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Medication Review > Anticoagulants and Thrombolytics > Flashcards

Anticoagulants and Thrombolytics Flashcards

1
Q

What monitoring tool is used to assess function of Unfractionated Heparin?

A

PTT = Partial Thromboplastin Time

  • INTRINSIC pathway
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2
Q

How does Unfractionated Heparin work?

A

binds Antithrombin III –> which IRREVERSIBLY inhibits Thrombin (Factor II) and Factor Xa

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3
Q

What is the difference in administration of Unfractionated Heparin for acute vs prophylactic treatment?

A

Acute? = Intravenous

PPx? = Subcutaneous (q10-12 hr)

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4
Q

What is HIT?

A

Heparin-induced Thrombocytopenia

  • immune system generates antibodies against heparin-platelet factor 4
  • paradoxical thrombosis in the setting of thrombocytopenia
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5
Q

What are 3 major adverse effects of Unfractionated Heparin use?

A
  1. Heparin-induced Thrombocytopenia (HIT)
  2. Osteoporosis
  3. HYPOaldosteronism (HYPERkalemia –> RTA Type 4)
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6
Q

What is the reversal agent of Unfractionated Heparin and how does it work?

A

Protamine Sulfate

  • positive charge binds to the negative charge of heparin, inactivating it
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7
Q

How does Low Molecular Weight Heparin (LMWH) work?

A

binds to Antithrombin III –> inhibits Factor Xa but has LESS EFFECT on Thrombin (Factor II)

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8
Q

Is Low Molecular Weight Heparin longer-acting or shorter-acting?

What medical condition effects the half-life of LMWH?

A

longer-acting = has prolonged half-life

RENAL INSUFFICIENCY increases the 1/2 life of LMWH

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9
Q

How is Unfractionated Heparin cleared vs LMWH?

A

Unfractionated Heparin? = processed by LIVER

LMWH? = processed by KIDNEYS

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10
Q

Which anticoagulant would be better for a patient with liver disease?

A

LMWH

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11
Q

Which anticoagulant would be better for a patient with kidney disease?

A

Unfractionated Heparin

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12
Q

Are heparin products safe for pregnancy?

A

YES!! –> LMWH better than Unfractionated Heparin though

  • easier to monitor, less side effects, more predictable
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13
Q

How does Fondaparinux work?

A

binds to Antithrombin III –> inhibits Xa more than Thrombin (Factor II)

  • binds with more specificity than LMWH
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14
Q

What are the 3 heparin-based medications used for anticoagulation?

Rank them in order of descending size.

A

Unfractionated Heparin, LMWH, Fondaparinux

heparin > LMWH > Fondaparinux

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15
Q

Which heparin product has the LOWEST risk of HIT?

A

Fondaparinux

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16
Q

What are the 3 main Direct Thrombin Inhibitors and when are they classically used?

A

Bivalirudin, Argatroban, Dabigatran

  • used in the setting of HIT (switch from heparin)
17
Q

What are the 2 main Direct Factor Xa Inhibitors and in what situation are they used for?

A

Rivaroxaban, Apixaban

  • used as ORAL MEDICATION = good for long-term prophylaxis because they do not have to be monitored
18
Q

What condition are Factor Xa Inhibitors typically used for?

A

Prophylaxis of Atrial Fibrillation

19
Q

What proteins are responsible for resolution of clots?

A

Protein C and Protein S

20
Q

What factors and proteins of the coagulation cascade require Vitamin K to function?

A

Factors 10, 9 ,7, 2 and Protein C/S

21
Q

What does Warfarin work?

A

inhibits VKOR (Vitamin K epOxide Reductase) = prevents conversion of Vitamin K epoxide (inactive) to Vitamin K (active)

  • prevents activation of Factors 10, 9, 7, 2 and Proteins C/S
22
Q

How is Warfarin administered and how long does it take for onset of effects?

A

Administration = ORAL

Onset of effects = 8-10 hours

23
Q

What is the half-life of Warfarin and what is the usual dosing per day?

A

1/2 life = 36-42 hours

  • typically QD dosing
24
Q

What is used to monitor Warfarin and what is the normal range for this value?

A

Use PT/INR (International Normalized Ratio)

Normal INR = 2-3

25
Q

Is Warfarin a good choice for pregnant patients?

A

NO! –> crosses the placenta

  • can lead to in-utero hemorrhages/abnormal bone growth
26
Q

What is the “heparin bridge”?

A

When starting Warfarin, heparin is co-administered, as Warfarin effects Protein C/S quicker than Factors 10, 9, 7, 2 and can lead to skin necrosis from paradoxical thrombosis

  • heparin blocks thrombosis from occurring due to decreased levels of Protein C/S from early Warfarin effects
  • without heparin co-administration, patients can develop serious SKIN NECROSIS
27
Q

What two options are available for Warfarin reversal?

A

Exogenous Vitamin K = delayed effects

Fresh Frozen Plasma = immediate effects (has formed coagulation factors)

Medication Review (2 decks)

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