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Pharm 2 > II. Anticoagulants > Flashcards

II. Anticoagulants Flashcards

1
Q

What are the steps of primary hemostasis?

A
  1. Injury
  2. Platelet adhesion
  3. Shape change
  4. Granulosis Release (ADP, TXA2)
  5. Recruitment of more platelets
  6. Formation of hemostatic plug
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2
Q

After injury occurs, the ____ response initiates within seconds.

A

vasoconstriction

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3
Q

What does the vasoconstriction response expose?

A

von Willebrand Factor (vWF)

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4
Q

once platelets activate, they adhere to the endothelium via ____ and ____.

A

collagen, vWF

Doesn’t bind unless you have the vasoconstriction injury response that exposes the von Willebrand’s factor

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5
Q

.vWF binds to platelets, which in turn bind to other platelets via ____, ultimately forming a ____.

A

Fibrinogen, platelet plug

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6
Q

____ is an integrin complex found on platelets thats acts as a transmembrane receptor for fibrinogen & vWF, thus aiding in platelet activation.

A

Glycoprotein IIb/IIIa

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7
Q

What forms a “chain-linkage” connecting platelets to one another (i.e., forming the platelet plug) during secondary hemostasis?

A

Fibrinogen

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8
Q

what is another name for Secondary Hemostasis

A

Coagulation cascade

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9
Q

Which neurotransmitter aids in the immediate vasoconstrictive process after injury occurs?

A

Serotonin

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10
Q

The fundamental reaction of blood clotting is the formation of a ____.

A

fibrin clot

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11
Q

____ (IIa) is a powerful platelet activator, and without there is no clot.

A

Thrombin IIa

Thrombin is the facilitator of the clot

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12
Q

____ is converted to thrombin (IIa).

A

Prothrombin (II)

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13
Q

Secondary hemostasis involves two pathways:

A
  1. Extrinsic or Tissue Factor
  2. Intrinsic
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14
Q

What is the role of the extrinsic pathway?

A

to generate a rapid rise in thrombin (IIa) via FVII-TF complex

Thrombin IIa is responsible for converting fibrinogen into fibrin clot

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15
Q

What is the coagulation test for the extrinsic pathway?

A

PT (Prothrombin Time)

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16
Q

What is the role of the Intrinsic pathway?

A

Factors IX, XI, XII lead to rise in Xa, which leads to increase in Thrombin (IIa)

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17
Q

what is the coagulation test for the intrinsic pathway?

A

PTT (Partial Thromboplastin Time)

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18
Q

What cofactors are required for secondary hemostsis?

A
  1. Calcium
  2. Phsopholipid
  3. Platelets - B12 & Folate
  4. Vitamin K - Factors II, VII, IX, X are K-dependent
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19
Q

Prothromin is Factor ____.

A

Factor II

Without Prothrombin, you don’t have Thrombin (IIa), and without Thrombin, you don’t clot

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20
Q

Fibrinolysis refers to:

A

breakdown of clot

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21
Q

What is the main enzyme responsible for the breakdown of fibrin clot?

A

Plasmin

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22
Q

What is given IOT form plasmin so that it may break down the clown in a stroke case?

A

Tissue Plasminogen Activator (TPA)

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23
Q

Secondary Hemostasis Picture

A
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24
Q

Fibrinolysis Picture

A
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25
Q

Platelet Plug Picture 1

A
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26
Q

Primary Hemostasis Picture

A
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27
Q

Heparin Specs Picture

A
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28
Q

Low Molecular Wight Heparin (LMWH) Specs Picture

A
29
Q

Protamine Specs Picture

A
30
Q

Warfarin Spec Picture

A
31
Q

Xarelto (Rivaroxaban) Specs Picture

A
32
Q

Eliquis (Apixaban) Specs Picture

A
33
Q

Fondaparinux (Arixtra) Specs Picture

A
34
Q

Dabigatran (Pradaxa) Specs Picture

A
35
Q

Recombinant Factor VIIa Specs Picture

A
36
Q

Aspirin (ASA) specs picture

A
37
Q

Clopidogrel (Plavix) Specs Picture

A
38
Q

Desmopressin (DDAVP) Specs Picture

A
39
Q

Thrombolytic Agents Picture

A
40
Q

Antifibrinolytics Picture

A
41
Q

Prothrombin → Thrombin = Fibrinogen → Fibrin clot Picture

A
42
Q

Coagulation Factors Picture

A
43
Q

If patient doesn’t respond to Heparin, give ____ to replenish ATIII

A

FFP

44
Q

What is the reversal for Heparin?

A

Protamine

Forms an ionic bond to heparin to form a stable salt lacking anticoagulant activity

45
Q

Protamine quick facts:

A
  1. Heparin reversal
  2. May cause HoTN, P. HTN, P. Edema, Allergic Rxn
  3. Give slowly! (15-20 min)
  4. Onset 5 min
  5. DOA 20-30 min
  6. Heparin Rebound
  7. 1mg/100 U dose
  8. 10 mg/mL
46
Q

Heparin blocks ____ & ____, while LMWH only blocks ____.

A

Heparin: Thrombin, Xa
LMWH: Xa

47
Q

What is the ultimate effect of HITT syndrome (Heparin Induced Thrombocytopenia & Thrombosis)?

A

Immunogenic reaction causing platelet activation, aggregation and thrombosis.

more likely with Unfractionated Heparin

48
Q

LMHW = ____ Heparin

A

fractionated

whereas Unfractionated has both HMWH & LMWH

49
Q

The longer tail of HMWH (i.e. Unfractionated) allows it to bind:

A

thrombin

50
Q

Factor VII is a part of what pathway?

A

Extrinsic

51
Q

Factor II is part of what pathway?

A

Common Pathway (part of the intrinsic pathway)

52
Q

Factors IX and X are a part of what pathway?

A

Intrinsic

53
Q

Which vitamin K dependent coagulation factor has the shortest half-life and is the first to drop after starting Warfarin?

A

VII

54
Q

A patient on Warfarin would use what lab test to monitor clotting time?

A

PT test

55
Q

what is added to the centrifuged plasma to test clotting time for a PT test for Warfarin patient?

A

Tissue Factor

56
Q

normal goal INR clotting time for patient on Warfarin?

A

2-3

57
Q

T/F: Warfarin is teratogenic.

A

TRUE

58
Q

Warfarin overdose (INR>10) without active bleeding, give____ to reverse.

If there is active bleeding, give ____.

A
  • Vitamin K (slow reversal) 10 mg PO or IV
  • FFP (fast reversal) 2-4 Units
  • Recombinant Factor VIIa
  • K Centra
59
Q

What does Warfarin inhibit?

A
  • Vitamin K formation (II, VII, IX, X)
  • Protein C
  • Protein S
60
Q

____ is a medication used for the urgent reversal of anticoagulation in adults with life-threatening bleeding or needing emergency surgery. It contains four clotting factors; what are they?

A

KCentra®

II, VII, IX, X (and protein C & S)

61
Q

____ is a medication used to promote blood clotting in individuals with certain bleeding disorders, such as hemophilia.

A

Recombinant Factor VIIa

62
Q

Recombinant factor VIIa activates ____, and requires what factors for proper function?

A

X to Xa

V, X, II (prothrombin)

63
Q

dose of Recombinant factor VIIa

A

20-40 mcg/kg

40-90 mcg/kg (emergencies)

64
Q

Amicable (Aminocaproic Acid) inhibits the binding of ____ to fibrin and its activation to ____.

A
  • plasminogen
  • plasmin
65
Q

Amicar dose

A

Loading dose: 5g or 10g (1st hour)

Maintenance: 1g/hour

66
Q

TXA is ____x as potent as Amicar

A

10

67
Q

TXA and Amicar both bind to the lysine receptor on ____, thus preventing clot breakdown.

A

Plasminogen or Plasmin

68
Q

Proteins dose

A

1 mg/100 U Heparin

69
Q

Does warfarin affect platelet function?

A

No

Pharm 2 (6 decks)

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