Exam #3: Blood Clots & Diabetes

Question 1

Warfarin (Coumadin)

Answer 1

Oral anticoagulant, delayed onset- takes days to work.
Not useful in emergencies
Good for long term prophylaxis of thrombosis
Prevents venous thrombosis in patients with prosthetic heart valves
Prevents thrombosis during afib- pts will be on indefinite warfarin

Question 2

Monitoring test for warfarin

Answer 2

PT- prothrombin time- measured in seconds

INR- international normalized ratio (consistent in all labs)

Question 3

Adverse effects of warfarin

Answer 3

hemmorhage (vit K for toxicity)

Fetal hemorrhage and teratogenesis. Crosses placenta and into breast milk- pregnant pt on heparin instead

Question 4

Warfarin drug interactions

Answer 4

Drugs that increase anticoagulants- sulfonamides, acetaminophen, cimetidine
Drugs that promote bleeding- heparin, aspirin
Drugs that decrease anticoagulant effects/inducers- antiepileptics, oral contraceptives, rifampin, bile-acid sequestrants

Question 5

Dabigatran Etexilate

Answer 5

Direct inhibitor of thrombin
PO
Risks of bleeding ~same as warfarin

Question 6

Advantages of dabigatran

Answer 6

Doesn’t require anticoagulation monitoring, little risk of adverse rxn, same dose for all pts

Question 7

Rivaroxaban

Answer 7

Binds to Factor X
Afib, DVT, PE
No monitoring/bloodwork necessary, same dose for all

Question 8

Aspirin (ASA)

Answer 8

Antiplatelet drug
Inhibits cyclooxygenase
Uses: stroke, TIA, chronic stable angina, stenting, acute MI, MI prevention

Question 9

Adverse effects of aspirin

Answer 9

Increases risk of GI bleeding, hemorrhagic stroke

Question 10

Clopidogrel (Plavix)

Answer 10

ADP receptor antagonist, antiplatelet
Less IC and GI bleeding than aspirin
Used in coronary artery stents, acute coronary syndromes
Same adverse effects as aspirin

Question 11

Abciximab—Glycoprotein (GP) IIb/IIIa antagonists

Answer 11

“Super aspirin”
Most effective antiplatelet drugs
Used IV
During percutaneous procedures- abciximab, aspirin, heparin given together

Question 12

When are Used IV dabciximab, aspirin, & heparin given together?

Answer 12

During percutaneous procedures- eg putting in a stent

Question 13

Alteplase (tPa)

Answer 13

Thrombolytic drugs
Converts plasminogen to plasmin
Used for stroke, pulmonary embolism, MI
MUST be given with 2 hrs of acute MI

Question 14

Minimizing risk of bleeding with Alteplase

Answer 14

Minimize movement, avoid subQ and IM injections, minimize use of concurrent anticoagulants

Question 15

Symptoms of type I DM

Answer 15

Sustained hyperglycemia, polyuria, polydipsia, polyphagia, ketonuria, weight loss.
Present young. Insulin dependent. Destruction of beta cells in the pancreas, insufficient insulin. Glucose swings wildly.

Question 16

Type II Symptoms

Answer 16

Family hx, non insulin-dependent, usually over 40 at onset.

Question 17

Long-term microvascular damage from DM

Answer 17

Retinopathy, nephropathy, neuropathy, gastroparesis (regurgitation, difficulty with digestion, pain), amputations, erectile dysfunction

Question 18

Hemoglobin A1C range for diabetes

Answer 18

6.5 or greater on 2 separate occasions

Question 19

FPG Test range for DM (Fasting blood sugar)

Answer 19

126mg/dL or greater on 2 occasions

Question 20

Impaired glucose tolerance

Answer 20

100-125 mg/dL FPG

Question 21

Goal of diabetes treatment

Answer 21

Tight control of blood glucose early in the disease- reduce CV, kidney, eye, and nerve damage

Question 22

Glycosylated hemoglobin- Hgb A1c

Answer 22

Test indicated serum glucose over the past 3 months

Want 7% or below

Question 23

Insulin lispro (Humalog)

Answer 23

Short duration, rapid acting insulin

Question 24

Insulin aspart (NovoLog)

Answer 24

Short duration, rapid acting insulin

Question 25

Insuline glulisine (Apidra)

Answer 25

Short duration, rapid acting insulin

Question 26

Regular insulin (Humulin R, Novolin R)

Answer 26

Short duration, slower acting

Question 27

Intermediate duration

Answer 27

Neutral protamine Hagedorn (NPH) insulin

Question 28

Insulin glargine

Answer 28

Long duration, (given QHS for next day coverage)

Question 29

Insulin detemir (Levemir)

Answer 29

Long duration- given once a day in evening for next day.

Question 30

Sliding scales for insulin in hospitals

Answer 30

Short acting insulin

Question 31

Adverse effects of heparin

Answer 31

Hemorrhage
Heparin induced thrombocytopenia (dropping platelets, paradoxical clotting- DVT of PE while on heparin, ischemia of digits)

Question 32

Lab parameter to check for heparin

Answer 32

aPTT- activated partial thromboplastin time

Question 33

Contraindications to heparin treatment

Answer 33

Brain surgery, spinal cord surgery, eye surgery

Question 34

Low molecular-weight (Enoxaparin, Daltaparin, tinaparin)

Answer 34

More consistent response between patients- one dose for all pts
Prevention of DVT following surgery
Treatment of established DVT

Question 35

How are low molecular weight heparins dosed?

Answer 35

SubQ injection.

Dosage based on body weight.

Question 36

Benefit of low molecular weight heparin

Answer 36

Does not require monitoring- can be given at home

Question 37

Enoxaparin, Daltaparin, tinaparin

Answer 37

Low molecular weight heparins

Question 38

Warfarin (Coumadin) Mechanism

Answer 38

Blocks biosynthesis of clotting factors

Vitamin K antagonist

Question 39

Adverse effects of Alteplase

Answer 39

Bleeding, may be oozing or life threatening. Intracranial bleeding.
Blood replacement may be needed