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Haematological Medications Flashcards

1
Q

How would you monitor unfractionated heparin levels?

A

APTT

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2
Q

How would you monitor LMWH?

A

Anti-Xa assay

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3
Q

How would you monitor warfarin activity?

A

INR

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4
Q

What is the mechanism of action of low molecular weight heparin?

A

Inactivates factor Xa (but not thrombin)

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5
Q

Why has LMWH replaced unfractionated heparin?

A

It is more predictable and has a longer half life

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6
Q

What is the mechanism of action of unfractionated heparin?

A

Inhibits thrombin, factor Xa and IXa

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7
Q

What are side effects of heparins?

A
  • Bleeding
  • Heparin induced thrombocytopenia
  • Osteoporosis - long term
  • Hyperkalaemia - due to aldosterone secretion
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8
Q

What are contraindicaitons for heparin use?

A
  • Bleeding disorders
  • Platelets < 60x109/L
  • Previous HIT
  • Peptic ulcer
  • Cerebral haemorrhage
  • Severe hypertension
  • Neurosurgery
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9
Q

What is the mechanism of action of Warfarin?

A

Inhibits vitamin K-dependent γ-carboxylation of coagulation factors II, VII, IX and X, thus leading to biologically inactive forms. Also inhibits Protein C initially, creating a pro-thrombitic effect

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10
Q

Why is LMWH given with warfarin when beginning therapeutic anticoagulation?

A

Warfarin is initially pro-thrombotic due to inhibition of protein C

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11
Q

What are the side effects of warfarin?

A
  • Skin necrosis - patients with protein C or protein S deficiency
  • Haemorrhage
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12
Q

What are contraindications to warfarin use?

A
  • Abnormalities of haemostasis
  • Hypersensitivity to warfarin
  • After an ischaemic stroke for 2–14 days
  • Surgery
  • Severe uncontrolled hypertension.
  • Active peptic ulceration.
  • Severe liver disease.
  • Pregnancy
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13
Q

How would you manage someone with warfarin overdose and there is major bleeding?

A
  • Stop warfarin
  • Prothrombin complex concentrate 30–50 units/kg or FFP (15 mL/kg).
  • Give vitamin phytomenadione (vitamin K1) 5 mg - Slow IV
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14
Q

If someone had an INR of >8 and was on warfarin, how would you manage them?

A

If no bleeding

  • Stop warfarin
  • 0.5-2.5mg Vitamin K - if risk factors for bleeding
  • Check INR Daily
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15
Q

If someone had an INR of 6-8 and was on warfarin therapy, how would you manage them?

A

Stop warfarin, then restart when INR < 5

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16
Q

How would you mange someone with an INR of 4.5-6 who was on warfarin?

A

Reduce warfarin or omit dose. Start again when INR <5

17
Q

When should you try to avoid vitamin K use in someone who has a high INR on warfarin?

A

On those who require long term coagulation - Vit K can make individuals develop prolonged warfarin resistance.

Use Prothrombin complex concentrate - contains Factor IX, which has more rapid effect than FFP

18
Q

What is warfarin activity increased by?

A
  • Alcohol
  • Allopurinol
  • Amiodarone
  • Aspirin and other NSAIDs
  • Omeprazole
  • Ciprofloxacin
  • Co-trimoxazole,
  • Macrolide antibiotics such as erythromycin
  • Metronidazole
  • Statins
  • Tamoxifen
  • Levothyroxine
19
Q

What is warfarin activity decreased by?

A
    • Carbemazepine
  • St John’s Wart
  • Rifampicin
20
Q

What are indications for warfarin use?

A
  • AF, cardioversion and dilated cardiomyopathy (target INR 2.5)
  • Mechanical prosthetic aortic (target INR 3.0) or mitral valve (target INR 3.5)
  • Venous thrombosis and pulmonary embolism (target INR 2.5).
21
Q

What is the mechanism of action of Fondaparinaux?

A

Fondaparinux binds to AT and inhibits only factor Xa

22
Q

What is the mechanism of action of Aspirin?

A

Irreversibly inhibits the enzyme cyclo-oxygenase, reducing production of thromboxane A2, a stimulator of platelet aggregation

23
Q

What is the mechanism of action of clopidogrel?

A

Pro-drug that is metabolized by the liver, partly by cytochrome P450 2C19, before it is biologically active. It blocks binding of ADP to platelet receptors and thus inhibits activation of the GpIIb/IIIa complex and platelet activation

24
Q

What is the mechanism of aciton of GIIb/IIIa inhibitors?

A

Prevent platelet aggregation by blocking the binding of fibrinogen to receptors on platelets.

25
Q

What are the main antiplatelet drugs?

A
  • Aspirin
  • Clopidogrel
  • Ticagrelor
  • GIIb/IIIa inhibitors
26
Q

What are the main side effects of aspirin?

A
  • Peptic ulceration
  • Bleeding
27
Q

What is the mechanism of action of most fibrinolytic drugs?

A

Hydrolyse a peptide bond in plasminogen to yield the active enzyme, plasmin, which promotes clot lysis.

28
Q

What are the main side effects of fibrinolytic drugs?

A
  • Increased risk of haemorrhage
  • Cardiac arrhythmias - during reperfusion of the myocardium
  • Hypotension
  • Allergic reactions (bronchospasm, urticaria) - streptokinase.

Haematology (34 decks)

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