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My Pharm II > Midterm > Flashcards

Midterm Flashcards

1
Q

Look at slide 3

A

.

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2
Q

Damage outside (extrinsic to) blood vessels triggers the release of ____________ (________,_________) from damaged cells.

A

thromboplastin

Factor III, tissue factor

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3
Q

Thromboplastin activates factor VII. VIIa, when complexed on the surface of the platelet with _________ and ____________ activates factor X (Xa), Which pathway

A

calcium (factor IV)

thromboplastin (IIIa)

EXTRINSIC

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4
Q

Trauma to the blood itself or exposure of the blood to collagen in a traumatized blood vessel wall activates factor ____. Which pathway

A

XII

EXTRINSIC

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5
Q

IXa when complexed on the platelet surface with activated factor _______ and _____ activates factor X (Xa). Which pathway?

A

VIII:C (VIII:Ca)

Ca++

INTRINSIC PATHWAY

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6
Q

Look at slide 7

A

.

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7
Q

Heparin acts as a catalyst to ____. To neutralize what?

A

Antithrombin III

Neutralizes:

  • Thrombin
  • Factor Xa
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8
Q

Heparin comes from ______

A

Porcine

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9
Q

Heparin MOA

A

Heparin induces a conformational change in the AT III that makes the reactive site more accessible to the protease

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10
Q

Heparin uses

A

Every type of clotting disorder

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11
Q

Heparin activity

A

Only acts on unbound factors

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12
Q

Heparin: The more you give, _______ DOA

A

Longer

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13
Q

Heparin is cleared by the ____________ system

A

reticuloendothelial

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14
Q

Heparin does NOT cross the placenta

A

.

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15
Q

Heparin resistance due to:

A
  • Increased concentration of Factor VIII.
  • Accelerated clearance of the drug with massive PE activates reticuloendothelial system ^ clearance
  • Inherited ATIII deficiency.
  • Acquired AT III deficiency in patients with cirrhosis, nephrotic syndrome or DIC.
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16
Q

Heparin Toxicity

A

-Bleeding (major bleeds in 1-33% of pts.)
-Thrombocytopenia (HIT)
-Abnl LFTs (increased transaminases)
Infrequent risk of osteoporosis and spontaneous vertebral fractures – (due to the fact that calcium is included in clotting cascade)

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17
Q

Look at slide 16

A

.

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18
Q

HIT reaction

A

Immune mediated response

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19
Q

Acts as a heparin antagonist by complexing with strongly acidic and anionic heparin to form a stable salt.

A

Protamine

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20
Q

LMWH: If emergency reversal is needed, protamine will neutralize about ____ of Anti-Xa activity of LMWHs.

A

65%

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21
Q

Protamine onset/Duration

A

Onset <5 mins, can last 2 hours

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22
Q

Look at slide 21-23

A

.

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23
Q

Protamine O.D.

A

Protamine may result in bleeding theoretically because it has anticoagulant and anti-platelet effects when given alone or in excess of heparin.

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24
Q

LMWH MOA

A
  • Inhibition of Factor Xa by antithrombin.

- Have some Factor IIa inhibition effect.

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25
Q

LMWH Adverse effects (3)

A
  • Thrombocytopenia (<1%)
  • Do not use in patients with HIT
  • Decrease dose in patients with chronic renal insufficiency
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26
Q

No effect on platelet function.

A

Fondaparinux (Arixtra)

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27
Q

Same risk of spinal or epidural hematoma as with LMWHs

A

Fondaparinux (Arixtra)

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28
Q

VTE px for adults in hospital for acute med illness only

A

Betrixaban (Bevyxxa)

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29
Q

If it has ”xa” in generic name, means _____ Xa inhibitor

A

oral

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30
Q

look at slide 33

A

.

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31
Q

Warfarin clotting factors take longer to regenerate

A

stop 5 days before procedure

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32
Q

Reverses Xa inhibitors, IIa inhibitors, Fondaparinux, and heparin. how does it bind?

A

Ciraparantag

Binds to anticoagulants through a hydrogen bond

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33
Q

look at slide 36-38

A

.

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34
Q

Used in place of heparin IV gtt in HIT pts

A

Argatroban

35
Q

Binds rapidly to the catalytic site/apolar region of both circulating and clot-bound thrombin.

A

Argatroban

36
Q

Argatroban Produces dose dependent increases in ? (4)

A
  • aPTT
  • ACT
  • PT
  • TT
37
Q

from leech spit

A

Hirudin analogs:

  • Bivalirudin (Angiomax ®)
  • Lepirudin (Refludin®)
38
Q

Hirudin Analog binds:

A

Binds irreversibly to the active catalytic and substrate-recognition sites of both circulating and clot-bound thrombin (Factor IIa).

39
Q

Indicated for thrombosis associated with HIT/HITTS

A

Hirudin Analogs

40
Q

Antihirudin antibodies form in ~40% of patients and may be associated with an increased anticoagulant effect of lepirudin.

A

.

41
Q

Look at slide 47-48

A

.

42
Q

Reverses Dabigatran (Pradaxa)

A

Idarucizumab (Praxbind ®)

43
Q

Warfarin MOA: Indirect anticoagulant that alters the synthesis of blood coagulation factors ___________ by interfering with the action of vitamin K. and also what else?

A

II, VII, IX, and X

As well as protein C and Protein S – natural anticoagulants**

44
Q

Pts are initially in a procoagulant state once warfarin is started until other factors become involved

A

.

45
Q

Look at slide 53

A

.

46
Q

Warfarin therapeutic range

A

2.5-3.5 for mech. Valve therapeutic 2-3 otherwise

47
Q

It’s a substrate, inducer, inhibitor – MANY DRUG INTERACTIONS

A

Warfarin

48
Q

Warfarin drug interactions (5)

A
  • Antibiotics
  • Other blood thinners, NSAIDs
  • Acetaminophen
  • Supplements (G supplements – garlic, gingko, ginseng)
  • Antiepileptics
49
Q

LMWH also keep patients out of the hospital instead of having to admit them to the hospital for heparin therapy.

A

.

50
Q

look at slide 71

A

.

51
Q

Absolute contraindications to thrombolytic agents

A
  • active internal bleed/sever trauma or surgery w/in 14 days
  • recent head trauma/CVA
  • BP >200/120
  • traumatic CPR
  • pregnant
52
Q

Relative contraindications to thrombolytic agents

A
  • chronic severe HTN
  • active Peptic ulcer disease
  • on anticoagulants
  • any other known bleeds
  • significant liver disease
  • if they’ve used streptokinase before.
53
Q

Procoagulant through plasmin inhibition

A

Epsilon Aminocaproic Acid (Amicar®)

54
Q

Big molecule brings in H2O to blood stream reducing viscosity

A

Low-molecular-weight Dextran

55
Q

Dextran-reactive___ antibodies present in most adults

A

IgG

56
Q

Rouleaux formation: what is it and side effect of what drug?

A

-May make subsequent cross-matching of blood difficult

Low-molecular-weight Dextran

57
Q 
Tranexamic Acid (TXA)
MOA: Competitive inhibitor of several plasminogen binding sites > reduced \_\_\_\_\_\_\_
A

plasmin

58
Q

Raplixa contains purified human plasma-derived _________ and

A

fibrinogen

thrombin

59
Q

Look at slide 84-85

A

.

60
Q

Which PCC contains heparin

A

Kcentra

61
Q

Kcentra contains what factors

A

II
VII
IX
X- inactive

62
Q

FEIBA contains what factors

A

II
VII (active)
IX
X

63
Q

Profilnine SD contains what factors

A

II
IX
X
(trace amts of VII)

64
Q

the most common inherited coagulation defect

A

Factor VIII - vWF

65
Q

look at slide 91

A

.

66
Q

connects platelets together

A

fibrinogen

67
Q

Which platelet aggregation inhibitor is reversible?

A

Ticagrelor (Brilinta®)

68
Q

Platelets exposed to ________ remain affected for the remainder of their lifespan

A

clopidogrel

69
Q

Stop Ticagrelor (Brilinta®) when?

A

5 days prior to surgery

70
Q

High risk side effect of diarrhea with?

A

Ticlopidine

71
Q

Reversible- platelet function returns to normal 1 hour after stopping infusion

A

Cangrelor (Kengreal)

72
Q

Determine when it is safe to proceed with surgery or regional anesthesia with platelet aggregation inhibitors when?

A

<20% inhibition

73
Q

Aggrenox®: contains

A
  • Dipyridamole pellets 200mg (slow release).

- ASA 25mg immediate release

74
Q

synthetic nonpeptide tyrosine derivative, rapidly reversible

A

Tirofiban (Aggrastat):

75
Q

synthetic cyclic heptapeptide, rapidly reversible

A

Eptifibatide (Integrelin):

76
Q

Fab fragment of a monoclonal antibody that binds selectively to GP IIb/IIIA receptors and dissociates slowly from it.

A

Abciximab (Reopro):

77
Q

NOT associated with an increased number of major bleeding episodes in patients requiring subsequent CABG surgery.

A

Platelet Glycoprotein (GP IIb/IIIa) Receptor Inhibitors

78
Q

Promotes platelet adhesiveness to the vascular endothelium

A

Desmopressin (DDAVP)

79
Q

Indwelling neuraxial catheters should be removed ___ hours after the last heparin dose and after evaluating the patient’s coagulation status.

A

2-4

80
Q

With newer drugs neuraxial blockade should be avoided until patients off of the drugs:

  • Clopidogrel/Prasugrel
  • Ticlopidyne
  • Abciximab
  • Eptifibatide and tirofiban
A

Clopidogrel/Prasugrel 7 days.
Ticlopidyne 14 days.
Abciximab 24-48 hours.
Eptifibatide and tirofiban 4-8 hours.

81
Q

SQ heparin:

No contraindication to the use of neuraxial techniques

A

.

82
Q

Look at slide 121

A

.

83
Q

Anticoags restart when

A

Restart 24 hours post-procedure (low bleed risk), 48-72 hours (high bleed risk)

My Pharm II (8 decks)

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