Hematology Flashcards
Cofactor for activation of antithrombin
Decreases thrombin, factor Xa
Immediate anticoagulation for PE, MI, DVT
Does not cross placenta
Use PTT to follow
Heparin
SE’s
Bleeding, thrombocytopenia, osteroporosis, drug interactions
Negative charge
Antidote is protamine sulfate (positive charge)
Heparin
IgG antibodies against
Heparin bound to platelet factor 4
Complex activates platelets
= thrombosis, thrombocytopenia
Heparin-induced thrombocytopenia (HIT)
Inhibits thrombin
Derivative of hirudin (leeches)
Anticoagulation in HIT
Lepirudin, bivalirudin
Interferes with synth, gamma-carboxylation of
II, VII, IX, X, C, S
(Vit.K dependent factors)
Chronic anticoagulation (MI, embolism prophylaxis, A-fib)
Long half-life
P450 metabolism
Warfarin
(Coumadin)
SE’s
Bleeding, teratogen, skin/tissue necrosis, drug interactions
Crosses placenta
Contraindicated in pregnant women
Follow with PT/INR
Warfarin
(Coumadin)
Reversal of warfarin OD
and severe OD
Vitamin K
Fresh frozen plasma
Heparin
Route
Site of action
Onset
Duration
Monitoring
Crosses placenta?
Parenteral
Blood
Rapid- seconds
Acute- hours
PTT
No
Warfarin
Route
Site of action
Onset
Duration
Monitoring
Crosses placenta?
Oral
Liver
Slow- limited by half lives of normal clotting factors
Chronic- days
PT/INR (extrinsic)
Yes (teratogenic)
Aid conversion of plasminogen to plasmin
(cleaves thrombin, fibrin)
Increases PT, PTT
Early MI, early ischemic stroke, severe PE
Bleeding, contraindicated in any recent bleeding problems
OD: aminocaproic acid
Thrombolytics
Alteplase (tPA), reteplase (rPA), tenecteplase (TNK-tPA)
OD: Aminocaproic acid inhibits fibrinolysis
Irreversible COX inhibitor
by covalent acetylation
Limited by platelet production only
Increases bleeding time
Decreases TXA2, prostaglandins
Gastric ulceration, tinnitus (VIII), renal failure, interstitial nephritis, upper GI bleeding, Reye’s syndrome, respiratory alkalosis, metabolic acidosis
Aspirin
Irreversibly blocks ADP receptors
Prevents fibrinogen binding to GP IIb/IIIa
Acute coronary syndrome, coronary stenting, thrombotic stroke prophylaxis
SE: neutropenia (1)
ADP receptor inhibitors
Clopidogrel, ticlopidine, prasugrel, ticagrelor
Ticlopidine can cause neutropenia
Phosphodiesterase III inhibitor
Inhibits platelt aggregation by increasing cAMP
Also vasodilates
Intermittent claudication, coronary vasodilation, prevention of stroke or TIA, angina prophylaxis
Nausea, headache, facial flushing, hypotension, abdominal pain
Cilostazol, dipyridamole
Bind GP IIb/IIIa on activated platelets
Acute coronary syndrome, percutaneous transluminal coronary angioplasty
Bleeding, thrombocytopenia
GP IIa/IIIb inhibitors
Abciximab, eptifibatide, tirofiban
Abciximab made of monoclonal antibody Fab fragments
