Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharm II MHM - Exam 2 > Anticoagulants Carey Lecture > Flashcards

Anticoagulants Carey Lecture Flashcards

1
Q

What are the categories of antithrombotics?

A
  • Anticoagulants
  • Fibrinolytics
  • Antiplatelets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What do anticoagulants do?

A

Stop clot formation and extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What do fibrinolytics do (in general)?

A

Break up existing clots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do antiplatelets do?

A

Decrease platelet activation and aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the two types of thrombi and how do they differ?

A
  • White thrombus (platelet rich, forms in arteries, MI)

- Red thrombus (fibrin/RBC rich, forms in veints, DVT/PE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does TXA2 do?

A

Vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does vWF do?

A

Binds to exposed collagen fibers at the injured vessel surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does fibrinogen do?

A
  • Forms bridges between adjacent platelets

- This results in an aggregate of platelets at the vessel injury site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does thrombin (factor IIa) do?

A

Converts fibrinogen to fibrin (which forms the stable clot)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the final result of the coagulation cascade?

A

Fibrin threads create a plug to make a stable clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the overall steps of platelet activation?

A
  • Injury
  • Collagen and vWF exposed
  • Platelet adherence and activation
  • Binding of fibrinogen
  • Aggregation and plug formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the mediators of platelet aggregation?

A

TXA2
ADP
5-HT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the pathways of the coagulation cascade and how are they activated?

A
  • Intrinsic (activated by exposed endothelium)
  • Extrinsic (activated by tissue damage)
  • Common (intrinsic and extrinsic merge together)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the first step in the common pathway of coagulation?

A

Activation of Factor Xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the last step in the intrinsic and extrinsic pathways of coagulation?

A

Activation of Factor Xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What factors are necessary to form a clot?

A 
Factor 2 (prothrombin)
Factor 10
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does Factor Xa do in the coagulation cascade?

A

Combines with Factor 2 (prothrombin) to form thrombin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What factors are targeted by Warfarin?

A

SNOT

Seven, Nine, Ten (0), Two

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does prothrombin time (PT) measure?

A

Activity of Factors 2, 7, 9, 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is INR?

A
  • International Normalized Ratio

- Same as PT but standardized worldwide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does PTT measure?

A

Activity of Factors 2, 5, 7, 9, 10, 11, 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is activated clotting time (ACT)?

A
  • Same as PTT but used in invasive/operating procedures

- Quicker result turnaround

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the indirect thrombin inhibitors?

A

Heparin
LMWH (Enoxaparin)
Fondaparinux

24
Q

How do indirect thrombin inhibitors act as anticoagulants?

A

Help antithrombin deactivate clotting factors

25
Heparin inhibits which clotting factors?
X and II
26
What is HIT?
- Heparin Induced Thrombocytopenia - Antibody mediated adverse effect of heparin - Strong a/w thrombosis
27
What are signs of HIT?
- Platelets fall more than 50% from baseline with nadir 20,000+ - Platelets start to fall on day 5-10 of therapy - Thrombosis occurs while on heparin - R/o other causes of thrombocytopenia
28
What is the treatment of HIT?
- Stop heparin, treat with IV direct thrombin inhibitor - Do NOT give platelets - Do NOT give warfarin until platelets return to normal
29
LMWH (enoxaparin) inhibits which factors?
Factors Xa, IIa
30
When should enoxaparin dose be reduced? When should it be stopped?
- Reduced in CrCl 20-30 ml/min | - Stopped in CrCl less than 20
31
What is fondaparinux and what does it do?
- Synthetic pentasaccharide | - Inhibits factor Xa via antithrombin
32
When should dose of fondaparinux be reduced? When should it be stopped?
- Reduced if CrCl less than 50 | - Stopped if CrCl less than 30
33
How are indirect thrombin inhibitors reversed?
- Discontinue drug - Give protamine sulfate by IV * Fondaparinux has NO reversal agent!
34
What are the direct Xa inhibitors?
- Rivaroxaban - Apixaban - Edoxaban
35
When should rivaroxaban dose be reduced? When should it be stopped?
- Reduced if CrCl 15-50 (AF) - Stopped if CrCl less than 30 (VTE) - Do NOT use in severe hepatic dysfunction
36
When should apixaban NOT be used?
Severe hepatic and renal dysfunction
37
When should edoxaban be reduced? When should it be stopped?
- Reduce if CrCl less than 50 - Stop if CrCl less than 15, greater than 95 * Do NOT use in moderate or severe hepatic dysfunction
38
What are the direct thrombin inhibitors and which route are they given?
- Bivalirudin (IV) - Argatroban (IV) - Dabigatran (oral)
39
How do direct thrombin inhibitors and antithrombin interact?
DTIs act independent of antithrombin
40
When should bivalirudin dose be reduced?
- CrCl less than 30 | - Hemodialysis
41
When should dabigatran be reduced? Stopped?
- Reduce if CrCl 15-30 (AF) | - Stop if CrCl less than 15 (AF) or less than 30 (VTE)
42
What does warfarin inhibit?
- Factors 2, 7, 9, 10 | - Proteins C and S
43
How should warfarin be dosed initially?
- Start low | - 5 mg daily
44
When should warfarin be started at 2.5 mg daily?
- 75+ yo - Hepatic insufficiency - Critically ill
45
If INR is less than goal two times, how should warfarin dose be adjusted?
Increase WEEKLY dose 10-20%
46
If INR is higher than goal two times, how should warfarin dose be adjusted?
Decrease WEEKLY dose 10-20%
47
When should INR goal be 2.5 to 3.5?
- Mechanical mitral valve - Any mechanical valve with risk factors (AF, HF, MI, embolism) - Pts with predisposition for clotting who had a clotting event when INR was at 2-3
48
What are examples of drugs that interact with warfarin to increase INR?
- Amiodarone - Bactrim - Cipro - Metronidazole
49
What are examples of drugs that interact with warfarin to decrease INR?
- Cigs - Rifampin - St. John's wort
50
When warfarin is stopped, how long does it take to return to baseline? How about if Vit K is given?
About 5 days | about 1 day with Vit K
51
How should Vit K be given to reverse warfarin?
- Oral route is preferred (better absorption) | - Do NOT use SC or IM (erratic absorption)
52
How should IV Vit K be administered?
- 10 mg always diluted with 50 mL NS | - Administer over 10-30 mins
53
Which anticoagulants have CYP interactions?
Rivaroxaban and apixaban | *Warfarin
54
Which anticoagulants have P glycoprotein interactions?
- Rivaroxaban - Apixaban - Edoxaban - Dabigatran
55
Which anticoagulants have reversal agents?
- Warfarin (Vit K) - Heparin (Protamine) - LMWH (Protamine)
56
Which anticoagulant is not good to use in poor OR excellent kidney function?
Edoxaban

Pharm II MHM - Exam 2 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions