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Anesthesia-phar > Antithrombotic Meds & Anesthesia Recommendations > Flashcards

Antithrombotic Meds & Anesthesia Recommendations Flashcards

1
Q

Heparin class and MOA

A

class: anticoagulant
MOA: forms a complex with antithrombin III which increases antithrombin IIIs activity 1,000x
- inhibits thrombin IIa and factor Xa (2a and 10a)
- Depresses factors IXa, XIa, and XIIa (9a, 11a, and 12a)

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2
Q

Heparin use and route

A

Use: DVT prophylaxis, PE, acute coronary syndrome
Route: IV, SQ

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3
Q

Heparin dose

A

SQ 5,000 units for DVT prophylaxis

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4
Q

Heparin onset and DOA

A

onset = rapid

DOA = 3 - 6 hours

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5
Q

Heparin metabolism and elimination

A

metabolism: liver
elimination: heparin-protamine complexes eliminated via reticuloendothelial system

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6
Q

Heparin considerations

A
  • check PTT
  • risk of HIT
  • bleeding risk
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7
Q

Protamine class and MOA

A

class = heparin antidote

MOA = combines with heparin to form an inactive compound without anticoagulation effects

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8
Q

Protamine use and route

A

use = reverse heparin

route = IV

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9
Q

Protamime Dose

A

based on heparin dose …

  • 1mg per 100U of Heparin
  • Give <5mg/min, risk of anaphylaxis
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10
Q

Protamine onset and DOA

A

Onset = 5 min

DOA = 2 hours

lasts shorter than heparin, rebound bleeding can occur

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11
Q

protamine metabolism and elimination

A

metabolized and eliminated by reticuloendothelial system

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12
Q

Protamine considerations

A
  • derived from salmon semen
  • anticoagulative effect
  • releases histamine
  • hypotension
  • pulmonary HTN
  • circ collapse
  • facial flushing
  • bronchoconstriction
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13
Q

Tranexamic Acid (TXA) class and MOA

A

Class = antifibrinolytic agent

MOA = synthetic reversible competitive inhibitor to the Lysine receptor found on plasminogen. The binding of this receptor prevents plasmin (activated form of plasminogen) from binding to and ultimately stabilizing the fibrin matrix.

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14
Q

TXA use and route

A

use = given IV to prevent or reduce bleeding and the need for transfusion

route = IV, PO

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15
Q

TXA Dose

A

1 g / 10 min

may repeat within 8 hours with MAX 2 g

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16
Q

TXA metabolism and elimination

A

Metabolism = liver (small portion)

elimination = renal (largely unchanged)

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17
Q

Rapid transfusion of TXA can cause ____.

A

hypotension

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18
Q

TXA contraindications

A
  • known allergy to TXA
  • intracranial bleeding
  • history of venous or arterial thromboembolism or active thromboembolic disease
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19
Q

Aspirin type and mechanism

A

Type = anti platelet

Mechanism = COX 1 inhibitor (irreversible)

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20
Q

ASA half life

A

20 min

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21
Q

ASA reversal agent

A

PLTs

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22
Q

ASA anesthesia recs

A

stop 7 days

23
Q

ASA lab monitoring

A

none

24
Q

NSAIDs type and mechanism

A

Type = anti platelet

Mechanism = COX 1 inhibitor, reversible

25
Q

NSAIDs ½ life

A

2 - 10 hours

26
Q

NSAIDs reversal

A

PLTs

27
Q

NSAIDs anesthesia recs

A

stop 24-48 hours before

28
Q

NSAIDs lab monitoring

A

none

29
Q

Clopidogrel type and mechanism

A

type = anti platelet

mechanism = ADP receptor antagonist

30
Q

Clopidogrel ½ life

A

7 hours

31
Q

Clopidogrel reversal

A

PLTs

32
Q

Clopidogrel anesthesia recs

A

Stop 5 - 7 days

33
Q

Clopidogrel lab monitoring

A

none

34
Q

LMWH type and mechanism

A

type = anti coagulant

mechanism = factor IIa and Xa antagonism (indirectly)

35
Q

LMWH ½ life

A

4.5 hours

36
Q

LMWH reversal

A

Protamine but partial reversal

37
Q

LMWH anesthesia recs

A

stop 12-24 hours before

38
Q

LMWH lab monitoring

A

Anti- Factor Xa assay

39
Q

Heparin ½ life

A

1.5 hours

40
Q

Heparin reversal

A

Protamine

41
Q

Heparin anesthesia recs

A

stop 6 hours before

42
Q

Heparin lab monitoring

A

PTT

43
Q

Warfarin type and mechanism

A

type = anticoagulant

mechanism = Vitamin K epoxide reductase antagonist

44
Q

Warfarin ½ life

A

2-4 days

45
Q

Warfarin reversal

A

Vitamin K

FFP

Recombinant Factor VII

46
Q

Warfarin anesthesia recs

A

Stop 4-5 days before

47
Q

Warfarin lab monitoring

A

PT

48
Q

t-PA type and mechanism

A

type = Fibrinolytic

mechanism = plasminogen activator

49
Q

t-PA ½ life

A

5 min

50
Q

tPA reversal

A

Anti-fibrinolytic (ex. = TXA)

51
Q

tPA lab monitoring

A

PT/PTT

52
Q

Name 3 plasmin inhibitors

A
  1. TXA
  2. Aproptinin (trasylol)
  3. Epsilon aminocapropic acid (Amicar, EACA)
53
Q

Aproptinin (Trasylol) class, MOA and use

A

class = anti fibrinolytic

MOA = slows breakdown of fibrin

used in cardiac surgey

54
Q

Epsilon Aminocaproic Acid (Amicar, EACA) MOA and use

A

Blocks plasmin from binding with fibrin, therefore prevent the breakdown of fibrin and keeps the clot intact

  • used with hemorrhage

Anesthesia-phar (18 decks)

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