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Cardiology > Anticoagulation > Flashcards

Anticoagulation Flashcards

1
Q

Normal hemostasis steps

A
  1. small blood vessel injury
  2. vasospasm decreases blood flow
  3. platelets adhere and form a plug to stop bleeding
  4. coagulation activation–>fibrin clot
  5. after vessel is repaired, clot removed by fibronolysis
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2
Q

Virchow’s Triad

A

venous stasis

hypercoagulobility

vascular injury

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3
Q

Parenteral anticoagulants

A

unfractionated heparin (UFH/Heparin)

low molecular weight heparins (LMWH)

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4
Q

Mechanism of action of heparin

A

prevents the conversion of fibrinogen to fibrin, preventing further clotting

does not affect established thrombus

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5
Q

Indications of heparin

A

venous thromboembolism (DVT/PE) tx and prophylaxis

unstable angina

acute MI

coronary bypass surgery

hemodialysis

angioplasty

IV line flushes

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6
Q

Pharmacokinetics of heparin

A

Non-linear elimination of heparin: be careful with dosing because half life increases as dose increases

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7
Q

Adverse reactions of heparin

A

Hemorrhage

Heparin induced thrombocytopenia (HIT): platelets <100,000, need to discontinue heparin

Heparin associated thrombocytopenia (HAT): mild thrombocytopenia, manage by observation

Long term: osteoporosis and hyperkalemia

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8
Q

Antidote for heparin

A

protamine

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9
Q

Adverse Reactions

A

Hemorrhage

Thrombocytopenia and osteoporosis, but less than heparin

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10
Q

Types of oral anticoagulants

A

Warfarin

Dabigatran

Rivaroxaban

Apixaban

(Warfarin only one with antidote)

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11
Q

Mechanism of action of warfarin

A

Interferes with hepatic synthesis of vitamin K dependent clotting factors (Vit K antagonist)

Onset of effect 36-72 hours

Not thrombolytic

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12
Q

Indications to use warfarin

A

Venous thromboembolis (DVT/PE) treatment and prophylaxis

Prosthetic heart valves

A fib

TIA/Stroke

Acute MI

Hypercoagulable states

Peripheral arterial occlusive disease

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13
Q

Pharmacokinetics of warfarin

(Absorption, distribution, metabolism)

A

Absorption: Well absorbed in GI tract 99%

Distribution: >97% bound to plasma proteins, crosses placenta, but not breast milk

Metabolism: Half life is 1-2 days, longer in elderly with CHF exacerbation

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14
Q

Adverse reactions of warfarin

A

Hemorrhage

Skin necrosis (rare, discontinue drug and administer vitamin K)

Purple toe syndrome

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15
Q

CI and precautions of warfarin

A

Patients with addition risks of hemorrhage

Noncompliance with drug therapy or monitoring

Alcoholism

Surgery, dental work

Spinal anesthesia or injectons

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16
Q

Warfarin drug interactions

A

*Assume an interaction until proven otherwise!

metabolized by CYP450

Increase INR: sulfamethoxazole (Septra)

Increase bleeding risk, but don’t change INR: Aspirin and NSAIDs

17
Q

Dietary considerations for warfarin

(food)

A

Make sure that vitamin K intake is consistent to stablize INR

Many supplements can affect platelet function and anticoagulation status–check

18
Q

Alcohol effects on Warfarin

A

Acute intake: increase INR

Chronic intake: decrease INR (inc hepatic metabolism)

Cirrhosis: increase INR (can’t metabolize)

19
Q

Anticoagulation recommendations for prevention of VTE

A

Vary depending on risk for VTE

  • Heparin
  • LMWH
  • Fondaparinux
  • Graduated compression stockings and/or intermittent pneumatic compression devices
20
Q

Anticoagulation recommendations for treatment of VTE

A

Parenteral anticoagulant and warfarin

  • Parenteral anticoagulant for 5-7 days (continuous infusion heparin OR subQ UFH, LMWH, or Fondaparinux)
  • Warfarin therapy begins on day 1 after first dose of parenteral anticoagulant
  • Overlap because heparin has long half life
  • Must have therapeutic INR for 2 days before stopping heparin

Thrombolytics

  • Not recommended for most patients because intracranial bleeding can occur
21
Q

CHADS2

A

Congestive heart failure

Hypertension

Age >75yrs

DM

Stroke or TIA

22
Q

Study of variability in hereditary factors as it relates to drug response in different populations

A

Pharmacogenetics definition

“Right Medicine for the Right Patient”

23
Q

Warfarin Therapy and CYP2C9

A

CYP2C9 variants are associated with a different warfarin maintenanace dose, time to stable dose, above range INRs and bleeding events

Screening for CYP2C9 may help prescribers avoid overanticoagulating

24
Q

Contraindications for Anticoagulation Therapy

A

Active bleeding

Hemophilia

Severe liver disease

Severe thrombocytopenia

Malignant HTN

Inability to meticulously supervise and monitor treatment

Cardiology (12 decks)

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