Anticoagulant Therapy

Question 1

List four types of Anticoagulant Therapy.

Answer 1

Standard unfractionated heparin (UFH)

Low molecular weight heparin (LMWH); Coumadin drugs, Thrombolytic agents (clot busters)

Question 2

Standard unfractionated (UFH): Mechanism of Action

Answer 2

Heparin by itself is NOT and anticoagulant

must complex with AT and AT is called the “heparin Co-factor”

Question 3

Standard unfractionated (UFH): indication for therapy

Answer 3

treatment of thrombosis to precent propagation

Question 4

Standard unfractionated (UFH): Administration

Answer 4

IV or subcutaneously (SQ)

Question 5

Standard unfractionated (UFH): Monitoring

Answer 5

APTT: (target for therapy, prophylaxis, daily plt counts to detect HIT)

Question 6

Standard unfractionated (UFH): Overdose

Answer 6

treat with protamine sulfate

Question 7

Low molecular weight heparin (LMWH): Mechanism of Action

Answer 7

Increases the inhibitor effect of AT on thrombin and Xa. Mainly Xa

Question 8

This is also known as Lovenox

Answer 8

Low molecular weight heparin (LMWH):

Question 9

Low molecular weight heparin (LMWH): administration

Answer 9

SQ

Question 10

Low molecular weight heparin (LMWH): Indication for therapy

Answer 10

Treatment of thrombosis to prevent propagation; not as commonly used but great for those needing to go home on heparin

Question 11

Low molecular weight heparin (LMWH): Monitoring

Answer 11

anti-Xa heparin assay (APTT is insensitive)

Question 12

Why is monitoring Low molecular weight heparin (LMWH) necessary?

Answer 12

For infants, children, obese or underweight patients, those with renal disease, or unexpected bleeding

Question 13

which brand is most common for long term anticoagulant therapy?

Answer 13

Coumadin

Question 14

Which brand is oldest brand name for long term anticoagulant therapy?

Answer 14

Warfarin

Question 15

Coumadin: Mechanism of Action

Answer 15

Coumadin blocks the action of vitamin K which si needed for the synthesis of the vitamin K dependent factors. There fore, slowing thrombin formation

Question 16

What are the Vitamin K dependent factors?

Answer 16

Prothrombin Group (II, VII, IX, X)

Question 17

Coumadin: Administration

Answer 17

Oral

Question 18

Coumadin: Delayed reaction or Immediate reaction?

Answer 18

Delayed reaction (3-5 days)

Question 19

Coumadin: Indication for therapy

Answer 19

Treatment of thrombosis to prevent propagation; prevention of thromboembolic disease in thrombophilia, mechanical heart valves, and high risk surgery.

Question 20

Coumadin: Monitoring

Answer 20

PT and INR

Question 21

Coumadin: Overdose

Answer 21

Treat by giving vitamin K and FFP if major bleeding

Question 22

Standard Unfractionated Heparin (UFH) has delayed or immediate reaction

Answer 22

Immediate reaction

Question 23

List sources of Vitamin K

Answer 23

Diet: green leafy vegetables, fish , and liver

Normal gut flora: E.coli, B.fragilis

Question 24

Three situations in which Vitamin K deficiency may occur.

Answer 24

Poor diet, long term antibiotic therapy, newborns

Question 25

Vitamin K makes the Prothrombin factors functional by___

Answer 25

By adding a 2nd carboxyl group on the gamma carbon. In Vita K deficiency or in the presence of a Vita K antagonist, these factors are released from the liver without the gamma-carboxylation rendering them nonfunctional

Question 26

Thrombolytic Agents (clot blusters): mechanism of action

Answer 26

Indiscriminately induce in vivo fibrinolysis by activating plasminogen to plasmin; not only get rid of bad clots but good clots too

Question 27

Types of Thrombolytic agents

Answer 27

Tissue plasminogen activator (TPA), streptokinase, urokinase

Question 28

Why is TPA considered the best/safest clot bluster?

Answer 28

because it will NOT activate circulating (free) plasminogen ..only fibrin bound

Question 29

The use of Therapeutic drug TPA

Answer 29

Life threatening thromboses

Must be given within 4-6 hours of onset