Pharm

Question 1

What is the mechanism of action of heparin

Answer 1

LMWH: binds antithrombin3 leading to inactivation of factor 10

Unfractionated: binds to anti thrombin 3 leading to inactivation of factor 10 and inhibits thrombin

Question 2

How is heparin administered, what are the differences between different types?

Answer 2

IV Administration

UF: bolts followed by infusion

F: subcutaneous injunction OD or BD

Question 3

What are the adverse effects of heparin?

Answer 3

Bleeding, bruising, heparin induced thrombocytopenia, osteoporosis (prolonged use), hyperkalaemia

Question 4

What are the contraindications for heparin use

Answer 4

Haemophilia, thrombocytopenia, peptic ulcers, bleeding disorders, alcoholism, uncontrolled hypertension, recent cerebral haemorrhage

Renal failure for LMWH

Question 5

What are the indications for use of heparin.

Answer 5

Prevention of thromboemboli, pre-surgery patients on warfarin do, DVT, PE, AF, MI, unstable angina, pregnancy adult peripheral arterial occlusion

Question 6

Name examples of different heparins

Answer 6

Deltaparin, enoxaparin, fondaparinux

Question 7

What is the difference between fractionated and infra tenanted heparin(chemical)? What is the effect on the use?

Answer 7

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

Question 8

What is the mechanism of action of heparin

Answer 8

LMWH: binds antithrombin3 leading to inactivation of factor 10

Unfractionated: binds to anti thrombin 3 leading to inactivation of factor 10 and inhibits thrombin

Question 9

How is heparin administered, what are the differences between different types?

Answer 9

IV Administration

UF: bolts followed by infusion

F: subcutaneous injunction OD or BD

Question 10

What are the adverse effects of heparin?

Answer 10

Bleeding, bruising, heparin induced thrombocytopenia, osteoporosis (prolonged use), hyperkalaemia

Question 11

What are the contraindications for heparin use

Answer 11

Haemophilia, thrombocytopenia, peptic ulcers, bleeding disorders, alcoholism, uncontrolled hypertension, recent cerebral haemorrhage

Renal failure for LMWH

Question 12

What are the indications for use of heparin.

Answer 12

Prevention of thromboemboli, pre-surgery patients on warfarin do, DVT, PE, AF, MI, unstable angina, pregnancy adult peripheral arterial occlusion

Question 13

Name examples of different heparins

Answer 13

Deltaparin, enoxaparin, fondaparinux

Question 14

What is the difference between fractionated and infra tenanted heparin(chemical)? What is the effect on the use?

Answer 14

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

Question 15

What is the mechanism of action of warfarin

Answer 15

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

Question 16

How do you monitor warfarin and why are you worried?

Answer 16

Bloods for INR

WARFARIN has small volume of distribution and can be affected by many factors which can effect coagulation

Question 17

What factors affect availability of warfarin

Answer 17

Disease that changes level of clotting factors I.e. Liver failure

CYP459 inducers and inhibitors

Question 18

What are the ADRs for warfarin

Answer 18

Teratogenic, bleeding, brushing, purpura, n&v diarrhoea, alopecia , pyrexia

Question 19

How is warfarin administered

Answer 19

Oral usually once daily

Question 20

What are the contraindications for warfarin use

Answer 20

Check risks 
Cerebral thrombosis
Peripheral arterial occlusion
Peptic ulcers
Hypertension
Pregnancy
Haemorrhagic stroke

Question 21

What are the indications for warfarin use

Answer 21

Prophylaxis in DVT, PE, AF, prosthetic heart valves

TIA,

Question 22

What class of drug is thrombin

Answer 22

Bit k inhibitor

Question 23

Why is it k important

Answer 23

Allows addition of gla domain on factors 2, 7, 9 and 10

Also important for proteins c and s