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Pharmacology > Antithrombotics > Flashcards

Antithrombotics Flashcards

1
Q

What are the 3 phases of blood Hemostasis?

A

Vascular spasm
Platelet plug formation
Coagulation

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2
Q

What are the three major drug classes of antithrombotics?

A

Antiplatelets
Anticoagulants
Fibrinolytics

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3
Q

What do antiplatelets mainly work on? What is another name for them?

A

Mainly work on arteries

Blood thinner

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4
Q

What are the 2 routes anticoagulants are given? What vessel do they mainly work on?

A

Oral
Parenteral

Mainly work on veins

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5
Q

What is the only route that fibrinolytics are given?

A

Parenteral

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6
Q

What type of receptor is P2Y12?

A

ADP receptor

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7
Q

What type of receptor is TP?

A

Thromboxane receptor

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8
Q

What type of receptor is G2b/3a?

A

Fibrinogen receptor

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9
Q

What type of receptor is GP1B?

A

vWF receptor on platelets

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10
Q

What activate a platelet?

A

Thromboxane

ADP

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11
Q

What are the 3 things that platelet activation causes?

A
  1. Change in platelet shape
  2. Express active fibrinogen receptor
  3. Release thromboxane and ADP
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12
Q

How can an NSAID help fight clotting?

A

NSAID is COX inhibitor

Inhibits thromboxane

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13
Q

How is an antiplatelet used for MI and strokes?

A

Prophylactically

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14
Q

Why are antiplatelet drugs used for unstable angina?

A

Because angina make you more prone to clotting and antiplatelets prevents platelets from being activated and sticking together

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15
Q

Why are antiplatelets used for acute MIs?

A

To prevent further clot forming

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16
Q

Why are antiplatelets used for precutaneous coronary intervention(ie angioplasty)?

A

To thin out blood during surgery

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17
Q

What are the 4 indications for antiplatelets?

A

MI and stroke prevention
Unstable angina
Acute MI
percutaneous coronary intervention

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18
Q

How does the intrinsic pathway start?

A

Collagen activating factor 12

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19
Q

What starts the extrinsic pathway?

A

Tissue thromboplastin activates factor 7

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20
Q

What is another name for tissue factor? Where is it released from?

A

Tissue thromboplastin

Released from subendothelial cells

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21
Q

What is needed to convert prothrombin into thrombin?

A

Factor 10a
Factor 5a
Ca2+

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22
Q

What turns fibrinogen into fibrin? Which is more soluble in blood?

A

Thrombin turns fibrinogen into fibrin

Fibrinogen is more soluble in the blood

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23
Q

What are the 4 different types of anticoagulant drugs?

A

Heparins
Vitamin K antagonists
Direct factor 10a inhibitors
Direct thrombin inhibitors

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24
Q

Where do natural heparins come from?

A

Liver

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25
Q

What are the 2 different types of heparins?

A

Unfractionated heparin

Low-molecular weight heparin

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26
Q

What route is heparin given?

A

IV

SC

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27
Q

What does aPTT stand for? What does it test? What medication is it used to monitor?

A

Activated partial thromboplastin time

Tests intrinsic pathway and common pathway

Used to monitor Heparin

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28
Q

What is used to prevent blood from clotting for aPTT

A

Citrated plasma

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29
Q

What is a normal aPTT? What is the aPTT for a pt on heparin?

A

25-35 seconds

45-70 seconds

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30
Q

What is added to blood in order to measure an aPTT(3)?

A

Ca2+
Kaolin
Phospholipids

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31
Q

What is the MOA of Heparins?

A

It enhances antithrombin 3 activity

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32
Q

What does antithrombin do?

A

Decreases activity of factor 10 and thrombin

33
Q

What are heparins indicated for? What can heparins be used for the management of?

A

VTE
Stasis of blood
Endothelial damage
Hypercoagulable conditions

Unstable angina
Coronary angioplasty
Cardiopulmonary bypass tubing

34
Q

Why can endothelial damage lead to a VTE?

A

Because these damages are usually caused by surgeries that increase the risk of DVT or PE

35
Q

What are two conditions that can cause hypercoagulability?

A

Burn wounds

DIC

36
Q

How does heparin help unstable angina?

A

Breaks down clots

37
Q

How does heparin help w/ coronary angioplasty?

A

Used during the surgery to prevent clots from forming

38
Q

How does heparin help when cardiopulmonary bypass tubing is being placed in a body?

A

Heparin prevents tubing from activating clotting cascade

39
Q

What percent of unknown deaths are d/t PE?

A

80%

40
Q

What does HIT stand for? What does HITT stand for? How is it caused?

A

Heparin induced thrombocytopenia

Heparin induced thrombocytopenia w/ thrombosis

IgG/PF-4/Heparin complex forms to cause either

  • thrombocytopenia…leading to bleeding
  • thrombosis…leading to clot forming
41
Q

If HITT/HIT is suspected in a pt, what should be done w/ the heparin?

A

Discontinue heparin

42
Q

What signs can suggest the presence of HIT/HITT?

A

Skin lesions at injection site

Acute systemic reaction

43
Q

What type of heparin is used during pregnancy?

A

LMWH

44
Q

What are the number of units used for a central line IV catheter lock flush of heparin? What are the units for a full dose of heparin?

A

1-100 units /mL

1000-40,000units/mL

45
Q

What is a coumarin?

A

Vitamin K antagonist

46
Q

What is a coumarins/vitamin K antagonist MOA?

A

Inhibits VKOR in the liver which turns vitamin K into active vitamin K which helps makes certain clotting factors

47
Q

How long does it take for warfarin(Coumadin) to have a full anticoagulant effect? What is given before warfarin kicks in?

A

2-3 days

Overlapped w/ heparin till warfarin has effect

48
Q

What are the indications for warfarin(Coumadin)?

A
  • Tx and prevention of VTE
  • Tx and prevention of thromboembolism d/t A-Fib or prosthetic heart valves
  • prevention of post MI
49
Q

Why can A-fib cause a thromboembolism?

A

Blood that is not moving tends to clot

50
Q

What can prosthetic heart valves cause thromboembolism?

A

Because they can cause stasis of blood and lead to clots

51
Q

Why is pregnancy a contraindication for warfarin(Coumadin)?

A

Because it can cross the placenta and cause hemolytic disease of newborns

52
Q

What is the antidote for warfarin(Coumadin)? Route?

A 
Vitamin K( phytonadione)
Fresh frozen plasma

IM
SC

53
Q

What is a food that is pro vitamin K?

A

Leafy greens

54
Q

Why is warfarin more beneficial then direct oral anticoagulants?

A
  • has antidote
  • INR is monitored
  • can be used for pt w/ heart valve issues
  • costs less
55
Q

What is PT? What pathway is it used to measure? what is it used to monitor? What units is it measured in?

A

Prothrombin time (pro time)

Measures time to clot for extrinsic and common pathway

Monitors pt on warfarin

INR

56
Q

If a pt has a high INR what does that mean for anticoagulant effect?

A

Higher INR=higher anticoagulant effect

57
Q

What is the INR for a pt on warfarin?

A

2-3 INR

58
Q

What is used to bind up Ca2+ in blood when measuring a PT?

A

Citrated plasma

59
Q

What is put into blood to start measuring a PT?

A

Ca2+

Thromboplastin

60
Q

If a pt has a too high of an INR what should be done w/ the next warfarin dose?

A

Hold the warfarin dose

61
Q

What should be given if a pt has a warfarin-associated major bleed?

A

PCC
FFP
Vitamin K

62
Q

What does PCC stand for? What does it do?

A

Prothrombin complex concentrate

Makes clotting easier

63
Q

What Sx can becoming present if INR is too high

A 
Hematuria (blood in urine)
Melena (blood in stool)
Petechia (pinpoint hemorrhage)
Ecchymoses (bruising)
Purpura (medium hemorrhages)
64
Q

Where does our vitamin K sources come from?

A

Food=50%

Bacteria in large intestine=50%

65
Q

What 3 conditions can affect clotting?

A

Alcoholism
Kidney disease
Liver disease

66
Q

What drug can interfere w/ warfarin or heparin?

A

NSAIDs

67
Q

What should be done before warfarin is given? What should be done before giving heparin?

A

Take a PT/INR test

Take aPTT test

68
Q

Before poking an individual on anticoagulants make sure you know what?

A

Make sure you know the pts INR

69
Q

What is a direct factor 10a inhibitor considered?

A

Direct oral anticoagulants

70
Q

What is a warning for pts taking direct factor 10a inhibitors?

A

Epidural catheters w/ these drugs can cause potential spinal hematomas

71
Q

What is the 3 contraindication for direct factor 10a inhibitors?

A

Any heart valve issue
Active bleeding
Pts w/ increased risk of bleeding

72
Q

What are the 2 indications for direct factor 10a inhibitors?

A
  • Tx and prevent VTE

- thromboembolism

73
Q

What is more beneficial for a pt on direct factor 10a inhibitors than taking an anticoagulant?

A

No monitoring required (no PT or aPTT taken)

74
Q

What is direct thrombin inhibitors MOA?

A

Inhibits thrombin from turning fibrinogen into fibrin

75
Q

What are two other names for fibrinolytics?

A

Thrombolytics

Clot busters

76
Q

What is the MOA of a fibrinolytic? Route?

A

Increases plasmin production which breaks down fibrin

IV

77
Q

What are endogenous forms of fibrinolytics?

A

tPA

Urokinase

78
Q

What is fibrinolytics indicated for?

A

Acute MI
PE
Thrombotic strokes

79
Q

What are contraindications of fibrinolytics?

A

Hemorrhagic stroke

Pharmacology (27 decks)

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