Hematologic meds Flashcards
Prothrombin time is screening for the function of the _______ pathway.
INR is a standardize PT designed to account for differences in _________
APPT: is a screening test for the ________ pathway
Extrinsic
Thromboplastin
Intrinsic
Oral anticoagulants include what drug categories and what drugs?
Indirect Thrombin Inhibitors: Warfarin
Direct Oral Factor Xa inhibitors: ApiXAban, RivaroXAban, EdoXAan
Direct Thrombin inhibitors: Dabigatran mesylate
Injectable anticoagulants include what drug categories and what drugs?
Indirect Thrombin Inhibitors : Heparin, LMWHs (Enoxaparin and Dalteparin), Fondaparinux
Direct Thrombin Inhibitors: Bivalirudin, Argatroban
In general, what is the clinical use of an Anticoagulant?
Venous thrombosis (DVT) Venous thromboembolism Artificial Heart Valves A-Fib Protein C and S bleeding disorders Prophylaxis after surgery
What kind of drug is Warfarin? What part of the cascade does it inhibit? What is its mechanism of action?
Oral Indirect Thrombin inhibitor
II (prothrombin), **VII (extrinsic pathway), IX, X
Inhibit VITAMIN K cofactors. (clot stuff needs VIT K)
Why use warfarin?
Prophylaxis and Tx of DVT, PE, Thromboembolic complications of A-fib and valve replacement
Prevent death following Stroke and MI
Protein C and S def.
Is anticoagulation based on the half life of warfarin? What if we need rapid effect?
No, it is based on half life of coagulation factors (2-7 days)
Combine with Heparin or LMWH until therapeutic INR reached
Describe INR in terms of monitor schedule, normal range, and goal catagories.
Measure INR bi-weekly at first hen Q4-6 as dosing is stabilized.
Normal = 0.8-1.2
Goal of 2-3 if = Prophylaxis of DVT and Tx of thrombotic disease
Goal of 2.5-3.5 if = artificial valve or medical condition w/ signs and symptoms of elevated INR??
What is the dose for Warfarin
It depends on the individual.
Ditrate does to therapeutic INR. @ 1 week you will see initial adjustment in PT, then adjust q2-3 days to get goal.
What are the hallmark adverse reactions of Warfarin?
Purple toe
Also skin necrosis and bleeding stuff.
Dont give it to preggos…. EVER.
If a warfarin patient presents with a high INR, what should you do?
Follow the table.
If it is high but under 4.5 –> Reduce or skip dose. Resume when INR is normal.
If between 4.5-10 –> Hold 1-2 doses and return when normal. If **URGENT SURGERY needed, give Vitamin K (Phytonadion).
If over 10 –> Hold warfarin and give Vitamin K (oral or IV)
If a warfarin patient presents with Major Bleeding, what should you do?
Give PCC (as opposed to FFP) Administer vitamin K slow IV
What is prothrombin complex concentrate used for? What are our two agents?
Urgent reversal of acquired coagulation factor deficiency (IE warfarin)
Kcentra - Prothrombin and factors + protein C and S
Profilnine - Factors
What is the reversal agent for Warfarin? Is this rapid push?
Phytonadion (vitamin K)
Give slow to avoid anaphylactic reactions (IV and PO) only)
This medication is extracted from porcine intestinal mucosa, binds to Anti-thrombin III to inhibit coagulation factors faster and is used to reduce thrombi expansion and prevent thrombin formation
Heparin (subq or IV only)
**BTW acts in minutes not hours and days like warfarin
Heparin crosses the placenta and travels via breast milk so it is totally contraindicated in pregnant patients right?
No. It does not do those things and is pregnancy cat C
What four major adverse reactions do you get with Heparin
Bleeding
Osteoporosis
Hyperkalemia
Heparin Induced Thrombocytopenia (plate below 150k) bleeding occurs under 50k
Who doesn’t get heparin?
Pts with or with Hx of HIT Active bleeding or hemophilia Thrombocytopenia or purpura HTN or IC hemm Recent surg or upcoming lumbar puncture
What do we use to monitor Heparin.
aPTT (activated partial thromboplastin time)
Hemoglobin, Hematocrit, platelets, bleeding
