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Pharmacology > Blood > Flashcards

Blood Flashcards

1
Q

Thrombotic States 5 血栓性

A

Venous thromboembolism (VTE)
Pulmonary embolus (PE)
Thromboembolic stroke
Transient ischemic attack (TIA)
Acute coronary syndrome (ACS)

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2
Q

What are 3 major cause of blood clot?

A

-Hypercoagulable
(pregnancy, cancer, disease)
-Endothelial injury
-Circulator stasis

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3
Q

What is hemostasis?

A

the stopping of a flow of blood.

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4
Q

Process of hemostasis

A

Injury to a blood vessel
then Blood vessel constriction
then Platelet plug formation
then Blood coagulation

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5
Q

Anticoagulation
action?

A

Prevent for further clot

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6
Q

Anticoagulation
Prophylactic action 3

A

Prevent fibrin deposits
Limits thrombus extension
Prevent thromboembolic complications

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7
Q

Anticoagulation
No direct effect on clots (doesn’t break them down)
So how does it work on clots that are already formed?

A

Induce the body’s response (plasmin) to break it down.
This is why we use anticoagulants on active DVTs.
Safer way to destroyed clot is natural body response

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8
Q

Heparins
agents

A

Unfractionated heparin (UFH)
**most common

Low molecular weight heparins (LMWH)
-Enoxaparin
-Dalteparin Estimate Deliver Time
-Tinzaparin “parin”

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9
Q

Unfractionated Heparin
a) Half-life
b) onset
c) excretion

A

Most common
a) 1-2 hr
b) immediate when used IV
c) Non-renal
Heparin breaks down everywhere, so not pee out

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10
Q

Unfractionated Heparin
What must need with this med?

A

Monitored by aPTT
wide range pf responses that differ with every pt
Too much coagulation= bleeding
Too little coagulation=clots

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11
Q

Unfractionated Heparin
reversal agent

A

protamine sulfate

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12
Q

Low Molecular Weight Heparin
a) Chemically consists?
b) Administered by

A

a) short-chains of polysaccharides
b) subcutaneous injection

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13
Q

Low Molecular Weight Heparin
a) Half-life
b) onset
c) excretion

A

a) 3-6 hours
b) 3-5 hours
Not for emergency
c) renal

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14
Q

Low Molecular Weight Heparin
Is this need monitor?

A

NO!
It is a predictable, pt response doesn’t vary

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15
Q

Heparin
ADRs

A

Bleeding
–Much less with LMWH
Thrombocytopenia
Hypersensitivity reactions

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16
Q

What is Thrombocytopenia?

A

Can lead HIT!
Don’t give heparin with HIT pts because all platelets are utilized
Monitor platelet count!

HIT= (heparin-induced thrombocytopenia)

Thromb=platelet
penia=little

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17
Q

LMWH Advantages

A

Predictable dosing/response
Safe outpatient treatment
Less bleeding
No need for routine laboratory monitoring

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18
Q

Fondaparinux

Found parin ux

A

Chemically related to the LMWHs
Administer SUQ
Causes less HIT
only for HIT pt who cannot take heparin
it is a pentasaccharide

19
Q

Argatroban
a) action?
b) indication?
c) reversal agent?

A

a) Direct thrombin inhibitor
b) Indicated for use in patients with HIT
Monitored by aPTT
c) Reversal agent – andexanet alpha

20
Q

Warfarin
a) route?
b) action?
c) Reversal agent

A

a) Oral administration
b) Block production of vitamin K-dependent clotting factors
c) vitamin K

21
Q

Warfarin
a) indication
b) contraindication

A

a) DVT
valve replacement,
atrial fibrillation,
AMI( heart attack)
b)pregnancy

Adjust dose to INR at 1.2-2.5 times control

22
Q

Warfarin
Pt education
a) what needs?
b) Drug interaction

A

a) regular INR monitoring
Consistent levels of activity
(don’t excise too much to change metabolize)
b) alcohol, aspirin, ibuprofen
herbal and OTC use, clear with a healthcare provider
Aspirin + Warfarin = bad bleeds

23
Q

Warfarin
Pt education
a) dietary modifications

A

a) No fad diets
Consistent vit k consumption
Consistent levels of activity
Need for medical alert bracelet/ID card

24
Q

Monitor for Over-Anticoagulation 5

A

Unexplained nosebleeds
Bleeding gums
Blood in urine
Blood in stool
Easy bruising

25
Q

Direct Thrombin Inhibitors

A

Dabigatran

26
Q

Dabigatran
Da(me) bigatran
a) action
b) DO NOT ….?

A

a) Oral direct thrombin inhibitor
–Bioavailability 3-7%

b) Big increase if capsules opened, must be swallowed whole
DO NOT open the capsules
FDA-approved in 2010

27
Q

Dabigatran
a) Elimination where?
b) Reversed with?

A

a) renal
No routine efficacy monitoring needed
b) idarucizumab

28
Q

Xa Inhibitors
agents

A

Rivaroxaban
Apixaban
Edoxaban xban

29
Q

Xa Inhibitors
ADRs

A

Bleeding
Dyspepsia　　消化不良
kind of chronic indigestion 消化不良
Must adjust doses in renal insufficiency

30
Q

Anticoagulation Cautions 4

A

Elderly
ID bracelet
Drug interactions
Severe consequences

31
Q

Aspirin
a) action
b) indication

A

a) Inhibit platelet aggregation by inhibiting the production of thromboxane
b)Used as secondary prophylaxis of heart attacks, strokes, and blood clots in patients at increased risk

Secondary means pt already had a such health issue

32
Q

Aspirin
a) 75-81 mg per day use for?
b) ADRs

A

a) Lower dose than for use as analgesic/antipyretic
b) GI bleeding(even with baby aspirin)

33
Q

IIb/IIIa Inhibitors
agents

A

Abciximab
eptifibatide
tirofiban

34
Q

IIb/IIIa Inhibitors
a) action
b) indication
c) ADRs

A

a) Inhibit platelet aggregation by preventing the binding
of adhesion ligands to the GP IIb/IIIa receptor on the platelet.
b)during the percutaneous coronary intervention (PCI) and acute coronary syndrome (ACS)
c) Bleeding

Injection ONLY

35
Q

Thrombolytics
a) action
b) indication

A

a) dissolve clots by activating plasmin
b) myocardial infarction
pulmonary embolism
deep vein thrombosis
stroke?

We use this for emergencies!!!!
We need to destroy the clot RIGHT NOW!!

36
Q

Thrombolytics
agents

A

alteplase
anistreplase
reteplase
streptokinase
urokinase

Clot buster!

37
Q

Thrombolytics
Contraindications

A

aneurysm　動脈瘤
active bleeding
brain tumor
stroke, CNS surgery within last 2 months
severe uncontrolled HTN
trauma

A lot, that is why we don’t give this

38
Q

Thrombolytics
Complications

A

bleeding
allergy
anistreplase
streptokinase

39
Q

Blood transfusion
a) Packed red blood cells
b) Washed red cells

A

a) prevent circulatory overload
b) decrease chance of allergy

40
Q

Blood transfusion
a) Fresh frozen plasma
b) Albumin

A

a) Provide clotting factors
b) volume expansion

41
Q

Blood transfusion
Complications

A

Hemolysis
Allergic reaction
Febrile reaction
Bacterial, viral contamination
Circulatory overload

42
Q

Is Enoxaparin need monitor?

A

no
LMWH

43
Q

Indicated for use in patients with HIT

A

Argatroban

Fondaparinux less HIT side effect

Pharmacology (34 decks)

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