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A13THP @ UoN > Anticoagulants > Flashcards

Anticoagulants Flashcards

1
Q

Define Anticoagulants

A

Drugs used to prevent coagulation

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2
Q

What are the two main types of anticoagulants?

A

Injectable anticoagulants ie. Heparins

Oral anticoagulants ie. Warfarin

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3
Q

What are the two main types of heparins?

A

Unfractionated Heparin

Low Molecular Weight Heparins (Enoxaparin, Tinzaparin)

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4
Q

How do heparins work?

A

Activate Antithrombin III

AIII inactivates clotting factors/thrombin by complexing w/ serine protease of the factors

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5
Q

When should heparin be used?

A

Immediate action
Used while Warfarin takes effect
Used to prevent thrombosis/clotting on collecting

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6
Q

What marker should be monitored during the use of unfractionated heparins?

A

Activated Partial Thromboplastin Time (APTT)

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7
Q

Which pathway does APTT examine?

A

Intrinsic pathway

Altered by changes in F XII, XI, IX, VIII, X, V, II, I

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8
Q

Do LMWHs require monitoring?

A

No

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9
Q

What effect does treatment with heparin have on platelets?

A

> 5 days heparin can lead to thrombocytopenia

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10
Q

Define DVTs

A

Deep Vein Thrombosis

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11
Q

What is a major secondary risk of DVTs

A

Pulmonary Embolism

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12
Q

What is a major cause of DVTs

A

Immobility in hospital

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13
Q

What are the signs/symptoms of DVTs?

A

Painful swelling in calf

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14
Q

What is diagnosis of DVT based on?

A

Ultrasound scan

D-dimer blood test

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15
Q

What are D-dimers?

A

Product of fibrinolysis raised in thrombosis

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16
Q

What are the risk factors for DVT/PE?

A 
Surgery
Pregnancy
Oestrogens
Malignancy
MI/Heart Failure
Obesity
Age >40
Coagulation Disorders
Immobility
History of VTE
Trauma
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17
Q

What is the regular drug treatment for DVTs in hospital?

A

Enoxaparin s.c.

18
Q

How does Warfarin work?

A

Vitamin k antagonist (blocks Vit. K reductase)

Vit K essential for prothrombin AND F X, IX, VI (1972) production

19
Q

When is Warfarin used?

A

Patients w/ replaced heart valves
Atrial Fibrillation
DVT/PE

20
Q

What are the problems with using Warfarin?

A

Many drug interactions
Narrow therapeutic window
Several days to act

21
Q

What is the INR?

A

International Normalised Ratio
Measure of clotting time based on prothrombin time
Ideally I

22
Q

What is the Prothrombin Time?

A

Time for coagulation following addition of thromboplastin

23
Q

What abnormalities prolong the Prothrombin Time?

A

Abnormalities of F VII, X, V, II, I
Liver Disease
Warfarin

24
Q

What is the effect of increased Warfarin action?

A

Bleeding:

  • Gastric
  • Cererbral
  • Haemoptysis
  • Blood in faeces
  • Blood in urine
  • Easy bruising
25
Q

How should Warfarin dosing/monitoring take place?

A

INR frequently monitored at start (2/wk) then increase interval (max 12 wks)

26
Q

How can Warfarin dosing be reversed?

A

Vitamin K

27
Q

When should Warfarin dosing be reversed?

A

Patient is bleeding
Very high INR (>8-10)
Warfarin overdose

28
Q

How should patients be counselled about taking Warfarin?

A 
Stick to regimen
Take at 6 pm
If dose missed DON'T take two, inform Dr
Don't take when pregnant
Consume alcohol in moderation
29
Q

What dietary modifications should be made when treated with Warfarin?

A

Avoid excessive green vegetables

Avoid high levels of Vit K

30
Q

What symptoms should patients be aware of and notify their doctors over?

A 
Haemoptysis
Blood in faeces
Blood in urine
Nose bleeds (>20-30 mins)
Easy bruising
Skin changes (necrosis)
Diarrhoea/Vomiting >2days
31
Q

What factors affect anticoagulant treatment in pregnant women?

A

Pregnancy produces thrombophilic state to prevent post partum haemmorhage
Thrombophilia - decreased venous return (gravid uterus/immobility)

32
Q

Why should Wafarin be avoided in pregnant women?

A

Teratogenic (Chondroplasia punctata, optic atrophy, mental retardation)
Avoid in T1/3
Favour LMWHs

33
Q

What is Dabigatran?

A

Oral thombin inhibitor

34
Q

What are the benefits of Dabigatran over Warfarin?

A

Less bleeding
Fewer interactions
Does not require monitoring
EQUALLY EFFECTIVE

35
Q

What is Rivaroxaban?

A

Oral inhibitor of activated F X

36
Q

What is Dipyridamole?

A

Antiplatelet drug

Phosphodiesterase inhibitor

37
Q

How does Dipyridamole work?

A

Phosphodiesterase inhibitor
Prevents cAMP/cGMP breakdown
Inhibits aggregation

38
Q

What is Streptokinase?

A

Thrombolytic medication

Fibrinolysis

39
Q

How does Streptokinase work?

A

Activates endogenous fibrinolysis system

40
Q

When is Streptokinase used?

A

Breakdown clots immediately after MI

A13THP @ UoN (19 decks)

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