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Pharm 2 > hematology > Flashcards

hematology Flashcards

1
Q

factor 1

A
  • fibrinogen
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2
Q

factors 2

A
  • prothrombin
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3
Q

factor 3

A
  • tissue factor
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4
Q

intrinsic pathway factors and measurement

A
  • 12, 11, 9, 8
  • PTT, ACT
  • heparin
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5
Q

extrinsic pathway factors and measurement

A
  • 7
  • measured by PT, INR
  • warfarin inhibits extrinsic
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6
Q

final common pathway factors

A
  • 10, 5, 2, 1
    (think of dollar denominations)
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7
Q

damage to the extrinsic pathway causes release of what

A
  • thromboplastin
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8
Q

what does heparin do

A
  • accelerates the rate at which ATIII neutralizes thrombin and factor Xa
  • effects unbound clotting factors
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9
Q

how is heparin metabolized

A
  • by the reticuloendothelial system
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10
Q

what causes heparin resistance

A
  • increased factor VIII
  • accelerated clearance of the drug with PE
  • ATIII deficiency (give 2 FFP to provide ATIII)
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11
Q

signs of HIT

A
  • sign is a massive drop in platelets
  • dose doesn’t matter when it comes to HIT
  • associated with IgG antibodies
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12
Q

diagnosing HIT

A
  • serotonin release assays (SRA) is the gold standard
  • ELISA testing detects IgG antibodies
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13
Q

protamine sulfate

A
  • heparin antagonist complexes with anionic heparin to form stable salt
  • LMWH are not as susceptible to protamine (65%)
  • 100 mg / 100 units of heparin
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14
Q

hypersensitivity reactions to protamine

A
  • fish sensitivity
  • previous protamine reversal
  • protamine containing insulin (NPH)
  • previous vasectomy
    ( pretreat w/ corticosteroid and antihistamine)
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15
Q

low molecular wright heparins

A
  • Dalteparin (Fragmin)
  • Enoxaparin (Lovenox)
  • Tinzaparin (Innohep)
    (dose adjustments with renal patients)
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16
Q

LMWH mechanism of action

A
  • inhibition of factor Xa by antithrombin
  • doesn’t effect aPTT or PT much
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17
Q

Fondaparinux (Arixtra)

A
  • specific inhibitor of factor Xa
  • ATIII mediated
  • not factor IIa effect
  • no effect on platelet function
  • same risk of hematoma as with LMWH
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18
Q

black box warning for LMWH and Fondaparinux

A
  • use of neuraxial blockade represents a significant risk of epidural hematoma
  • wait at least 12 hours
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19
Q

Xa inhibitors

A
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Edoxaban (Savaysa)
  • hold 1 day prior to surgery w/ normal CrCl
20
Q

andexanet alpha (andexxa)

A
  • reverses factor Xa inhibitors
  • black box warning for thromboembolic events, ischemic events, arrest, death
21
Q

argatroban

A
  • direct thrombin inhibitor (factor IIa)
  • used for prevention and treatment of thrombosis in pts with HIT
  • goal is aPTT 1.5-3x baseline
  • no reversal
22
Q

direct thrombin inhibitors (hirudin analogs) names and how they work

A
  • bivalirudin (angiomax)
  • lepirudin (refludin)
  • from saliva of the medicinal leech
  • direct thrombin inhibitor
  • binds irreversibly to both circulating and clot bound thrombin
23
Q

dabigatran (Pradaxa) and its reversal

A
  • oral direct thrombin inhibitor
  • Specific antidote: Idarucizumab and Ciraparantag
24
Q

warfarin

A
  • indirect anticoagulant that alters factors II, VII, IX, X by interfering with vitamin K
  • Vit. K is required for this carboxylation
  • never give to pregnant people
25
Q

warfarin reversal

A
  • vitamin K1 but takes up to 24hrs
  • oral recommended, IV for emergency (never subQ)
  • for immediate hemostatic FFP 10-20 ml/kg
26
Q

warfarin reversal chart

A
  • 3-5 = hold dose
  • 5-9 hold 1-2 doses and may use vitamin K
  • > 9 and no bleeding, oral vitamin K
  • serious bleeding give vitamin K IV
27
Q

warfarin perioperative management

A
  • goal INR is 1.5
  • hold at least 5 days prior to surgery
  • restart based in bleeding risk
  • bridge therapy not necessary unless stroke or clot within 3 months
28
Q

thrombolytic agents

A
  • alteplase
  • reteplase
  • tenecteplase
  • streptokinase
  • urokinase
29
Q

what thrombolytic agents do

A

t-PA binds to fibrin and plasminogen and converts bound plasminogen to plasmin
- work to break up any kind of clot

30
Q

thrombolytic agent toxicity

A
  • lysis of fibrin at vascular sites = major risk of hemorrhage
31
Q

low molecular weight dextran (dextran 40)

A
  • prevent thromboembolism by decreasing blood viscosity (expansion of intravascular volume)
32
Q

epsilon aminocaporic acid (amicar)

A
  • synthetic monoaminocarboxylic acid
  • indirect inhibitor of plasmin’s antiplatelet effects, inhibiting fibrinolysis
  • used for excessive bleeding
33
Q

tranexamic acid (TXA)

A
  • competitive inhibitor of several plasminogen binding sites, leading to inhibition of fibrinolysis and reduced plasmin activity
  • bleeding prophylaxis
  • avoid with seizures
34
Q

raplixa (fibrin sealant)

A
  • spray dried fibrin sealant to control bleeding
  • purified fibrinogen and thrombin
  • dissolved in the blood causing a reaction between fibrinogen and thrombin to form a clot
35
Q

NovoSeven RT (factor VIIa)

A
  • used for pts with hemophilia A or B or factor VII deficiency
  • works in the extrinsic pathway activating factor X, generating thrombin and fibrin
  • expensive
  • high risk of thromboembolic events
36
Q

off label uses of NovoSeven RT

A
  • emergent warfarin induced bleeding
  • spontaneous intracranial hemorrhage
  • massive bleeding
37
Q

prothrombin complex concentrate names

A
  • kcentra
  • FEIBA
  • Profilnine SD
38
Q

Sodium Citrate

A
  • binds free Ca in the blood
39
Q

sodium citrate toxicity

A
  • presents initially as paresthesia around the mouth or extremities followed by hypotension
40
Q

factors that promote platelet adhesion

A
  • vonWillebrand’s factor and factor VIII
41
Q

factors that promote platelet activation

A
  • thrombin (factor IIa combines with thrombin receptor
42
Q

factors that promote platelet aggregation

A
  • thromboxane-A2 and ADP uncover fibrinogen receptors and factor 1 attaches platelets together
43
Q

aspirin

A
  • cyclo-oxygenase (COX) inhibitor
  • stops the conversion of arachidonic acid to thromboxane A2
44
Q

NSAIDs

A
  • depression of thromboxane A2 production
45
Q

thienopyradine ADP- receptor antagonists

A
  • clopidogrel (plavix)
  • ticlopidyne (ticlid)
  • prasugrel (effient)
  • ticagrelor (brilinta)
46
Q

thienopyridine ADP- receptor antagonists (P2Y12 inhibitors)

A
  • bind selectively to ADP site on platelets preventing fibrinogen-platelet binding
  • irreversibly modify receptor
47
Q

cangrelor (kengreal)

A
  • IV P2Y12 inhibitor

Pharm 2 (10 decks)

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