anticoagulation

Question 1

Heparin

Mechanism of action

Answer 1

Activates antithrombin, which  action of IIa (thrombin) and factor Xa. Short half-life.

Question 2

Clinical uses

Answer 2

Immediate anticoagulation for pulmonary embolism (PE), acute coronary syndrome, MI, deep venous thrombosis (DVT). Used during pregnancy (does not cross placenta). Follow PTT.

Question 3

Adverse Affects

Answer 3

Bleeding, thrombocytopenia (HIT), osteoporosis, drug-drug interactions. For rapid reversal
(antidote), use protamine sulfate (positively charged molecule that binds negatively charged heparin).

Question 4

CAUTIONS AND CONTRA-INDICATIONS

Answer 4

1) Heparin sensitivity
2) Haemophilia and other bleeding disorders 3)Severe hypertension
4) Severe hepatic or renal disease
5) In patients undergoing surgery on brain, eye or spinal cord

Question 5

Warfarin

Mechanism of action

Answer 5

Interferes with γ-carboxylation of vitamin K–
dependent clotting factors II, VII, IX, and X, and proteins C and S. Metabolism affected by polymorphisms in the gene for vitamin K epoxide reductase complex (VKORC1). In laboratory assay, has effect on EXtrinsic pathway and  PT. Long half-life.

The EX-PresidenT went to war(farin).

Question 6

Clinical uses

Answer 6

Chronic anticoagulation (eg, venous thromboembolism prophylaxis, and prevention of stroke in atrial fibrillation). Not used in pregnant women (because warfarin, unlike heparin, crosses placenta). Follow PT/INR.

Question 7

Adverse affects

Answer 7

Bleeding, teratogenic, skin/tissue necrosis drug-drug interactions.

For reversal of warfarin, give vitamin K.

For rapid reversal, give fresh frozen plasma (FFP) or PCC.

Question 8

CAUTIONS AND CONTRA-INDICATIONS

Answer 8

1) Peptic ulceration
2) Severe hypertension
3) Pregnancy (due to teratogenicity)🤰🏻‼️
4) Caution if recent surgery