HEMOSTASIS COAGULATION

Question 0

WHAT DOES ANTITHROMBIN DO?

Answer 0

ITS A NATURAL ANTICOAG. THAT INACTIVATES CLOTTING FACTORS 2,10.

Question 1

WHAT DOES HEPARIN DO TO ANTITHROMBIN?

Answer 1

HEPARIN MAKES ANTITHROMBIN ( A NATURAL ANTICOAGULANT PROTEIN IN YOUR BODY) WORK FASTER.

Question 2

DOES UNFRACTIONATED HEPARIN WORK EQUALLY WELL ON FACTOR 2 (THROMBIN) AND FACTOR 10?

Answer 2

YES. THE LONGER UNFRACT. HEPARIN CHAIN MAKES IT POSSIBLE TO CATALYZE THE INACTIVATION OF FACTOR 2 AND 10 IN A 1:1 RATIO.

Question 3

WHAT PREFERENCE OF CLOTTING FACTOR DOES LMWH HAVE AND WHY?

Answer 3

LMWH CATALYZES THE INACTIVATION OF FACTOR 10 MORE EFFICIENTLY THAN FACTOR 2 BECAUSE LMWH HAS A SHORTER TAIL THAN UNFRACT. HEPARIN.

Question 4

WHICH IS MONITORED WITH PTT?

Answer 4

UNFRACTIONATED HAPARIN.

Question 5

WHY ISNT LMWH MONITORED WITH A PTT?

Answer 5

PTT IS MORE SENSITIVE TO CHANGES IN FACTOR 2 LEVEL AND LMWH AFFECTS FACTOR 10 MUCH MORE THAN 2.

Question 6

WHAT ARE SOME OF THE MAJOR RESULTS OF THE SHORTER CHAIN ON LMWH?

Answer 6

MOSTLY RENAL EXCRETION AND METABOLISM, 90-100% ABSORBED SYSTEMICALLY FROM SUBQ (OPPOSED TO 20%) , IT IS ONLY PARTIALLY REVERSED BY PROTAMINE.

Question 7

IS LMWH USED FOR BRIDGING?

Answer 7

YES

Question 8

WHAT DO YOU USE TO MONITOR VERY HIGH LEVELS OF HEPARIN (UFH)?

Answer 8

ACT, ACTIVATED CLOTTING TIME

Question 9

WHAT ARE ADVERSE EFFECTS OF EITHER TYPE OF HEPARIN?

Answer 9

BLEEDING, HIT, RARE-OSTEOPOROSIS, HYPERKALEMIA, INCREASED AST AND ALT.

Question 10

WHAT ARE SIDE EFFECTS AND THINGS TO THINK ABOUT WHEN GIVING PROTAMINE?

Answer 10

COMMON SIDE EFFECTS: BRADYCARDIA, HYPOTENSION, FLUSHING, N/V.
PRIOR EXPOSURE TO NPH INSULIN IS THE MOST COMMON FACTOR FOR PREDISPOSING TO AN ANAPHYLACTIC RXN WITH PROTAMINE. OTHER REASONS: FISH ALLERGY, MEN WITH VASECTOMY HAVE ANTIPORTAMINE IgG.

Question 11

WHICH HAS A LONGER HALF LIFE, HEPARIN OR PROTAMINE?

Answer 11

HEPARIN SO REPEAT PROTAMINE DOSING MAY BE REQUIRED.

Question 12

WHAT IS MOA OF DIRECT THROMBIN INHIBITORS (DTI)?

Answer 12

DONT NEED ANTITHROMBIN (LIKE UFH AND LMWH DO), IT DIRECTLY INHIBITS ALL ACTIONS OF THROMBIN. WORKS ONLY ON FACTOR 2.

Question 13

WHY IS ARGATROBAN AN OUTLIER OF THE DTI’S?

Answer 13

ITS METABOLIZED IN THE LIVER INSTEAD OF THE KIDNEYS LIKE OTHER DTI’S.

Question 14

WHAT IS A MAJOR DRAWBACK TO DABIGATRAN? A DIRECT THROMBIN INHIBITOR.

Answer 14

NO REVERSAL AGENT IS AVAILABLE!

Question 15

IS PTT A USEFUL TEST FOR DABIGATRAN?

Answer 15

LIMITED USEFULNESS. THERE IS NOT A LINEAR RELATIONSHIP BTW DABIGATRAN AND PTT BUT IF PTT IS AT BASELINE, SURGERY CAN PROCEED.

Question 16

WHAT IS THE MOA OF FACTOR 10 INHIBITORS?

Answer 16

INHIBIT FACTOR 10 ONLY (NOT 2) EITHER INDIRECTLY USING ANTI THROMBIN OR DIRECTLY BY ACTING DIRECTLY ON FACTOR 10

Question 17

WHAT IS A GOOD RULE OF THUMB FOR ALL DRUGS TO FIGURE OUT IF DRUG IS CLEARED FROM SYSTEM?

Answer 17

5X (1/2 LIFE) OF DRUG

Question 18

WHAT IS THE MOA OF WARFARIN?

Answer 18

ITS A VIT K ANTAGONIST (VIT K PRODUCES CLOTTING FACTORS). CLOTTING FACTOR 2 7 9 10 PRODUCTION IS INHIBITED. VIT K ALSO INHIBITS SYNTHESIS OF NATURAL ANTICOAGULANTS POTEIN C AND C.

Question 19

HOW DO YOU MONITOR WARFARIN?

Answer 19

INR. DESIRED THERAPUTIC INR IS 2-3.

Question 20

DIETARY CONSIDERATIONS WITH COUMADIN?

Answer 20

CONSISTANT INTAKE OF VIT K FOODS. SEPARATE SOY AND FIBER FOODS BY A MINIMUM OF 4 HRS BECAUSE IT BINDS TO COUMADIN IN THE GUT AND PREVENTS ITS ABSORPTION.

Question 21

WHO SHOLD RECEIVE BRIDGE THERAPY?

Answer 21

ONLY PTS WITH SIGNIFICANT RISK FOR THROMBOSIS, AVOID IT IF YOU CAN. MECHANICAL HEART VALVE, STROKE OR TIA IN PAST 3 MO. VTE IN KPAST 3 MO.

Question 22

HOW IS COUMADIN REVERSED?

Answer 22

IMMEDIATE REVERSAL: FFP OR PROTHROMBIN COMPLEX CONCENTRATE PCC.
REVERSAL IN 8 HRS: VIT. K WILL TAKE EFFECT IN 8 HRS. SO TAKE AN INR 8 HRS LATER….NOT SOONER.

Question 23

WHAT IS THE ONLY CLASS OF DRUGS THAT DISSOLVES THE CLOT?

Answer 23

FIBRINOLYTICS OR THROMBOLYTICS.

Question 24

ASPIRIN MOA?

Answer 24

IRREVERSIBLE INHIBITION OF PLATELET COX ENZYME. UNLIKE OTHER NSAIDS ASA ACETYLATES COX1 AND 2. THIS INHIBITS PLATELET AGGREGATION FOR THE LIFE SPAN OF THE PLT (7-10 DAYS) SO NEED TO HOLD ASA 7-10 DAYS PRIOR TO SURGERY.