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CMBM exam 5 > Coagulants and Anti-Coagulants > Flashcards

Coagulants and Anti-Coagulants Flashcards

1
Q

What are physiological activators of platelets?

A 
Thrombin
ADP
Epinephrine 
Collagen
Arachidonic acid
Thromboxane A2
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2
Q

What are platelet inhibitors?

A

Prostacyclin

Nitric oxide

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3
Q

What state does the body prefer?

A

Vasodilation and anticoagulant state

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4
Q

What produces thrombin to stimulate platelets to release arachadonic acid?

A

Collagen

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5
Q

What is arachidonic acid converted to for an inc in platelet aggregation?

A

Thromboxane

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6
Q

What is heparin?

A

Prevention of venous thrombosis
Treatment of deep venous thromboembolism
Early treatment of pts with unstable angina and acute MI

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7
Q

Normal heparin is in a ______ preparation.

A

Heterogeneous

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8
Q

What releases the heparin to bind at more sites?

A

Antithrombin-protease interaction

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9
Q

What does the half-life depend on for heparin?

A

Dose

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10
Q

What is a major complication of heparin?

A

Bleeding excessively
Thrombocytopenia
Osteoporosis with long time use

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11
Q

What is the molecule difference between low molecular weight heparin (LMWH) and regular heparin?

A

More homogeneous mixture

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12
Q

What are the characteristics of LMW heparin?

A

Reduced interaction with platelets
Half-life is twice and long
Bio-availability at 90%
More predictable anticoagulant response

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13
Q

How can heparin toxicity be minimized?

A

Right pt
Careful control of dose
Close monitoring of aPTT

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14
Q

What should be done for all pts receiving heparin?

A

Platelet count should be performed frequently

New thrombus

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15
Q

When should heparin be discontinued?

A

If thromboembolic disease is due to heparin

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16
Q

What are the contraindications for heparin?

A

Hypersensitivity
Active bleeding
Co-morbidies

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17
Q

How must heparin be administered?

A

IV dose parenterally
Intermitten
NEVER IM

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18
Q

What should be done for heparin reversal?

A

Administer protamine sulfate (negates anticoagulant action)

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19
Q

How does warfarin work?

A

Blocks the carboxylation of glutamate residues in prothrombin, factors VII, IX and X and proteins C and S
Results in biologically inactive molecules - no coagulation
Interferes with vit K

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20
Q

What does warfarin prophylax or treat?

A

Venous thrombosis + extension
Pulmonary embolism
Thrombic complications

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21
Q

What are the major adverse effects of warfarin?

A

Hemorrhage

Crosses the placenta and is teratogenic

22
Q

What is considered the most reliable clinical test for clotting?

A

Prothrombin time (PT)

23
Q

What is the International Normalized Ratio (INR)?

A

Mathematical correction of the PT ratio for differences in sensitivity of thromboplastin reagents

24
Q

Should a large loading dose of warfarin be used?

A

Probably not

25
Q

When switching from heparin to warfarin, how should it be cone?

A

Can be started along with heparin

Heparin should be continued for at least 4 days

26
Q

What should the dosing monitoring for warfarin be like?

A

Start with a low dose (5 mg)
Stabilize the dose via INR and monitor
Adjust if/when necessary
Monitor INR regularly

27
Q

What are the signs of warfarin OD?

A

Unsual bleeding

in stool or urine, excessive menstral bleeding, nose bleeds or gums, bleeding from tumor, ucler or lesions

28
Q

If warfarin falls below INR 2.0 what occurs?

A

A diminished effect

29
Q

If warfarin falls below INR 1.5 what occurs?

A

No efficacy

30
Q

If warfarin is above INR 4 what occurs?

A

Safety is compromised

31
Q

What are the warfarin analogs?

A

Dicumarol (incomplete absorb, GI issues)

Phenindione (Renal and hepatic effects)

32
Q

What should be for warafin reversal?

A

Discontinue drug
Administer vit K
May need plasma, prothrombin complex or VIIa

33
Q

What are the new oral anticoagulants?

A

Dabigatran
Rivaroxaban
Apixaban

34
Q

What is the mechanism of action for dabigatran

A

Factor Iia Inhibitor
Prodrug - converted by nonspecific esterases in plasma and liver
Reversibly and competitively binds to active site free and clot-bound thrombin (factor IIa)

35
Q

What are the indications for dabigatran?

A

Prevention of stroke and systemic embolism in pts with atrial fibrillation
Primary prevention of venous thromboembolism

36
Q

What are the side effects to dabigatran?

A

Excessive bleeding

Severe dyspepsia

37
Q

What is the mechanism of action for rivaroxaban?

A

Factor Xa inhibitor

Binds to active site of factor Xa and affects free and platelet bound factor Xa

38
Q

What are the indications for rivaroxaban?

A

Primary prevention of venous thromboembolism

Prevention of stroke and systemic embolism in pts with AF

39
Q

What are the side effects of rivaroxaban?

A 
Mild hepatic impairment
Bleeding
Musculoskeletal pain
Pruitus
Blisters
Upper ab pain
Syncope
40
Q

What is apixaban?

A

Oral direct inhibitor of factor Xa

Selective and reversible inhibitor of free and clot-bound factor Xa as well as prothrombinase activity

41
Q

What are the indications for apixaban?

A

Prevent stroke and systemic embolism in AF

Primary prevention of venous thromboembolism

42
Q

What is Ecarin Clotting Time?

A

Meizothrombin generation test used to measure thrombin inhibitors
Added to plasma an time to clot formation is measured

43
Q

How does aspirin work?

A

Blocks prostoglandin synth by inhibiting cycooxygenase

Thromboxane A2 formation is inhibited

44
Q

When do hemostatic levels return to normal after using aspirin?

A

36 hours

45
Q

What is the most common side effect of aspirin?

A

GI irriation

46
Q

How do fibrinolytics create a lytic state?

A

By breaking down hemostatic thrombi and thromboemboli

47
Q

Streptokinase

A

Protein synthesized by streptococci

Combines with proactivator plasminogen

48
Q

Urokinase

A

Human enzyme synthesized by kidney

Converts plasminogen to active plasmin

49
Q

Ticlodipine

A

Metab by liver
Renal impairment inc plasma conc
Prevention of recurrence of thrombic stroke

50
Q

What are the adverse events of ticlodipine?

A

GI issues
Leukopenia
Thrombic thrombocytopenia purpura
Side effects limited when dose below 500 mg/d

CMBM exam 5 (19 decks)

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