Exam #3: Blood Clots & Diabetes Flashcards
Warfarin (Coumadin)
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
Monitoring test for warfarin
PT- prothrombin time- measured in seconds
INR- international normalized ratio (consistent in all labs)
Adverse effects of warfarin
hemmorhage (vit K for toxicity)
Fetal hemorrhage and teratogenesis. Crosses placenta and into breast milk- pregnant pt on heparin instead
Warfarin drug interactions
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
Dabigatran Etexilate
Direct inhibitor of thrombin
PO
Risks of bleeding ~same as warfarin
Advantages of dabigatran
Doesn’t require anticoagulation monitoring, little risk of adverse rxn, same dose for all pts
Rivaroxaban
Binds to Factor X
Afib, DVT, PE
No monitoring/bloodwork necessary, same dose for all
Aspirin (ASA)
Antiplatelet drug
Inhibits cyclooxygenase
Uses: stroke, TIA, chronic stable angina, stenting, acute MI, MI prevention
Adverse effects of aspirin
Increases risk of GI bleeding, hemorrhagic stroke
Clopidogrel (Plavix)
ADP receptor antagonist, antiplatelet
Less IC and GI bleeding than aspirin
Used in coronary artery stents, acute coronary syndromes
Same adverse effects as aspirin
Abciximab—Glycoprotein (GP) IIb/IIIa antagonists
“Super aspirin”
Most effective antiplatelet drugs
Used IV
During percutaneous procedures- abciximab, aspirin, heparin given together
When are Used IV dabciximab, aspirin, & heparin given together?
During percutaneous procedures- eg putting in a stent
Alteplase (tPa)
Thrombolytic drugs
Converts plasminogen to plasmin
Used for stroke, pulmonary embolism, MI
MUST be given with 2 hrs of acute MI
Minimizing risk of bleeding with Alteplase
Minimize movement, avoid subQ and IM injections, minimize use of concurrent anticoagulants
Symptoms of type I DM
Sustained hyperglycemia, polyuria, polydipsia, polyphagia, ketonuria, weight loss.
Present young. Insulin dependent. Destruction of beta cells in the pancreas, insufficient insulin. Glucose swings wildly.
Type II Symptoms
Family hx, non insulin-dependent, usually over 40 at onset.
Long-term microvascular damage from DM
Retinopathy, nephropathy, neuropathy, gastroparesis (regurgitation, difficulty with digestion, pain), amputations, erectile dysfunction
Hemoglobin A1C range for diabetes
6.5 or greater on 2 separate occasions
FPG Test range for DM (Fasting blood sugar)
126mg/dL or greater on 2 occasions
Impaired glucose tolerance
100-125 mg/dL FPG
Goal of diabetes treatment
Tight control of blood glucose early in the disease- reduce CV, kidney, eye, and nerve damage
Glycosylated hemoglobin- Hgb A1c
Test indicated serum glucose over the past 3 months
Want 7% or below
Insulin lispro (Humalog)
Short duration, rapid acting insulin
Insulin aspart (NovoLog)
Short duration, rapid acting insulin
Insuline glulisine (Apidra)
Short duration, rapid acting insulin
Regular insulin (Humulin R, Novolin R)
Short duration, slower acting
Intermediate duration
Neutral protamine Hagedorn (NPH) insulin
Insulin glargine
Long duration, (given QHS for next day coverage)
Insulin detemir (Levemir)
Long duration- given once a day in evening for next day.
Sliding scales for insulin in hospitals
Short acting insulin
Adverse effects of heparin
Hemorrhage
Heparin induced thrombocytopenia (dropping platelets, paradoxical clotting- DVT of PE while on heparin, ischemia of digits)
Lab parameter to check for heparin
aPTT- activated partial thromboplastin time
Contraindications to heparin treatment
Brain surgery, spinal cord surgery, eye surgery
Low molecular-weight (Enoxaparin, Daltaparin, tinaparin)
More consistent response between patients- one dose for all pts
Prevention of DVT following surgery
Treatment of established DVT
How are low molecular weight heparins dosed?
SubQ injection.
Dosage based on body weight.
Benefit of low molecular weight heparin
Does not require monitoring- can be given at home
Enoxaparin, Daltaparin, tinaparin
Low molecular weight heparins
Warfarin (Coumadin) Mechanism
Blocks biosynthesis of clotting factors
Vitamin K antagonist
Adverse effects of Alteplase
Bleeding, may be oozing or life threatening. Intracranial bleeding.
Blood replacement may be needed
