blood meds

Question 1

heparin nature

Answer 1

large polysaccharide, water soluble. hepatic metabolism.

Question 2

is heparin safe for pregnancy?

Answer 2

yes. it is large and does not cross the barrier

Question 3

heparin mechanism

Answer 3

binds to antithrombin III and facilitates its binding to factors II, X, IX, XI, XII. this causes rapid inactivation of these factors.

Question 4

how do we monitor heparin function

Answer 4

PTT

Question 5

what is the antidote for heparin

Answer 5

protamine sulfate. this is chemical antagonism with fast onset.

Question 6

what are the uses for heparin

Answer 6

rapid anticoagulation for thromboses, emboli, unstable angina, DIC and open heart surgery

Question 7

what is the toxicity of heparin

Answer 7

bleeding, osteoporosis, HIT. HSR

Question 8

what is the nature of warfarin

Answer 8

small molecule, lipid-soluble, derivative of vitamin K. t

Question 9

is warfarin safe for pregancy

Answer 9

no. it can cross the barrier

Question 10

mechanism of warfarin

Answer 10

decreases hepatic synthesis of vitamin K dependent factors. including protein C and S. prevents gamma-carboxylation of clotting

Question 11

how do we monitor warfarin

Answer 11

PT and INR

Question 12

antagonist for warfarin (antidote)

Answer 12

vitamin K or fresh frozen

Question 13

uses of warfarin

Answer 13

long-term anticoagulant. for thromboses, post-MI, emboli, heart valve damage, atrial arrhythmia.

Question 14

what are the toxicites of warfarin

Answer 14

bleeding, skin necrosis (use heparin to start), drug interactions. teratogenic

Question 15

what is the antidote for HIT

Answer 15

argatroban

Question 16

what is the alternative to warfarin. what are the positives to using it

Answer 16

dabigatran. no checking the INR.

Question 17

what are the two thrombolytics

Answer 17

streptokinase and alteplase

Question 18

streptokinase

Answer 18

bacterial formulated plasminogen activator. it is cheap so used.

Question 19

what is the downfall of streptokinase

Answer 19

it acts on free plasminogen, so it is not clot specific. there is HSR.

Question 20

alteplase

Answer 20

plasminogen activator and thrombolytic. this acts on clots specifically, not on free plasminogen. only works on fibrin-bound plasminogen. there is no allergy since it is human

Question 21

complications to the thrombolytics

Answer 21

bleeding, intracerebral hemorrhage.

Question 22

what are the antidotes to the thrombolytics

Answer 22

aminocaproic acid, tranexamic acid.

Question 23

aspirin

Answer 23

low dose for anticoagulant. prevent MI and recurrance in A fib and TIA. there are no SE for low dose use

Question 24

ticlopimide/clopidigrel

Answer 24

blocks ADP receptors on platelets and decreases their activation. alternative for aspirin. used in TIA, post-MI, unstable angina.

Question 25

SE of ticlopimide/clopidigrel

Answer 25

hemorrhage, leukopenia, thrombocytopenic purpura.

Question 26

Abciximab/eptifibatide/tirofiban

Answer 26

binds and blocks glycoprotein IIb/IIIa receptors decreases platelet aggregation. and preventing cross-linking. used in coronary syndromes and post-angioplasty.