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2nd year > Anticoagulation therapeutics > Flashcards

Anticoagulation therapeutics Flashcards

1
Q

what are anticoagulants?

A

They prevent the blood from clotting as quickly or as effectively as normal

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2
Q

what are fibrinolytics?

A

stimulate the breakdown/ dissolution of a thrombus/ blood clot
activate fibrinolytic pathway

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3
Q

what are anti-fibrinolytics?

A

promote clotting by preventing or slowing the process of fibrinolysis
prevent break down of blood clots

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4
Q

what are the stages of haemostasis?

A 
vascular spasm
formation of platelet plug
conversion to a clot by reinforcement with fibrin 
tissue repair
gradual removal of clot
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5
Q

what is haemostasis?

A

first phase of acute wound healing

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6
Q

what is antithrombin?

A

anticoagulant
inactivates thrombin
inactivates factor Xa and IXa

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7
Q

anticoagulants

A

heparin
warfarin
DOACs

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8
Q

how does heparin work?

A

affects factor Xa production through the intrinsic pathway

affects IIa

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9
Q

LMWH

A

greater effect on factor Xa than IIa

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10
Q

unfractionated heparin

A

affects factor Xa and IIa equally

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11
Q

what is fondaparinux?

A

synthetic heparin

only affects factor Xa

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12
Q

half life of unfractionated heparin?

A

short - 1 hour

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13
Q

half life of LMWH

A

4 hours - short

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14
Q

excretion of unfractionated heparin?

A

not renal

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15
Q

excretion of LMWH

A

renal

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16
Q

reversal of heparin and LMWH

A

unfractionated heparin can be completely revered by protamine
LMWH can only be partially reversed by protamine

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17
Q

risk associated with heparin

A

heparin-induced thrombocytopenia
autoimmune induced low platelets, risk of DIC
higher risk with unfractionated than LMWH

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18
Q

fondaparinux

A

longer half life - 17 hours
renally excreted
cannot be reversed
few reports of heparin-induced thrombocytopenia

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19
Q

administration of heparin

A

IV infusion

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20
Q

administration of LMWH

A

subcutaneous injection

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21
Q

onset of action of heparin

A

quick onset - minutes

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22
Q

onset of action of LMWH

A

long half life

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23
Q

monitoring for heparin and LMWH

A

heparin requires monitoring with APTR but LMWH doesn’t require any

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24
Q

e.g. of LMWH

A

dalteparin

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25
Q

indications for use of heparin/ LMWH

A 
DVT
PE
VTE prophylaxis
perioperatively 
during haemodialysis
during open heart surgery 
safe for use in pregnancy
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26
Q

contraindications for heparin

A 
haemorrhagic disorders 
thrombocytopenia 
severe hypertension 
trauma 
surgery
lumbar puncture
spinal/epidural anaesthesia 
liver disease 
renal impairment
27
Q

complications of heparin

A

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

28
Q

how does warfarin work?

A

vitamin K antagonist

inhibits carboxylation of factors II, VII, IX, X

29
Q

administration of warfarin

A

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

30
Q

pharmacokinetics of warfarin

A

peak effect several days later
metabolised by CYP450
initially prothrombotic

31
Q

indications for warfarin

A

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

32
Q

contraindications for warfarin

A 
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
33
Q

complications of warfarin

A

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

34
Q

drug interactions

A

can increase or inhibit warfarin’s effect

35
Q

what drugs potentiate warfarin’s effect?

A 
metronidazole 
co-trimazole 
aspirin 
cephalosporins
broad spectrum antibiotics
36
Q

what drugs inhibit warfarin’s effect?

A

rifampicin
carbamazepine
colestyramine

37
Q

examples of DOACs

A

rivaroxaban
apixaban
dabigatran

38
Q

how does rivaroxaban work?

A

directly inhibits factor Xa

39
Q

how does apixaban work?

A

directly inhibits factor Xa

40
Q

how does dabigatran work?

A

direct thrombin inhibitor

41
Q

downsides of DOACs

A

drug interactions
very difficult to reverse
no easy reversal

42
Q

benefits of DOACs

A

longer term therapy

no monitoring needed

43
Q

half-life of DOACs

A

longer than heparin

44
Q

daily doses of DOACs

A

once daily for rivaroxaban

twice daily for apixaban and dabigatran

45
Q

how are DOACs excreted?

A

renally

46
Q

drug interactions with rivaroxaban and apixaban

A

potent dual inhibitors of CYP3A4 and P-gp

47
Q

drug interactions with dabigatran

A

P-gp inducers

48
Q

indications for DOACs

A

similar to warfarin

surgical prophylaxis

49
Q

contraindications for DOACs

A 
acute bleeding 
coagulopathies 
severe renal insufficiency 
pregnancy or breastfeeding 
severe hypertension 
endocarditis
50
Q

complications of rivaroxban

A

constipation

headaches

51
Q

complications of apixaban

A

lower risk of GI bleeds than the other DOACs

52
Q

complications of dabigatran

A

GI disturbance
diarrhoea
GI bleed risk

53
Q

fibrinolysis

A

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

54
Q

what is plasmin

A

antithrombotic

55
Q

how do fibrinolytics work?

A

increase activity of tPA

break down fibrin

56
Q

examples of fibrinolytics

A

alteplase
streptokinase
urokinase

57
Q

indications for fibrinolytics

A

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

58
Q

contraindications for fibrinolytics

A 
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
59
Q

complications of fibrinolytics

A 
anaphylaxis 
cardiac arrest
cardiogenic shock 
heart failure
CNS haemorrhage
hypotension 
pericarditis
60
Q

ischaemic stroke treatment

A

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

61
Q

risk of treating ischaemic stroke with fibrinolytics

A

haemorrhagic transformation

ischaemic stroke can become haemorrhage of brain

62
Q

how do antifibrinolytics work?

A

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

63
Q

example of antifibrinolytic

A

tranexamic acid

2nd year (48 decks)

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