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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
LMWH Adverse effects (3)
- Thrombocytopenia (<1%) - Do not use in patients with HIT - Decrease dose in patients with chronic renal insufficiency
26
No effect on platelet function.
Fondaparinux (Arixtra)
27
Same risk of spinal or epidural hematoma as with LMWHs
Fondaparinux (Arixtra)
28
VTE px for adults in hospital for acute med illness only
Betrixaban (Bevyxxa)
29
If it has ”xa” in generic name, means _____ Xa inhibitor
oral
30
look at slide 33
.
31
Warfarin clotting factors take longer to regenerate
stop 5 days before procedure
32
Reverses Xa inhibitors, IIa inhibitors, Fondaparinux, and heparin. how does it bind?
Ciraparantag Binds to anticoagulants through a hydrogen bond
33
look at slide 36-38
.
34
Used in place of heparin IV gtt in HIT pts
Argatroban
35
Binds rapidly to the catalytic site/apolar region of both circulating and clot-bound thrombin.
Argatroban
36
Argatroban Produces dose dependent increases in ? (4)
- aPTT - ACT - PT - TT
37
from leech spit
Hirudin analogs: - Bivalirudin (Angiomax ®) - Lepirudin (Refludin®)
38
Hirudin Analog binds:
Binds irreversibly to the active catalytic and substrate-recognition sites of both circulating and clot-bound thrombin (Factor IIa).
39
Indicated for thrombosis associated with HIT/HITTS
Hirudin Analogs
40
Antihirudin antibodies form in ~40% of patients and may be associated with an increased anticoagulant effect of lepirudin.
.
41
Look at slide 47-48
.
42
Reverses Dabigatran (Pradaxa)
Idarucizumab (Praxbind ®)
43
Warfarin MOA: Indirect anticoagulant that alters the synthesis of blood coagulation factors ___________ by interfering with the action of vitamin K. and also what else?
II, VII, IX, and X As well as protein C and Protein S – natural anticoagulants**
44
Pts are initially in a procoagulant state once warfarin is started until other factors become involved
.
45
Look at slide 53
.
46
Warfarin therapeutic range
2.5-3.5 for mech. Valve therapeutic 2-3 otherwise
47
It’s a substrate, inducer, inhibitor – MANY DRUG INTERACTIONS
Warfarin
48
Warfarin drug interactions (5)
- Antibiotics - Other blood thinners, NSAIDs - Acetaminophen - Supplements (G supplements – garlic, gingko, ginseng) - Antiepileptics
49
LMWH also keep patients out of the hospital instead of having to admit them to the hospital for heparin therapy.
.
50
look at slide 71
.
51
Absolute contraindications to thrombolytic agents
- active internal bleed/sever trauma or surgery w/in 14 days - recent head trauma/CVA - BP >200/120 - traumatic CPR - pregnant
52
Relative contraindications to thrombolytic agents
- chronic severe HTN - active Peptic ulcer disease - on anticoagulants - any other known bleeds - significant liver disease - if they’ve used streptokinase before.
53
Procoagulant through plasmin inhibition
Epsilon Aminocaproic Acid (Amicar®)
54
Big molecule brings in H2O to blood stream reducing viscosity
Low-molecular-weight Dextran
55
Dextran-reactive___ antibodies present in most adults
IgG
56
Rouleaux formation: what is it and side effect of what drug?
-May make subsequent cross-matching of blood difficult Low-molecular-weight Dextran
57
``` Tranexamic Acid (TXA) MOA: Competitive inhibitor of several plasminogen binding sites > reduced _______ ```
plasmin
58
Raplixa contains purified human plasma-derived _________ and
fibrinogen thrombin
59
Look at slide 84-85
.
60
Which PCC contains heparin
Kcentra
61
Kcentra contains what factors
II VII IX X- inactive
62
FEIBA contains what factors
II VII (active) IX X
63
Profilnine SD contains what factors
II IX X (trace amts of VII)
64
the most common inherited coagulation defect
Factor VIII - vWF
65
look at slide 91
.
66
connects platelets together
fibrinogen
67
Which platelet aggregation inhibitor is reversible?
Ticagrelor (Brilinta®)
68
Platelets exposed to ________ remain affected for the remainder of their lifespan
clopidogrel
69
Stop Ticagrelor (Brilinta®) when?
5 days prior to surgery
70
High risk side effect of diarrhea with?
Ticlopidine
71
Reversible- platelet function returns to normal 1 hour after stopping infusion
Cangrelor (Kengreal)
72
Determine when it is safe to proceed with surgery or regional anesthesia with platelet aggregation inhibitors when?
<20% inhibition
73
Aggrenox®: contains
- Dipyridamole pellets 200mg (slow release). | - ASA 25mg immediate release
74
synthetic nonpeptide tyrosine derivative, rapidly reversible
Tirofiban (Aggrastat):
75
synthetic cyclic heptapeptide, rapidly reversible
Eptifibatide (Integrelin):
76
Fab fragment of a monoclonal antibody that binds selectively to GP IIb/IIIA receptors and dissociates slowly from it.
Abciximab (Reopro):
77
NOT associated with an increased number of major bleeding episodes in patients requiring subsequent CABG surgery.
Platelet Glycoprotein (GP IIb/IIIa) Receptor Inhibitors
78
Promotes platelet adhesiveness to the vascular endothelium
Desmopressin (DDAVP)
79
Indwelling neuraxial catheters should be removed ___ hours after the last heparin dose and after evaluating the patient’s coagulation status.
2-4
80
With newer drugs neuraxial blockade should be avoided until patients off of the drugs: - Clopidogrel/Prasugrel - Ticlopidyne - Abciximab - Eptifibatide and tirofiban
Clopidogrel/Prasugrel 7 days. Ticlopidyne 14 days. Abciximab 24-48 hours. Eptifibatide and tirofiban 4-8 hours.
81
SQ heparin: | No contraindication to the use of neuraxial techniques
.
82
Look at slide 121
.
83
Anticoags restart when
Restart 24 hours post-procedure (low bleed risk), 48-72 hours (high bleed risk)

My Pharm II (8 decks)

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