Anticoagulants, Thrombolytics, & Antiplatelets Flashcards
Platelet membrane receptors include….
Glycoprotein (GP) Ia receptor, binding to collagen (C)
GP Ib binding von Willebrand factor
GP IIb/IIIa binding fibrinogen & other macromolecules
During thrombus formation, what is released from the endothelium?
What is released form the degranulating platelet?
Antiplatelet prostacyclin (PGI2)
Aggregating substances - adenosine, diphosphate, thromboxane A2, & serotonin (5-HT)
What is the common synonym for component/factor II?
Prothrombin
What is the common synonym for component/factor VII?
Proconvertin
What is the common synonym for component/factor IX?
Plasma thromboplastin component (PTC)
What is the common synonym for component/factor X?
Stuart-Prower factor
What is the MOA of heparin & LMWH?
antithrombin w/ inactivation of factor Xa
What is the MOA of fondaparinux?
Indirect factor Xa inhibitor
What is the MOA of rivaroxaban, apixaban, & edoxaban?
Direct factor Xa inhibitors
What is the MOA of dabigatran, bivalirudein, desirudin, & argatroban?
Direct thrombin inhibitors
In patients w/ DVT or PE & no CA, what initial anticoagulant therapy is suggested?
Dabigatran, rivaroxaban, apixaban, or edoxaban
These are preferred over vit K antagonist therapy
What is the prototype of LMWH?
Enoxaparin (Lovenox)
What are the advantages of LMWH (when compared to UFH)?
Predictable anticoagulation dose response
Lower incidence of thrombocytopenia
Reduced need for lab monitoring
What is a disadvantage of both LMWH & UFH?
Bleeding risk: ecchymosis at administration site
What is the 1/2 life of factor VII?
4-6 hrs
What do you do if INR is btwn 5-10?
Hold 1-2 doses
Check INR within 24 hrs
Resume lower dose when INR is within range
What do you do if INR is > 10?
Administer oral vit K 2.5-5mg
Hold 2 doses
Check INR within 24 hrs
Repeat vit K prn & resume lower dose when INR is in range
How do you convert from enoxaparin to warfarin?
Warfarin must be on board for 5 days & INR score must be within goal range for at least 24 hrs before discontinuing enoxaparin
What are ADEs of heparin?
Bleeding, obvi
Thrombocytopenia
Osteoporosis
Elevated transaminases
How do you reverse heparin?
Protamine sulfate IV (salmon sperm)
What increases & decreases the effect of warfarin?
Cytochrome P450 inducing drugs decrease effect
Cytochrome P450 inhibitions increase effect
