Coagulation & Dyslipidemia

Question 1

What is heparin used for and its mechanism of action?

Answer 1

Heparin is used to prevent clot formation by controlling function and synthesis of clotting factors. It is a first-line medication due to fast onset and elimination (IV or injection only).

Question 2

What are the side effects of heparin?

Answer 2

bleeding & thrombocytopenia (decreased platelets)

Question 3

What is heparin-induced thrombocytopenia (HIT) and how quickly do symptoms occur?

Answer 3

Profound drop in platelets secondary to heparin use. Usually occurs 5-10 days after heparin exposure in a heparin-naive patient. Drop can occur within a day if pt was previously exposed within 100 days.

Question 4

What is the primary concern with HIT?

Answer 4

High rate of thrombus formation -> amputation/death

Question 5

What are ways to reverse HIT?

Answer 5

Discontinuation of all heparin products, use of a direct thrombin inhibitor, waiting to initiate warfarin until platelets have recovered.

Question 6

What is warfarin and how long does it take for it to work?

Answer 6

Oral anticoagulant that takes a few days before anticoagulant effect is seen. You start with a parenteral agent and warfarin until INR is therapeutic. INR=international normalized ratio that determines the clotting tendency of blood

Question 7

What are some side effects/complications of taking warfarin?

Answer 7

Side effects: bleeding & skin necrosis
Complications: requires close monitoring, patient education, and is highly affected by diet, other medications & genetic

Question 8

What is a reversal agent for warfarin?

Answer 8

Vitamin K

Question 9

What are P2Y12 inhibitors?

Answer 9

P2Y12 are proteins found on platelets that are important in regulating clotting. P2Y12 inhibitors work to prevent the clotting mechanism.

Question 10

What are P2Y12 inhibitors typically combined with?

Answer 10

aspirin; usually for 12 months in post-CABG patients

Question 11

What are the side effects of P2Y12 inhibitors?

Answer 11

bleeding, headache, dyspnea

Question 12

What are thrombolytic agents?

Answer 12

Help to break down a thrombus, once formed, to restore flow.

Question 13

What are the therapeutic uses for statins?

Answer 13

Dyslipidemia, post-MI, prevention of CV disease.

Done by decrease cholesterol production in the liver, plaque reduction, antioxidant effects

Question 14

What is the difference between a pulmonary embolism (PE) and deep vein thrombosis (DVT)?

Answer 14

DVT is a clot within the venous system while a PE is a clot in the pulmonary veins, commonly a dislodged clot from a DVT.

Question 14

When do statins work best?

Answer 14

Given at bedtime.

Question 16

What is the mechanism of action for statins?

Answer 16

decrease cholesterol production in the liver: up-regulate LDL surface receptors -> increase LDL breakdown and decrease VLDL production

Question 17

What are the side effects of statins?

Answer 17

myopathy, headache, GI, myalgia, rhabdomyolysis (rare)

Question 18

What is hemophilia?

Answer 18

A condition in which the blood lacks factors required to effectively clot.

Question 19

What are inherited hypercoagulable states?

Answer 19

Genetic predisposition to high levels of clotting.

ex) elevated levels of fibrinogen

Question 20

What are acquired hypercoagulable states?

Answer 20

High levels of clotting due non-genetic factors.

ex)cancer, prenancy, birth control, previous embolisms

Question 21

What is the purpose of thrombolytics? What is the primary agent?

Answer 21

Breakdown already formed thrombus to reestablish blood flow. tPA = tissue plasminogen activator