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Apex Flashcards > anticoagulants > Flashcards

anticoagulants Flashcards

1
Q

heparin MOA and what pathways it inhibits

A

inhibits intrinsic and final common pathways. heparin binds to antithrombin and accelerates its anticoagulation ability 1,000 fold. also inhibits platelet function.

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2
Q

failed heparinization should prompt consideration of which deficiency

A

antithrombin deficiency

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3
Q

charge, solubility, vd of heparin

A

large, negatively charged, water soluble, and have small vd

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4
Q

how is heparin metabolized

A

via heparinase

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5
Q

2 pathways for heparin elimination

A

degradation by macrophages and renal excretion

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6
Q

does heparin cross the placenta

A

no

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7
Q

1u of heparin is defined as

A

volume of heparin containing solution that prevents 1mL of citrated sheep blood from clotting for 1h following addition of .2mL of 1:100 CaCl

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8
Q

standard amount of heparin administered for heart surgery

A

300-400u/kg

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9
Q

heparin dose for VTE prophylaxis

A

5000u SQ BID or TID

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10
Q

active VTE dose

A

5000U IV then infusion of ~1250U/h to maintain aPTT 1.5-2.5x normal

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11
Q

unstable angina and acute MI dose of heparin

A

5000U then 1000U/h infusion

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12
Q

side effects of protamine

A

HoTN r/t histamine release (give slowly), pHTN r/t TXA2 and serotonin release, allergic rx (esp with hx of previous sensitization to NPH insulin, fish allergy, vasectomy, multiple drug allergies

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13
Q

MOA of warfarin

A

inhibits enzume vitamin k epoxide reductase complex/ VKORc1 which is responsible for converting vitamin K to its active form.
indirectly blocks 2,7,9,10, protein c and protein s

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14
Q

antidotes of warfarin

A

vitk and FFP

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15
Q

how long after start of warfarin will therapeutic concentration be achieved?

A

36-72h

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16
Q

for minor procedures, how is it recommended to reverse warfarin

A

10-20mg vitk

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17
Q

for increased risk procedures, how is it recommended to reverse warfarin

A

1-2u FFP, recombinant factor 7a or prothrombin complex concentrate

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18
Q

risk factors for vitamin k deficiency include

A

poor diet intake, antibiotic therapy (decreases healthy flora for vitk absorption), malabsorption due to biliary tract disease, hepatocellulr disease

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19
Q

another name for exogenously administered vitk

A

phytonadione

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20
Q

how many hours does it take to restore vitk dependent clotting factors in the blood after vitk administration

A

4-8h

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21
Q

dosage of vitk

A

10-20mg PO IM or IV

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22
Q

which route should be avoided for vitk administration

A

IV r/t life threatening anaphylaxis

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23
Q

ADP receptor inhibitors include (4)

A

prasugrel, ticlodipine, clopidogrel, ticagrelor

24
Q

stop how long before procedure: clopidogrel

A

5-7d

25
Q

stop how long before procedure: ticlodipine

A

14d

26
Q

stop how long before procedure: prasugrel

A

7-10d

27
Q

stop how long before procedure: ticagrelor

A

5-7d

28
Q

GPIIb/IIIa receptor antagonists include

A

abciximab, eptifibatide, tirofiban

29
Q

stop how long before procedure: abciximab

A

3d

30
Q

stop how long before procedure: eptifibatide

A

1d

31
Q

stop how long before procedure: tirofiban

A

1d

32
Q

non specific cox inhibitors include

A

ASA, NSAIDS

33
Q

stop how long before procedure: ASA

A

7d

34
Q

stop how long before procedure: NSAIDS

A

1-2d

35
Q

COX2 inhibitors include

A

rofecoxib, celecoxib

36
Q

stop how long before procedure: COX2 inhibitors

A

n/a

37
Q

anti platelet classes include

A

ADP receptor inhibitors
GPIIb/IIIa antagonists, COX inhibitors, COX2 inibitors

38
Q

anticoagulant classes include

A

heparins (factor 2, 10a), thrombin inhibitors, factor 10 inhibitors, vitamin k antagonists

39
Q

examples of heparins include

A

unfractionated, LMWH, enoxaparin, dalteparin, tinzaparin

40
Q

stop how long before procedure: unfractionated heparin

A

6h

41
Q

stop how long before procedure: LMWH, enoxaparin, dalteparin, tinzaparin

A

1-2d

42
Q

thrombin inhibitor examples

A

argatroban, bivalrudin

43
Q

stop how long before procedure: argatroban

A

4-6h

44
Q

stop how long before procedure: bivalrudin

A

2-3h

45
Q

factor 10 inhibitor example

A

fondaparinux

46
Q

stop how long before procedure: fondaparinux

A

4d

47
Q

vitamin k antagonist example

A

warfarin

48
Q

stop how long before procedure: warfarin

A

2-4d

49
Q

fibrinolytic drug class examples

A

plasminogen activators

50
Q

plasminogen activator examples

A

tPA, streptokinase

51
Q

stop how long before procedure: tPA

A

1h

52
Q

stop how long before procedure: streptokinase

A

3h

53
Q

ACA MOA

A

plasminogen activation inhibitor

54
Q

TXA MOA

A

plasminogen activation inhibitor

55
Q

aprotonin MOA

A

decreases bleeding via inhibition of plasmin, kallikrein, thrombin, protein C

56
Q

DDAVP MOA

A

decreases bleeding via stimulation of factor 8 and vitamin K release

57
Q

protamine MOA

A

decreases bleeding via reversing effects of heparin

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