Anticoagulation therapeutics Flashcards

Question

indications for use of heparin/ LMWH

Answer 1

``` DVT PE VTE prophylaxis perioperatively during haemodialysis during open heart surgery safe for use in pregnancy ```

Answer 2

``` haemorrhagic disorders thrombocytopenia severe hypertension trauma surgery lumbar puncture spinal/epidural anaesthesia liver disease renal impairment ```

Answer 3

bleeding heparin-induced thrombocytopenia - thrombotic events can be reversed with discontinuation or protamine hypersensitivity reactions

Answer 4

vitamin K antagonist | inhibits carboxylation of factors II, VII, IX, X

Answer 5

loading dose - 5mg per day must measure INR - aim for 2-3 in most cases and over 2 in all cases needs daily administration initially prothrombotic so give with heparin until target INR reached

Answer 6

peak effect several days later metabolised by CYP450 initially prothrombotic

Answer 7

moving away from its use due to need for daily blood tests and variable doses DVT PE AF mechanical prosthetic heart valves - main use

Answer 8

``` pregnancy and 48 hours post-partum haemorrhagic stroke recent ischaemic stroke severe renal disease severe hepatic disease peptic ulcer GI bleed severe hypertension recent surgery ```

Answer 9

initially prothrombotic bleeding - increased risk due to interactions teratogenic - disordered bone development skin necrosis

Answer 10

can increase or inhibit warfarin's effect

Answer 11

``` metronidazole co-trimazole aspirin cephalosporins broad spectrum antibiotics ```

Answer 12

rifampicin carbamazepine colestyramine

Answer 13

rivaroxaban apixaban dabigatran

Answer 14

directly inhibits factor Xa

Answer 15

directly inhibits factor Xa

Answer 16

direct thrombin inhibitor

Answer 17

drug interactions very difficult to reverse no easy reversal

Answer 18

longer term therapy | no monitoring needed

Answer 19

longer than heparin

Answer 20

once daily for rivaroxaban | twice daily for apixaban and dabigatran

Answer 21

potent dual inhibitors of CYP3A4 and P-gp

Answer 22

P-gp inducers

Answer 23

similar to warfarin | surgical prophylaxis

Answer 24

``` acute bleeding coagulopathies severe renal insufficiency pregnancy or breastfeeding severe hypertension endocarditis ```

Answer 25

constipation | headaches

Answer 26

lower risk of GI bleeds than the other DOACs

Answer 27

GI disturbance diarrhoea GI bleed risk

Answer 28

tissue plasminogen activator converts plasminogen into plasmin plasmin breaks fibrin down into fibrin degradation productions

Answer 29

antithrombotic

Answer 30

increase activity of tPA | break down fibrin

Answer 31

alteplase streptokinase urokinase

Answer 32

acute MI - if no immediate surgery acute ischaemic stroke - within 4 hours massive PE occluded central venous access

Answer 33

``` aneurysm/dissection will cause bleeding if there is any predisposition/ reason for it history of cerebrovascular event history of coagulation defects GI ulcers GI bleed pancreatitis recent surgery recent trauma severe hypertension cavitating lung disease endocarditis ```

Answer 34

``` anaphylaxis cardiac arrest cardiogenic shock heart failure CNS haemorrhage hypotension pericarditis ```

Answer 35

if presentation outside of 4 hour window - too late for fibrinolytic treatment so treat with embolectomy

Answer 36

haemorrhagic transformation | ischaemic stroke can become haemorrhage of brain

Answer 37

competitively inhibit activation of plasminogen to plasmin prevents fibrinolysis doesn't cause clotting just prevents break down of clots

Answer 38

tranexamic acid