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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
How do Metronidazole and Fluconazole affect Warfarin?
CYP2C9 inhibitors. INC WARFARIN
26
St . John Wart affects warfarin in what way?
Inducer DEC effects. CYP3A4, 2C9
27
Grapefruit and Diltiazem affect warfarin via?
INC Effects. CYP3A4 inhibitors
28
How is the half life of warfarin 30+hrs?
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
What is monitored while Mr. KFC is on warfarin?
INR. 1. Daily Inpatient 2. BID outpatient until INR stable. INR Goal 2-3. MAY BE HIGHER in some.
30
What occurs with INR?
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
What admister method should be avoided with warfarin?
NO IM injection, risk of hematoma. GOOD-PO, Sub Q, IV
32
Mr. KFC has VTE and PMH of PE. His risk include MI, CVA. EKG-Afib. What RX is ideal?
Warfarin
33
What are reasons to slow and low dose warfarin?
1.Elderly, 2. Comorbid 3. Wt 4. EtOH- INC Warfarin
34
What are major ADE of Warfarin?
#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
When is person on lifelong warfarin?
1. Afib, 2. Valve dz 3. Prosthetic heart 4. EF <30 LV dyx
36
Is warfarin ok for Preg?
NO
37
Which ABX is concern w/ warfarin?
Trim/Sulfameth- displaces warfarin off albumin. DEC effects. NSAIDs/ Acetaminophen, antiplatelet
38
What is the downside of warfarin?
Monitor for 2 wk_then weekly_biweekly_monthly
39
What RX reverses warfarin affects?
Phytonadione- NO IM. 2. Prothrombin Complex Concentrate
40
What diet concerns should be addressed with warfarin pts?
Keep Vit K levels consistent in diet. Same time daily. Multivitamins. 2. ETOH and Black licorice
41
Which Rx prevents fibrinogen to fibrin?
Heparins: Enoxaparin,
42
What cofactor does Heparin affect?
Primarily IIa and Xa- prothrombin to thrombin conversion
43
What is main goal of Heparin?
Prophylaxis+ Acute TX. Acute DVT, PE, Unstable angina, MI, Afib
44
What are s/s of Heparin induced thrombocytopenia, ADE?
Dec in platelet counts
45
When should prophlaxsis Heparin be dosed?
2hr prior to surgery-5000unit 2. Q 8-12hr until walking
46
Is Heparin ok for baby?
YES
47
What are the DAOACs?
B. E. A. R 1. Betrixaban, Edoxaban, Apixaban, Rivaroxaban
48
Pt has PMH of Mitral stenosis. Which is DOC to prevent assoc with VTE d/t Afib and valve replacement?
Warfarin
49
Which DAOAC is primary direct thrombin inhibitor?
Dabigatran
50
What are warning for dagigtan, Rivaroxaban, Apixaban, Edoxaban, Betrixaban?
spinal/epidural hematomas
51
What are the main DI for direct actin oral antocoag?
Glycoprotein CYP 3A4
52
Which drug is ideal if CrCL <30
Warfarin
53
Apixaban and Edoxoban have wt restriction of what?
<60kg (<132)
54
What food is caution with Rivaroxaban?
Lactose, milk intolerance
55
Describe caution with Betrixaban?
LFT, Hepatic impaired. Take w/ food
56
What is dose for Dabigatran?
150 BID
57
What is dose to remember for Edoxaban?
60mg DAILY
58
How and when to dose adjust with anticoagulants?
1. >80y 2. Wt- <60, >120kg, BMI>40 3. Renal and Liver dfx 4. DI
59
What is reversal drug for DOACs?
Arapazine/Ciraparantag

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