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Advanced Clinical Procedures > Anticoagulants and Antiplatelets > Flashcards

Anticoagulants and Antiplatelets Flashcards

1
Q

Know the factors common to both the intrinsic and extrinsic pathways of coagulation.

A

X, V, II (prothrombin: activated to IIa: thrombin), I (fibrinogen; activated to Ia: fibrin)

Four dependent on Vit K: II, VII, IX, X

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2
Q

Heparin effects what part of the clotting cascade?

A

Main therapeutic affect on factors Xa and IIa

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3
Q

How is heparin monitored?

A

Monitor anticoagulant effects via aPTT, anti-factor Xa assay, or heparin levels

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4
Q

What are the Indications for Heparin?

A

PE and DVT treatment and prophylaxis

ACS – use depends on NSTEMI vs. STEMI and management strategy (PCI vs. medical); dosing protocols

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5
Q

Side effects of Heparin:

A

Heparin induced thrombocytopenia can occur (HIT)

Long-term use may increase risk for osteoporosis

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6
Q

Heparin is completely reversed by _________.

A

protamine sulfate

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7
Q

T/F: Heparin does not require continual monitoring.

A

False, Inconsistent effects require monitoring

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8
Q

_________ is the Anticoagulant of choice in severe renal dysfunction.

A

Heparin

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9
Q

How is Heparin eliminated?

A

Eliminated via Reticuloendothelial system, not by kidneys

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10
Q

How do we monitor Warfarin and what is the goal?

A

Monitor with INR; Normal: 0.9 – 1.1, goal: 2-3 (mitral valve replacement, 2.5-3.5)

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11
Q

What are the indications for warfarin?

A

DVT, PE, antiphospholipid syndrome, atrial fibrillation, protein C/S deficiency, mechanical valve replacement, etc.

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12
Q

Pearls of Warfarin:

A

Holding a dose often reduces INR by 0.5 – 1 point

Efficacious, cheap, old and known, no renal adjustments

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13
Q

How long does it take for the therapeutic effects of warfarin? What is the adjustment based on?

A

Therapeutic effects take 2-3 days to start, 5-7 days for full effects. Loading only minimally effective. Adjust based on total weekly dose (TWD) by 10-20%. Monitor INR weekly until stable and then increase interval.

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14
Q

What is the antidote of warfarin?

A

“Antidote” is vitamin K. PCC, FFP, platelets also given in cases of bleeding.

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15
Q

Warfarin has ___________ benefits.

A

Cardioprotective benefits

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16
Q

What is Dabigatran (Pradaxa)

A

Direct thrombin (IIa) inhibitor (ANTI-PLATELET).

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17
Q

How does dabigatran work?

A

Orally active; inhibits free and clot-bound thrombin

18
Q

What is the half life of dabigatran adn where is it eliminated?

A
  • T ½ 12-14 hours

* 80% renal elimination

19
Q

What are the indications for dabigatron?

A

Stroke and systemic embolism in AF

DVT/PE treatment and prophylaxis

20
Q

How is dabigatran dosed?

A

Warfaring -> Dabigatran: start dabigatran when INR < 2

21
Q

What are the pearls of dabigatran?

A

More effective for AF vs. warfarin; as effective in DVT/PE

Limited drug and no food interactions

No antidote or reliable way to stop/reverse bleeding

No way to monitor degree of anticoagulation

22
Q

Dabigatran is toxic to ________.

A

the heart

23
Q

Monitoring is required for which anticoag?

A

heparin

24
Q

What is an example of a LMWH?

A

Lovenox

25
Q

Is monitoring required for LMWH?

A

no

26
Q

What determines dosing for LMWH?

A

weight based dosing

27
Q

What are the indications for LMWH?

A

PE and DVT treatment and prophylaxis

ACS – use depends on NSTEMI vs. STEMI and management strategy (PCI vs. medical); dosing protocols

28
Q

What drug can be used for patients with HIT?

A

arixtra

29
Q

What part of the clotting cascade do direct thrombin inhibitors function at?

A

factor IIa (thrombin), IV only

30
Q

Why dont we use more direct thrombin inhibitors?

A

they are expensive

31
Q

What does warfarin interact with?

A

Diet – vitamin K containing foods. Ok to consume, just have to maintain consistent intake

Medications:
o CYP: 2C9&raquo_space; 3A4 inhibitors and inducers– Amiodarone
o Antibiotics: Septra, metronidazole

32
Q

What does CHADS2 score stand for?

A

CHF, HTN, Age (>75), DM, Stroke (2 points)

33
Q

What determines the treatment for a fib?

A

chads2 score

34
Q

what is the treatment for chads 1 score?

A

anticoag or ASA + plavix

35
Q

what is the treatment for chads 2 score?

A

anticoag or ASA + plavix

36
Q

What is the mechanism of action for asprin?

A

COX-1 inhibitor to prevent formation of TXA 2. Vasoconstriction, platelet aggrigation.

37
Q

T/F: low doses of ASA are as efficacious as higher doses

A

true

38
Q

What is the mechanism of action of clopidogrel?

A

irreversible inhibition of P@Y12 receptor, reduces platelet aggrigation.

39
Q

What is an indication for clopidogrel?

A

ACS

40
Q

What antiplatelets are used in orthopedic surgeries?

A

rivaroxaban (xarelto) and apixaban

41
Q

How is xarelto taken?

A

once daily dose, must take with meals

42
Q

When is prasugrel used?

A

in ACS patients with DM

Advanced Clinical Procedures (18 decks)

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