Fibro

Question 0

Plasmin

Answer 0

Degrades fibrin clots, fibrinogen, factor 5 and 8

No discrimination btwn norm and pathological

Question 1

Tissue plasminogen activator

Answer 1

Catalyzes conversion of plasminogen to plasminogen

Question 2

When is tpa most effective?

Answer 2

When bound to fibrin mesh

Question 3

What is tpa inhibited by?

Answer 3

Plasminogen activator inhibitor

Question 4

Thrombin and inflammatory cytokines increase the release of what?

Answer 4

Pai

Question 5

Alpha 2 antiplasmin

Answer 5

Inactivates circulating Plasmin

Question 6

Thrombocytes drugs dissolve what?

Answer 6

Already formed clots by activating plasminogen forming Plasmin

Question 7

Indications for thrombocytopenia agents

Answer 7

Acute mi 
Stroke
Artery occlusion 
Pe 
VTE

Question 8

MOA of thrombocytopenia agents c

Answer 8

Activating plasminogen and form Plasmin
Nonspecific
Bleeding cause circulating plasminogen
Degrade factor 5 and 8

Question 9

How to reverse thrombocytopenia agents

Answer 9

Blood replacement

Aminocaproic acid

Question 10

Streptokinase

Answer 10

Beta hemolytic streptococci
Allergic rxns
Bleeding activation of free Plasmin
Antithrombolytic agent

Question 11

Alteplase

Answer 11

Anti. Thrombocytopenia agent

Recombinant human tpa

Question 12

Reteplase

Answer 12

Antithrombolytoc agent

Derivative of rTPA

Question 13

Tenecteplase

Answer 13

Antithrombolytoc agent
Derivative of rTPA
Resistant to PAI

Question 14

ADR of thrombocytopenia agents

Answer 14

Bleeding
Re thrombosis can occur
Anticoags are co admin continued after thrombolytic therapy
If have trauma don’t use

Question 15

Tenecteplase causes what?

Answer 15

Degradation of blood clots by activating plasminogen

Question 16

Anti platelet drug is a member of class of agents that do what?

Answer 16

Block platelet activation and aggregation

Question 17

Overdose of heparin is treated how?

Answer 17

Protamine sulfate

Question 18

MOA of Protamine sulfate

Answer 18

Binds to heparin forming an inactive complex that’s reversible

Question 19

Ibuprofen and low dose aspirin?

Answer 19

Ibuprofen reduces anti platelet effect of aspirin

Aspirin taken 2 h before ibuprofen

Question 20

Syndrome where pts develop antibodies to hapten when heparin molecules bind platelets causing depletion is?

Answer 20

Hit

Question 21

Which agent is used for continued coagulation therapy in pt with hit?

Answer 21

Argatroban

Lepirudin

Question 22

What is required for synthesis of key coag factors?

Answer 22

Vit k

Question 23

Which factors are dependent on vit k?

Answer 23

Prothrombin
Factor VII
Factor IX
Factor X

Protein C and S

Question 24

What is key to calcium binding and increase the activity of factors?

Answer 24

2nd cooh on carboxy glutamate acid

Question 25

Vitamin k reductase

Answer 25

Converts oxidized vit k to reduced vit k Needed to do carboxylate on of coag factors Blocked by warfarin

Question 26

Vit k quinone reductase

Answer 26

Converts intermediate to reduced form of vit k | Not affected by warfarin

Question 27

MOA warfarin

Answer 27

Racemic Blocks VKORC1 Prevents regeneration of vit k

Question 28

Half life prothrombin

Answer 28

60 h

Question 29

Half life factor 7

Answer 29

4-6 h

Question 30

Factor 9 half life

Answer 30

24h

Question 31

Factor x half life

Answer 31

48-72

Question 32

Protein c half life

Answer 32

8 hours

Question 33

Protein s half life

Answer 33

30 h

Question 34

What do you have to wait till they decay to see onset of warfarin?

Answer 34

Half life of protein c and s

Question 35

Onset of action of warfarin

Answer 35

8-12 h

Question 36

Peak action of warfarin

Answer 36

4-5h

Question 37

Which form of warfarin is more active?

Answer 37

S

Question 38

Cyp mediated metabolism of s warfarin

Answer 38

2c9 | Interacts with fenofibrate

Question 39

Cyp metabolism for r warfarin

Answer 39

1a1, 1a2, 3a4

Question 40

ADR of Warfarin

Answer 40

Bleeding Crosses placenta Skin necrosis

Question 41

Drug interactions with warfarin

Answer 41

Abs decreased by cholestyramine Increase free drug, increase effect ex aspirin, sulfonamides Inhib 1a2, 2c9, 3a4 increase effect Inducers of 1a2, 2c9, 3a4 decrease effect Platelet/clotting drugs increase risk bleeding Antibiotics

Question 42

Disease state interactions with warfarin

Answer 42

Hypo/hyperthyroid Diarrhea Liver dysfunction

Question 43

Food interactions with warfarin

Answer 43

Vit k rich foods decrease effect

Question 44

What is expected to have the greatest effect on warfarin plasma levels?

Answer 44

2c9

Question 45

MOA of warfarin

Answer 45

Reduced syn of functional clotting factors

Question 46

You adjust warfarin based on what?

Answer 46

Inr

Question 47

Warfarin monitoring

Answer 47

Pt | Inr

Question 48

Pt

Answer 48

Activity of clotting factors | Norm is 11 to 13.5 sec

Question 49

Inr

Answer 49

Pt vs control | Accounts for variability in thromboplastin sensitivity

Question 50

Target inr for warfarin

Answer 50

2-3

Question 51

High inr

Answer 51

Risk of bleeding

Question 52

Low inr

Answer 52

Risk of clotting