Pharm Flashcards
What is the mechanism of action of heparin
LMWH: binds antithrombin3 leading to inactivation of factor 10
Unfractionated: binds to anti thrombin 3 leading to inactivation of factor 10 and inhibits thrombin
How is heparin administered, what are the differences between different types?
IV Administration
UF: bolts followed by infusion
F: subcutaneous injunction OD or BD
What are the adverse effects of heparin?
Bleeding, bruising, heparin induced thrombocytopenia, osteoporosis (prolonged use), hyperkalaemia
What are the contraindications for heparin use
Haemophilia, thrombocytopenia, peptic ulcers, bleeding disorders, alcoholism, uncontrolled hypertension, recent cerebral haemorrhage
Renal failure for LMWH
What are the indications for use of heparin.
Prevention of thromboemboli, pre-surgery patients on warfarin do, DVT, PE, AF, MI, unstable angina, pregnancy adult peripheral arterial occlusion
Name examples of different heparins
Deltaparin, enoxaparin, fondaparinux
What is the difference between fractionated and infra tenanted heparin(chemical)? What is the effect on the use?
Unfractionated is a combination of different heparin compounds and so less predictable in terms of response with short half life I.e. Infusion and bolts
fractionated heparin are single compounds such as deltaparin or enoxaparin, fondaparinux and so have more predictable response and can be administered once or twice daily
What is the mechanism of action of heparin
LMWH: binds antithrombin3 leading to inactivation of factor 10
Unfractionated: binds to anti thrombin 3 leading to inactivation of factor 10 and inhibits thrombin
How is heparin administered, what are the differences between different types?
IV Administration
UF: bolts followed by infusion
F: subcutaneous injunction OD or BD
What are the adverse effects of heparin?
Bleeding, bruising, heparin induced thrombocytopenia, osteoporosis (prolonged use), hyperkalaemia
What are the contraindications for heparin use
Haemophilia, thrombocytopenia, peptic ulcers, bleeding disorders, alcoholism, uncontrolled hypertension, recent cerebral haemorrhage
Renal failure for LMWH
What are the indications for use of heparin.
Prevention of thromboemboli, pre-surgery patients on warfarin do, DVT, PE, AF, MI, unstable angina, pregnancy adult peripheral arterial occlusion
Name examples of different heparins
Deltaparin, enoxaparin, fondaparinux
What is the difference between fractionated and infra tenanted heparin(chemical)? What is the effect on the use?
Unfractionated is a combination of different heparin compounds and so less predictable in terms of response with short half life I.e. Infusion and bolts
fractionated heparin are single compounds such as deltaparin or enoxaparin, fondaparinux and so have more predictable response and can be administered once or twice daily
What is the mechanism of action of warfarin
Antagonism of bit k and so inhibiting gla addition to factors 2, 7, 9 and 10. Takes time to have an effect
Prothrombotic effect in the initial phase due to effect on protein C and S
How do you monitor warfarin and why are you worried?
Bloods for INR
WARFARIN has small volume of distribution and can be affected by many factors which can effect coagulation
What factors affect availability of warfarin
Disease that changes level of clotting factors I.e. Liver failure
CYP459 inducers and inhibitors
What are the ADRs for warfarin
Teratogenic, bleeding, brushing, purpura, n&v diarrhoea, alopecia , pyrexia
How is warfarin administered
Oral usually once daily
What are the contraindications for warfarin use
Check risks Cerebral thrombosis Peripheral arterial occlusion Peptic ulcers Hypertension Pregnancy Haemorrhagic stroke
What are the indications for warfarin use
Prophylaxis in DVT, PE, AF, prosthetic heart valves
TIA,
What class of drug is thrombin
Bit k inhibitor
Why is it k important
Allows addition of gla domain on factors 2, 7, 9 and 10
Also important for proteins c and s
