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Haematology > Anticoagulants > Flashcards

Anticoagulants Flashcards

1
Q

What are the common indications for anticoagulation?

A

venous thrombosis; atrial fibrillation

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2
Q

How are protein C and S activated?

A

by thrombin bound to thrombomodulin

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3
Q

What is the mechanism of heparin?

A

potentiates antithrombin by stabilising anti-thrombin:protein complex

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4
Q

how is heparin administered?

A

parenteral (IV/SC)

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5
Q

What are the 2 forms of heparin?

A

unfractionated and LMWH

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6
Q

What are the mechanisms of anti-thrombin?

A

inhibts fibrinogen–fibrin and amplification steps

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7
Q

What protein is bound to anti-thrombin in the complex that unfractionated heparin works on?

A

thrombin

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8
Q

What is the protein bound to anti-thrombin that LMWH works on?

A

Xa

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9
Q

How is unfractionated heparin monitored?

A

APTT

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10
Q

How is LMWH monitored?

A

anti-Xa assayu

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11
Q

What is the aim for the change to APTT in heparin?

A

1.5-2x normal

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12
Q

Why is monitoring of LMWH not required?

A

much more predictive dosing- based on weight, whereas unfractionated isn’t so predictable

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13
Q

What are the complications of heparin thepray?

A

bleeding; heparin induced thrombocytopenia (with thrombosis); osteoporosis

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14
Q

What bloods should be monitored in patients on heparin?

A

FBC

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15
Q

What causes heparin induced thrombocytopenia?

A

develop antibody to platelet factor IV which causes platelets to stick together

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16
Q

Which form of heparin is HITT more likely in?

A

unfractionated

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17
Q

What is the anti-dote to heparin?

A

protamine sulphate

18
Q

Give two examples of coumarin anticoagulants?

A

warfarin; phenindione

19
Q

What is the mechanism of coumarin anticoagulants?

A

inhibition of vitamin K

20
Q

What are the vitamin k dependent factors?

A

II; VII; IX and X; protein C and S

21
Q

What is the function of the carboxylation by vitamin K?

A

need second carboxyl group to makr chemical bond strong enough

22
Q

How is warfarin metabolised?

A

cytochrome P450

23
Q

How should warfarin be taken?

A

at same time every day (6pm recommended)

24
Q

Why does warfarin therapy need to be monitored?

A

narrow therapeutic window

25
Q

What is the equation for INR?

A

(patients PT/mean normal PT)^ISI

26
Q

What is the ISI?

A

callibration factors as thromboplastin can be different across labs

27
Q

What is generalyl the target INR?

A

2-3

28
Q

What are the factors that influence bleeding risk on warfarin?

A

intensity of anticoagulation; comrobidities; drug interactions

29
Q

What should be done with a patient on warfarin if any other medications are changed?

A

check INR

30
Q

What is the mnemonic for drugs that potentiate warfarin?

A

O! DEVICES

31
Q

What does O! dEVICES stand for?

A 
Omeprazole
Disulfriam
Erythromycin
Valproate
Isoniazide
Ciprfloxacin and cimetidine
Ethanol (acute)
Sulphonamides
32
Q

What is the mnemonic for drugs that inhibt warfarin?

A

PC BRAS

33
Q

What does PC BRAS stand for

?

A 
Phenytoin
Carbamazepine
Barbiturates 
Rifampicin
Alcohol (chronic)
Sulfonylureas
34
Q

How long does vitamin K take to work?

A

6 hours

35
Q

How long does a clotting factor transfusion take to work?

A

immediate

36
Q

What is the main new thrombin inhibitor?

A

dabigatram

37
Q

What is the difference between the new and old anticoagulants?

A

new agents bind directly to the coagulation factors

38
Q

What new agents are Xa inhibitors?

A

rivaroxaban; apixaban

39
Q

What are the benefits of the new anticoagulation agents?

A

oral and no monitoring; less interactions

40
Q

What is the con of the new anticoagulants?

A

no specfic antidote

Haematology (29 decks)

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