hemorrhage

26
Q

what is required for heparin to bind to antithrombin?

A

sulfate groups that have a negative charge

27
Q

what produces straight chain sulfated mucopolysaccharides?

A

mast cells and basophils

28
Q

where is heparin extracted from?

A

porcine small intestine or bovine lung

29
Q

what advantages of LMWH?

A

more predictable pharmacokinetic profile
lower incidence of thrombocytopenia and osteoporosis

30
Q

how is LMWH administered?

A

SQ injection site
longer half life than UFH

31
Q

what type of heparin requires monitoring?

A

UFH
if monitoring is needed for LMWH, it requires an anti-factor Xa level

32
Q

what is fondaparinux sodium?

A

synthetic sulfated pentasaccharide that has a half life of 17-21 hours

33
Q

what is fondaparinux used for?

A

VTE
prophylaxis in patients undergoing hip fracture surgery, hip replacement, knee replacement, or abdominal surgery

34
Q

is fondaparinux able to be reversed by protamine sulfate?

A

no
it also has a low potential for thrombocytopenia

35
Q

what is the indication for rivaroxaban and apixaban?

A

treatment and prevention of VT and PE
prevention of thrombosis in NV afib

36
Q

what is edoxaban indicated for?

A

treatment of VT and PE after 5 to 10 days with parenteral anticoag
prevention of thrombosis in NV afib

37
Q

what is an important note about edoxaban?

A

it cannot be used in patients with a CrCl above 95 mL/min
will easily be excreted then

38
Q

what is the indication for betrixaban (bevyxxa)?

A

prevention of VTE in hospitalized patients at risk for VTE

39
Q

what is andexanet?

A

the reversal agent for apixaban and rivaroxaban
under investigational use with edoxaban and enoxaparin

40
Q

what is the blacked boxed warning for andexanet?

A

increased risk for thromboembolic events

41
Q

what is the mechanism of DTIs?

A

bind to the active site of thrombin, to exosites of thrombin, or both
inhibit both soluble and fibrin-bound thrombin

42
Q

how non-heparinoid parenteral agents function?

A

do not act through antithrombin-III
inhibit free thrombin and fibrin-bound thrombin instead

43
Q

what is lepirudin’s MOA?

A

irreversible inhibition of thrombin

44
Q

what does lepirudin treat?

A

given via IV to treat HIT

45
Q

for bivalirudin, what amino acids bind to the catalytic site?

A

Phe-Pro-Arg-Pro

46
Q

what is argatroban derived from?

A

L-argine

47
Q

what is dabigatran indicated for?

A

prevention of stroke and systemic embolism in pts with nonvalvular afib

48
Q

what is the reversal agent for dabigatran?

A

idarucizumab (praxbind) –> humanized IgG1 FAB fragment

Therapeutics 2 - Exam 4 (9 decks)

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