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Hematology > Anticoagulants Lecture PDF > Flashcards

Anticoagulants Lecture PDF Flashcards

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1
Q

2 steps of coagulation and their details

A

1) Formation of platelet plug from aggregation and bridge formation and glycoprotein IIb/IIIa activation on thrombocytes
2) fibrin production from fibrinogen bound to the 2b/3a receptors (coagulation, intrinsic with all the factors present in the vascular system activated when blood makes contact with collagen exposed as a result of trauma to vessel wallor extrinsic with thromboplastin (tissue factor) from outside the vasculature being required to work)

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2
Q

The intrinsic and extrinsic clotting pathways converge at factor ____, this functions to ____ to ____ also known as ___ and ____

A

X, which converts prothrombin to thrombin (factor 2 to factor 2a)

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3
Q

Thrombin positive feedback loop

A

It further increases activity of factor VIII and V to further increase activation of further factor X to convert prothrombin to thrombin

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4
Q

Thrombosis is a disease involving…

A

Pathogenic functioning of hemostatic mechanisms

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5
Q

Arterial thrombosis can result in ___ or ____, because of ____

A

stroke, heart attack, lack of perfusion

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6
Q

Venous thrombosis damage occurs because….

A

The emboli breaks off and travels very far in the vascular system and often becomes larged in far away sites such as pulmonary arteries

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7
Q

3 major classes of drug therapy for thromboembolic disorders and their action

A
  • anticoagulants (disrupt coagulation cascade, suppressing fibrin production)
  • antiplatelet drugs (inhibit platelet aggregation)
  • thrombolytic drugs (promote lysis of fibrin acting like plasmin, causing clot dissolution)
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8
Q

Anticoagulants are more effective in preventing ___ while antiplatelets are more effective in preventing ____

A

venous thrombosis, arterial thrombosis

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9
Q

All agents that affect hemostasis affect…

A

…bleeding risk, must assess mucous membranes for internal bleeding when on these drugs

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10
Q

Warfarin drug class, mechanism of action

A
  • Anticoagulant,

- inhibits synthesis of clotting factors including factor X and thrombin as a vitamin K antagonist

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11
Q

Heparin and dabigatrin drug class, mechanism of action

A
  • Anticoagulant

- inhibit clotting factor activity either Xa or thrombin

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12
Q

Anticoagulants DOC for…

A

…DVT and PE (also collectively shortened to VTE)

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13
Q

Unfractionated heparin definition

A

Injected heparin that activates antithrombin

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14
Q

Heparin activity on antithrombin

A

Binds to antithrombin and thrombin siultaneously, forming a ternary complex needed for thrombin inactivation

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15
Q

Heparin acts within ____ time range

A

minutes of IV administration

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16
Q

Heparin therapuetic uses (2)

A
  • preferred anticoagulant for pregnancy

- preferred agent during PE, stroke, DVT, and MI

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17
Q

Heparin ADR’s (4)

A
  • Hemmorrhaging in about 10% of patients
  • Spinal/epidural hematoma
  • heparin induced thrombocytopenia
  • cross contamination from animal source resulting in allergic rxn
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18
Q

Overdosage of heparin can be treated with…

A

…protamine sulfate

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19
Q

Laboratory test for heparin monitoring is….

A

….activated partial thromboplastin time (APTT)

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20
Q

APTT normal value range

A

24-33 seconds

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21
Q

Heparin is prescribed in…

A

…units, not mg, because preparations tend to differ from one another into anticoagulant activity when compared on a mg basis

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22
Q

Low molecular weight heparin advantages (3)

A
  • can be given on fixed dose schedule
  • doesn’t require APTT monitoring
  • As effective of standard heparin
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23
Q

Enoxaprin (lovenox) drug class, indications, administration

A
  • low molecular weight heparin
  • approved for prevention of DVT flollwoing surgery, treatment of DVT and PE
  • administered via SC
24
Q

Warfarin (coumadin and Jantoven) drug class

A

Vit K antagonist anticoagulatn

25
Q

Warfarin (coumadin and Jantoven) mech of action

A

Inhibit vit K epixide reductaes complex 1 needed to convert vit K to active form, which then decreases production of active vit K dependent clotting factors (II, VII, IX, X)

26
Q

Warfarin (coumadin and Jantoven) doesn’t affect ___. As a result it takes ____ to see response

A

clotting factors that are already made, several days

27
Q

After discontinuation of warfarin (coumadin and Jantoven), how long does coagulation remain inhibited?

A

2-5 days because of long half life of warfarin

28
Q

Warfarin (coumadin and Jantoven) therapeutic uses

A
  • Prevent venous thrombosis and PE

- prevention of thrombosis during atrial fibrilation

29
Q

Warfarin (coumadin and Jantoven) monitoring therapy test

A

Prothrombin time

30
Q

Prothrombin time (PT)/INR

A

Most common test for evaluating warfarin therapy performed by adding a thromboplastin reagent and calcium to citrated plastma and measuring time required for clot to form, have to use INR to standardize reporting of prothrombin time by taking into account relative differences in sensitivity of tissue thromboplastin

31
Q

INR formula

A

(PT patient/PT control) x ISI (international sensitivity index)

32
Q

When dosage of warfarin (coumadin and Jantoven) is changed, it takes ___ for INR to reflect the effects of the new dose

A

36 hours

33
Q

Warfarin (coumadin and Jantoven) ADR’s (2)

A
  • hemorrhage

- skin necrosis and purple toe syndrome

34
Q

Kcentra definition (oh lawdy its a doozy)

A

A 4 factor prothrombin complex concentrate for reversal of warfarin anticoagulation

35
Q

Direct thrombin inhibitors definition and how do they differ from heparins?

A

Inhibit thrombin directly opposed to heparins that act thru antithrombin

36
Q

Dabigatran etexilate (pradaxa) drug class

A

Direct thrombin inhibitor

37
Q

Dabigatran etexilate (pradaxa) advantages over warfarin (4)

A
  • rapid onset
  • no need to monitor anticoaguation
  • lower risks of major bleeds
  • few food drug interactions
38
Q

Dabigatran etexilate (pradaxa) mechanism of action

A

Synthetic, nonpeptide, reversible direct thrombin inhibitor, therefore preventing conversion of fibriongen to fibrin, prevents activation of factor XIII, preventing conversion of soluble fibrinogen to insoluble fibrin

39
Q

Bivalirudin (angiomax) function

A

An IV anticoagulant that can be used in place of heparin in patients with unstable angina undergoing coronary angioplasty

40
Q

Argatroban (acova) function

A

Intravenous anticoagulant for treatment associated with heparin induced thrombocytopenia

41
Q

Rivaroxaban (Xarelto) function

A

Act as a direct factor Xa inhibitor indirectly preventing formation of thrombin

42
Q

Apixaban (Eliquis)function

A

A direct factor Xa inhibitor indirectly preventing formation of thrombin

43
Q

3 groups of antiplatelet drugs which is strongest?

A
  • aspirin
  • GP IIb/IIIa receptor antagonists (strongest)
  • P2Y ADP receptor antagonists
44
Q

Once a clotting cascade begins, it has a…

A

…domino effect where it is self sustaining and self reinforcing

45
Q

4 vitamin K dependant coagulation factors

A

II, VII, IX, X

46
Q

Antithrombin III function, what drug is it very involved with?

A

Inactivates clotting factors by forming a complex with them preventing widespread coagulation beyond the site of vessel injury, intimately involved with heparin

47
Q

Plasmin function, what 2 things activates it?

A

Removal of clot through disolving fibrin after activation from precursor state plasminogen, activated by thrombin and tPA

48
Q

Fondaparinux sodium (Arixta) drug class, therapeutic uses

A
  • antithrombin identical anticoagulant

- Enhance antithrombin activity to help prevent DVT

49
Q

Heparin to warfarin administration

A

Often desirable as warfarin is oral and can allow for discharge, because of delay btwn warfarin administration and antithrombolytic effect, have to overlap approx 4 days and only discontinue heparin when INR is adequate for condition to be treated

50
Q

Warfarin effect on pregnancy

A

Teratogenic effect and can cause fetal malformation

51
Q

Aspirin (ASA) mech of action

A

Causes irreversible inhibition of cyclooxygenase enzyme preventing synthesis of thromboxane A2 to promote aggregation and vascular smooth muscle to promote constriction

52
Q

Clopidogrel (plavix) drug class, mech of action, ADR’s

A
  • Oral antiplatelet
  • irreversibly blocks p2y adp receptors and subsequet activation of glycoprotein iib/iiia complex and aggregation of platelets
  • well tolerated but can cause thrombotic thrombocytopenic purpura
53
Q

Thrombotic thrombocytopenic purpura

A

Rare autoimmune blood clotting disorder that blocks o2 flow to vital organs

54
Q

Ticagrelor (Brilinta) mech of action and unique fact

A

-Reversible P2Y ADP receptor antagonist that wears off faster than clopidogrel

55
Q

Glycoprotein IIb/IIIa receptor antagonists are also known as ___ and are usually administered via ___

A

super aspirins, IV

56
Q

Alteplase (activase) function

A

Bio identical to tPA used to convert plasminogen to plasmin to digest fibrin as a thrombolytic

Hematology (15 decks)

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