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SUMPHARM > CV-Coags - CV-Coags > Flashcards

CV-Coags - CV-Coags Flashcards

1
Q

DVT, PE, Prophalxis, Hypercoag dz, CVA, MI, Prosthetic valves all require what type of RX?

A

Anticoagulants

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2
Q

What RX anticoagulants require parenteral administration?

A
  1. Heparin 2. Low MW Heparins 3. Factor Xa inhibitors 4. Direct Thrombin Inhibitors
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3
Q

Which oral agent is Vit K Antagonist because Vit K help blood clots?

A

Warfarin

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4
Q

What factors does Vit K activate?

A

Progresss clotting 1. Factor II prothrombin, VII proconvertin, IX thromboplastin, X

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5
Q
  1. Clopidogrel/Prasugrel/Ticlopidine/Ticagrelor(Brilinta®), 2. ASA/Dipyridamole, 3. Glycoprotein IIB/IIIA Inhibitors
A

Antiplatelet Agents

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6
Q

What are clotting factors?

A

Zymogen proteins that lead to clot formation made in the liver, that circulate w/in the plasma and on blood vessel walls

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7
Q

What happens with a scratch/injury?

A

Vascular phase 1. vasoconstriction 2. collagen released signal platelets to adhere 3. Endothelial cells release TNF

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8
Q

What activates zymogen clotting factors?

A

Tissue necrosis factor: released by collagen, endothical cells, and platelets. Goal- activate VII _ VIIa.

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9
Q

What is the extrinsic pathway?

A

Tissue injury_TNF_ VII_VIIa

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10
Q

What is intrinsic pathway

A

Clotting factors 9-12 activate each other like a chain

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11
Q

Which factors balance and checkpoint for stop or go of clotting factors?

A

Protein C&S

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12
Q

What do majority of anticoagulants do?

A

They stop formation of clotting factor into active form. Affect VIIa!

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13
Q

Which agent blocks plasminogen_plasmin

A

tPA-Tissue plasminogen activators

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14
Q

Which class affects only prothrombin to thrombin?

A

IIa inhibitors

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15
Q

Which class affects prothrombin_thrombin + others?

A

Xa inhibitors

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16
Q

What is Primary goal of anticlotting RX?

A

Prevention+TX of thrombosis in vv. and aa

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17
Q

What is Secondary goal of anticlotting RX?

A

only for arterial or intracardiac thrombosis

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18
Q

Which have higher platelet count?

A

aa and cardiac vessels. Clot form a WHITE THROMBUS

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19
Q

Which have lower platelet count?

A

Veins- make sense less clots to lung and heart d/t constant return to heart. RED THROMBUS. VV-capacity holds more blood volume

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20
Q

Mr. KFC had a MI, PMH CVA, and PE. What type of agent dissolve existing thrombus for acute treatment of thrombosis?

A

Fibrinolytic-TPA

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21
Q

What is MOA of warfarin?

A

Inhibits Vit K. thus L/T block clotting factors 2,7.9,10, C&S

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22
Q

What may happen initially with Warfarin?

A

**Inhibits C&S so my have procoag initially. DEC Cofactor_ INC clot initially . IF lingers consider Acquired protein C deficiency

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23
Q

What is S-warfarin?

A

Warfarin isomer mirror image, S-activates CYP2CP. 3-4x potent V-K antagonist

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24
Q

Which CYP enzyme increases Warfarin drug in body?

A

Inhibitors INC drug in body. Inducers DEC

25
Q

How do Metronidazole and Fluconazole affect Warfarin?

A

CYP2C9 inhibitors. INC WARFARIN

26
Q

St . John Wart affects warfarin in what way?

A

Inducer DEC effects. CYP3A4, 2C9

27
Q

Grapefruit and Diltiazem affect warfarin via?

A

INC Effects. CYP3A4 inhibitors

28
Q

How is the half life of warfarin 30+hrs?

A

Binds to albumin. RX bound to drug_ other drug potential to kick warfarin off and stay in body for longer times. INC serums levels

29
Q

What is monitored while Mr. KFC is on warfarin?

A

INR. 1. Daily Inpatient 2. BID outpatient until INR stable. INR Goal 2-3. MAY BE HIGHER in some.

30
Q

What occurs with INR?

A

Measures Prothrombin time- time for blood to clot. Low/fast time- large clots thus risk , slow/High time_ bleeding, hemorrhage, blood not clotting fast enough.

31
Q

What admister method should be avoided with warfarin?

A

NO IM injection, risk of hematoma. GOOD-PO, Sub Q, IV

32
Q

Mr. KFC has VTE and PMH of PE. His risk include MI, CVA. EKG-Afib. What RX is ideal?

33
Q

What are reasons to slow and low dose warfarin?

A

1.Elderly, 2. Comorbid 3. Wt 4. EtOH- INC Warfarin

34
Q

What are major ADE of Warfarin?

A

1 Gangrene- Protein C dfx- small clots in body, so jams vessels. 2. Hemorrhage, -nose, bruising, hemoptysis, melena- blood upper GI, dark by time in stool. Hematochezia- bright red. Other: N/V/D, Derm, Alopecia, Mouth ulcers,

35
Q

When is person on lifelong warfarin?

A
  1. Afib, 2. Valve dz 3. Prosthetic heart 4. EF <30 LV dyx
36
Q

Is warfarin ok for Preg?

37
Q

Which ABX is concern w/ warfarin?

A

Trim/Sulfameth- displaces warfarin off albumin. DEC effects. NSAIDs/ Acetaminophen, antiplatelet

38
Q

What is the downside of warfarin?

A

Monitor for 2 wk_then weekly_biweekly_monthly

39
Q

What RX reverses warfarin affects?

A

Phytonadione- NO IM. 2. Prothrombin Complex Concentrate

40
Q

What diet concerns should be addressed with warfarin pts?

A

Keep Vit K levels consistent in diet. Same time daily. Multivitamins. 2. ETOH and Black licorice

41
Q

Which Rx prevents fibrinogen to fibrin?

A

Heparins: Enoxaparin,

42
Q

What cofactor does Heparin affect?

A

Primarily IIa and Xa- prothrombin to thrombin conversion

43
Q

What is main goal of Heparin?

A

Prophylaxis+ Acute TX. Acute DVT, PE, Unstable angina, MI, Afib

44
Q

What are s/s of Heparin induced thrombocytopenia, ADE?

A

Dec in platelet counts

45
Q

When should prophlaxsis Heparin be dosed?

A

2hr prior to surgery-5000unit 2. Q 8-12hr until walking

46
Q

Is Heparin ok for baby?

47
Q

What are the DAOACs?

A

B. E. A. R 1. Betrixaban, Edoxaban, Apixaban, Rivaroxaban

48
Q

Pt has PMH of Mitral stenosis. Which is DOC to prevent assoc with VTE d/t Afib and valve replacement?

49
Q

Which DAOAC is primary direct thrombin inhibitor?

A

Dabigatran

50
Q

What are warning for dagigtan, Rivaroxaban, Apixaban, Edoxaban, Betrixaban?

A

spinal/epidural hematomas

51
Q

What are the main DI for direct actin oral antocoag?

A

Glycoprotein CYP 3A4

52
Q

Which drug is ideal if CrCL <30

53
Q

Apixaban and Edoxoban have wt restriction of what?

A

<60kg (<132)

54
Q

What food is caution with Rivaroxaban?

A

Lactose, milk intolerance

55
Q

Describe caution with Betrixaban?

A

LFT, Hepatic impaired. Take w/ food

56
Q

What is dose for Dabigatran?

57
Q

What is dose to remember for Edoxaban?

A

60mg DAILY

58
Q

How and when to dose adjust with anticoagulants?

A
  1. > 80y 2. Wt- <60, >120kg, BMI>40 3. Renal and Liver dfx 4. DI
59
Q

What is reversal drug for DOACs?

A

Arapazine/Ciraparantag

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