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Pharm Test 4 > Lecture 8 Anti-coagulants > Flashcards

Lecture 8 Anti-coagulants Flashcards

1
Q

Extrinsic pathway:
Factor(s) =
Other important molecule =
Lab test that measures it =

A

7;
thomboplastin aka tissue factor;
PT

“PT outside at 7”

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2
Q

Intrinsic pathway:
Factor(s) =
Lab test =

A

12, 11, 9, 8;

aPTT

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3
Q

common pathway:
Factors =
what does thrombin do

A

10, 5;
cleaves fibrinogen to fibrin

“10 / 5 = 2”

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4
Q

what 2 things are required to cross link/polymerize the fibrin molecules?

A

factor 13 (activated by thrombin)and calcium

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5
Q

all clotting factors except for VWF are produced in the _____.

A

liver

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6
Q

the ___ pathway is triggered when collagen is exposed on the wall of the blood vessel

A

intrinsic

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7
Q

_____ alters thrombin so it can activate protein C and S to inactivate what factors?

A

thrombomodulin;
5, 8

“CS58”

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8
Q

Antithrombin 3 (AT3) inhibits what factors? what are the important ones tho

A

thrombin (2), 7, 9, 10, 11, 12;

Xa and thrombin

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9
Q

Warfarin:

mechanism of action

A

inhibits vitamin K epoxide reductase (VKOR)

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10
Q

vitamin K is essential for ____ of the ____ in factors _____

A

gamma carboxylation, glu;
10, 9, 7, 2, C, S;

“1972 CS”

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11
Q

what lab measures warfarin action? what pathway?

A

PT, extrinsic

“the EX-PresidenT went to WAR”

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12
Q

how long does it take for warfarin to act?

A

3-5 days for full effect

long half life

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13
Q

What metabolizes warfarin? where does this occur

A

CYP2C9, in the liver

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14
Q

how to reverse warfarin overdose:

stop warfarin, then administer ____ and _____

A

Vitamin K, fresh frozen plasma

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15
Q

can you use warfarin during pregnancy?

A

no

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16
Q

drugs that effect warfarin:
pharmacokinetic interactions are related to ____.
pharmacodynamic interactions are related to ____

A

enzyme induction or inhibition;

interaction with clotting processes

17
Q

Heparin:

binds the ____ charged region of ____. this _____ the reaction rate

A

positively, AT3; increases

18
Q

heparin-AT3 complex mainly inhibits what 2 factors?

A

2 (thrombin) and 10

19
Q

How long does it take for heparin to act?

A

immediate ie given via IV

short half life

20
Q

what lab measures heparin action? what pathway?

A

aPTT, intrinsic

21
Q

most common side effect of heparin and warfarin

A

increased bleeding

22
Q

how do you reverse the action of heparin?

A

protamine sulfate (positively charged molecule binds heparin)

23
Q

what is HIT? which form is worse?

A

heparin induced thrombocytopenia;

type 2

24
Q

mechanism of HIT: heparin complexes with _____. this causes development of ____. this causes platelets to ____ and _____

A

platelet factor 4; IgG antibodies;

lyse, release activating granules –> hypercoaguable state

25
Q

what other side effect does heparin have?

A

osteoporosis

26
Q

is heparin positively or negatively charged? protein or polysacharride?

A

negatively charged, polysacharride

27
Q

2 LWMH’s mentioned in FA

A

dalteparin, enoxaparin;

also danaparoid, tinzaparin

28
Q

LMWH’s preferentially inhibit _____. what lab measures this?

A

factor Xa;

no lab does

29
Q

LMWHs and fondaparinaux have a ____ half life than heparin. More or less risk of side effects? effect of protamine sulfate?

A

longer, less risk;

doesn’t really help

30
Q

_____ is a synthetic indirect inhibitor of factor Xa

A

fondaparinaux

31
Q

mechanism of action of rivaroxabn and apixaban:

A

directly inhibit factor Xa

32
Q

factor Xa inhibitors are used for treatment and prophylaxis of ___, ___, and stroke prophylaxis in patients with _____

A

DVT, PE, Afib

33
Q

what factor Xa inhibitor was recently approved.

how is it excreted?

A

edoxaban, renally

34
Q

____ reverses factor Xa inhibition by acting as a decoy protein

A

andexanet

35
Q

mechanism of action for argatroban, bivalirudin, dabigatran:

A

direct thrombin inhibitors

36
Q

direct thrombin inhibitors are indicated for prevention of ____ and systemic embolism in patients with ___ AFib

A

stroke, non-valvular

37
Q

what humanized monoclonal antibody inhibits a factor 10a inhibitor? what is the specific 10a inhibitor?

A

idarucizumab inhibits dabigatran

Pharm Test 4 (13 decks)

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