anticoagulants

Question 1

Heparin:

Answer 1

targets X and II, complete antidote effect. Cleared via RES. AA: resistance, thrombocytopenia. Wait til after thrombo is fixed before giving it like warfarin.

Question 2

LMWH:

Answer 2

factors X if small, II if bigger, Partial antidote effect, renal excretion.

Question 3

Fondaparinux:

Answer 3

Synthetic, factor X only. Smallest. Renally excreted, no antidote effect. Not for pst <50kg.

Question 4

anticoag antidote

Answer 4

Protamine sulfate: chemical antagonism, rapid af. Forms stable ion pair and eliminated via RES.

Question 5

Xabans:

Answer 5

Factor Xa inhibitors: blocking thrombin generation, AA bleeding. ANTIDOTE: andexanet alfa(decoy). LOWER rate of intracranial bleeding. Substrate for p-glycoprotein. For Afib, DVT, PE. Riva nd apix for prophylaxis hip or knee sx. Not good for pets with heart valves.

Question 6

Edoxaban:

Answer 6

kidney excretion

Question 7

Dabigatran:

Answer 7

prodrug, competitive inhibitor of thrombin, 80% eliminated in urine, p-glycoprotein substrate. No mechanical heart valves. AA: bleeding, Gi bleeding

Question 8

Hirudin:

Answer 8

thrombin inhib.

peptide, so autoantibodies can occur to make shit ineffective. Short acting and fast

Question 9

Bivalirudin:

Answer 9

also a peptide, for HIT patients that need coronary intervention.
thrombin inhib

Question 10

Argatroban

Answer 10

liver metabolism, prolings INR, complicated transition to warfarin.

Question 11

Vitamin K Reductase and Quinone reductase Inhibitor: warfarin

Answer 11

DVT, PE, afib, godo for mechanical heart valves
Warfarin: no effect on fully carboxylated coagulation factors, so must be cleared prior to making an effect. Can take 4-5 days. Hep to warfarin bridging is important for thrombosis risk patients due to this. MUST MEASURE INR, can cause birth defects. Fuck ton fo interactiosn know them by now
Antidote: vitamin K analog injection.

Question 12

Fibrinolytic drugs:

Answer 12

help dissolve clots via plasminogen factor (t-PA). Clot MUST be formed before drugs can work (besides streptokinase)
Alteplase, reteplase
Streptokinase: no enzymatic activity, forms a complex with plasminogen, not selective.
Anistreplase

Question 13

Fibrinolytic reversal agents:

Answer 13

blocks interaction between plasmin and fibrin. Be Careful with pts who have hematuria because it can cause ureteral obstructions.
Epsilon-aminocaproic acid
Tranexamic acid