Heparin LMWH Fondaparinux , Direct Thrombin inhibitors , Xa inhibitors

Question 1

Heparin MOA

Answer 1

-binds Antithrombin III

• Heparin-ATIII complex irreversibly inactivates thrombin and factor Xa
  (“Trapped throm-beaver and foX”)

Question 2

which lab value should be monitored when Heparin therapy is initiated ?

Answer 2

-aPTT - activated partial thromboplastin time

• measures the function of the intrinsic pathway of the coagulation cascade

(“Birdwatching father looking at Woodpecker inside tree trunk”)

Question 3

what can Heparin be used for ?

Answer 3

• can be used for deep vein thrombosis prophylaxis
  (“heppy hunter Hunting at the iliofemorial river”)

-heparin can be used for acute treatment of deep vein thrombosis
(“Beaver dam ion the iliofemoral river”)

-can be used for prophylaxis and acute treatment of pulmonary embolism (PE)
(“Birds nest on ischemic tree branch”)

• Continuous heparin drip can help reduce the development of the PE

-Heparin is used in the setting of an acute MI, heparin is used to prevent clot formation and extension
(“Broken heart strings”)

-IV heparin adminstration useful in the setting of acute DVT, PE, and MI
(“poison ivy on tree”)

Question 4

Adverse effects of Heparin

Answer 4

• INCREASED RISK OF BLEEDING! - moniter aPTT !
• Heparin induced thrombocytopenia, - occurs when antibodies are made against heparin complex with platelet factor 4

(“Heppy hunter Shooting four clay plates” )
(“plates on the floor”)

• HIT results in paradoxical thrombosis in the setting of thrombocytopenia [HITT]
  (“Throm-beaver dam around broken plates”)

-heparin can cause hyperaldosteronism even in low doses
(“depleted mineral mine” )

• leads to Hyperkalemia
  (“Big K on depleted mine entrance”)

-heparin can cause osteoporosis

(“Porous termite damage”)

Question 5

what can reverse the anticoagulant effect of Unfractioned Heparin?

Answer 5

Protamine Sulfate- positively charged peptide
(“positively charged protection fence stopping the heppy heparin hunter”)

**less effective for LMWH and fondaparinux**

Question 6

LowMolecularWeightHeparin Properties
(“Heppy hunter’s daughter”)

_Enoxa /_parin
_Dalte /_parin

Answer 6

-LMWH-antithrombin complex inhibits factor Xa with less of an effect on thrombin
(“Heppy hunter’s daughter holding 1 FoX in small trap”)

-LMWH has a prolonged half-life
(“Long tapering flag”)

-Does not require aPTT monitoring

-LMWH is eliminated renally (Heparin in liver ) and can stay in the system if there is renal insufficiency
(“Decay flag breaking a kidney shaped rock”)

-heparin/LMWH is safe during pregnancy. “keep that baby heppy with heparin”
(“Heppy pregnant hunter momma”)

-less likely to induce HIT
(“intact pigeon clay plates”)

Question 7

Fondaparinux properties

(“Fido the dog with a pair of FoXes”)

Answer 7

-binds antithrombin III with higher specificity that LMWH
(“Fido the dog holding 2 foX cages”)

-fondaparinux-antithrombin complex inhibits factor Xa with less of an effect on thrombin
(“fido the dog holding 2 foX cages with no beavers “)

-Lowest risk of HIT
(“no broken plates around Fido the dog”)

Question 8

Name Direct Thrombin inhibitors

(“intruding gator lunching on that thrombeaver”)

Answer 8

“no intRUDIN - BIG GATOR“

• **BivaliRUDIN
• ar-GAT-Roban
• Dabi-GAT-Ran**

Question 9

when should Direct Thrombin inhibitors be administered ?

Answer 9

in case of HIT

( Heparin Induced Thrombocytopenia)

Question 10

name the Direct Factor Xa inhibitors

(“BANNED foXes”)

Answer 10

XABAN-suffix

• *Rivaro**/XABAN
• *api**/XABAN

Question 11

Direct Factor Xa inhibitors properties

Answer 11

-factor Xa inhibitors bind directly to Xa
(“angry overall jeans gal directly grabbing foX”)

-are oral medications
(“blonde dude wearing overall jeans opens his mouth”)

-used for long term anticoagulation in atrial fibrillation
(“tv showing irregularly irregular signal”)