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🄼💊 CARDIO PATH/RX > pharm- 9-23- HEPARIN Rx > Flashcards

pharm- 9-23- HEPARIN Rx Flashcards

1
Q

A: Describe composition of Regular Heparin

B: Where is it found

C: Acidic or Basic

A

A: Regular Heparin is composed of BOTH low AND High molecular weight components

B: Normally found in [mast cell granules] along with Histamine and Serotonin. (Extracted from Pig intestine and Beef lung)

C: ACIDIC

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2
Q

[1 Unit Heparin] = [___ µg Heparin] = [___ µg Protamine]

B: This means 1200 Units of Heparin can be neutralized with ____ mg of Protamine

A

[1 Unit Heparin] = [10 µg Heparin] = [10 µg Protamine]

B: This means 1200 Units of Heparin can be neutralized with 12 mg of Protamine

(Just move the decimal to the left 2 places)

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3
Q

5 Molecular Actions of Heparin

A

FN’ PLT

  1. Inhibits Factors 12A / 11A / 10A / [Thrombin Factor 2A]
  2. Stops Platelet Aggregation at High concentrations
  3. Neutralizes positive charge in vascular lining
  5. Stimulates release of [Tissue Factor Pathway Inhibitor - TFPI] –> Inhibits [Factor 10 and 9]
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4
Q

Heparin

A: Route of Administration (2)

B: Which 2 routes can you NOT use

C: Describe Heparin’s charge

D: Monitored using what test? What’s therapeutic range for Heparin?

A

A: Mostly IV but also SubQ sometimes

B: NO ORAL OR RECTAL

C: Highly charged at all pH’s

D: Because there’s poor correlation between pt weight and dose, heparin is Monitored using aPTT and Therapeutic range =

([2 - 2.5 seconds] x [Pt baseline aPTT])

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5
Q

HEPARIN

A: How is it metabolized (2)

B: Onset of Action

B2: Half life

C: MOA

C2: Heparin requires _____ before working

D: What 2 compounds neutralizes Heparin?

A

A: Hepatically metabolized by Heparinase into small componenets and 25% Excreted in Urine

B: Onset of Action = 5-10 min.

B2: Half life = 1-3 hours

C: MOA: Complexes with [AntiThrombin3] to speed up its inhibition of [Factor 10A] and [Thrombin Factor 2A]. Heparin requires [Heparin CoFactor 2].

D: Can be neutralized by [Platelet Factor 4] and [Protamine Sulfate]

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6
Q

4 Main Side Effects of Heparin

A
  1. Bleeding
  3. Osteoporosis with chronic OR large doses
  4. Alopecia with chronic doses
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7
Q

2 Main Indications of Heparin

A

A: Surgical/Prophylactic/Therapeutic Anticoagulation

B: Unstable angina and related coronary syndromes

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8
Q

Side Effects of [Protamine Sulfate] (2)

B: route of administration

A
  • Bradycardia
  • hypOtension
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9
Q

[Low Molecular Weight Heparin]

A: Route of Administration

B: 4 Reasons it’s superior to [Native Heparin]

C: Indications (3)

D: Generic Name

A

[Low Molecular Weight Heparin]

A: SubQ

B: 100% Bioavailability! (Heparin is less than 30%) + [longer duration of action] + Less thrombocytopenia + Less bleeding

C: “Low MW Heparin is an AID”

1) DVT Prophylaxis and Tx
2) Acute Coronary Syndrome
3) Interventional/Surgical CV procedures

D: Enoxaparin

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10
Q

When should you give just [AntiThrombin3] to a pt? (5)

B: Route of Administration

C: MOA

D: Side Effects

A
  1. Pt with acquired/congenital [AT3 Deficiency]
  2. Sepsis
  3. DIC
  4. Thrombophilia
  5. Hypercoagulable State

B: IV

C: DIRECTLY Inhibits [Thrombin Factor 2A]

D: NO SIDE EFFECTS

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11
Q

Hirudin

A: MOA

B: Route of Administration

C: Indications

D: Adverse Effects

E: Where is it extracted from

A

Hirudin

A: DIRECTLY inhibits [Thrombin Factor 2A]

B: IV

C: Anticoagulant for previous HIT pts

D: Bleeding

E: Leech Saliva (but is now offered as a recombinant)

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12
Q

Argatroban

A: MOA

B: Route of Administration

C: Indications

D: Adverse Effects

A

“the HAB gang”

Argatroban

A: DIRECTLY inhibits [Thrombin Factor 2A]

B: IV

C: Anticoagulant for previous HIT pts

D: Bleeding

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13
Q

Bivalirudin

A: MOA

B: Route of Administration

C: Indications

D: Adverse Effects

A

“the HAB gang”

Bivalirudin = Hybrid between Hirudin and Tripeptide

A: DIRECTLY inhibits [Thrombin Factor 2A]

B: IV

C:

  1. Anticoagulant for previous HIT pts
  2. PTCA anticoagulation

D: Bleeding

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14
Q

[Fondaparinux Pentasaccharide]

A: MOA

B: Route of Administration

C: Indications

D: Adverse Effects

A

[Fondaparinux Pentasaccharide]

A: Complexs with [AntiThrombin3] like Heparin but only inhibits [Factor 10A]

B: SubQ

C: DVT Management

D: Bleeding

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15
Q

Warfarin

A: Indications (2)

B: Monitoring

A

A: Prolonged Treatment and Prevention of DVT and aFib

B: PT / INR

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16
Q

Warfarin

A: MOA: Competitively antagonizes _____ for [____ VKORC] —> Inhibition of _______ (needed for __ binding) ] in [Factors ________]

B: Warfarin has a _____[fast vs. slow] onset of action so is NOT used for _______. Long Half-Life due to ___% binding to plasma ____.

C: Route of Administration

D: Elimination

A

Competitively antagonizes [Oxidized Vitamin K] for [Hepatic VKORC] —> Inhibition of [Glutamic Acid carboxylation (needed for Ca+ binding)] in [Factors 2/7/9/10]

B: Warfarin has a SLOW onset of action so is NOT used for acute situations. Long Half-Life due to 97% binding to plasma albumin.

C: ORAL

D: Hepatically hydroxylated –> inactive compounds but metabolism varies between pts

17
Q

Warfarin Therapeutic Range (2)

A

Warfarin

A: Therapeutic= ( [1.5 seconds] x [Pt baseline PT/INR] )

or

[2.5-3.5 INR post heart surgery]

18
Q

4 Side Effects of Warfarin

A
  1. Marked hypOproThrombinemia —> [ecchymosis/purpura/hematuria/hemorrhage]
  2. ALL ORAL ANTICOAGULANTS PASS PLACENTAL BARRIER —> Fetal Malformation
  4. Drug-Drug interaction
19
Q

Vitamin K

A. ____-SOLUBLE Vitamin found in ____\_and made by ____\_ microbiota. Structurally similar to ____\_.

B. MOA

C: Indications (3)

D: Side Effects

A

Vitamin K

A. MAINLY FAT-SOLUBLE Vitamin found in green vegatables and made by gut microbiota. Structurally similar to Warfarin.

B.[Reduced Vitamin K] participates in [Glutamic Acid Carboxylation] of [Factors 2/7/9/10] –> allows Ca+ to bind and activation

C:

1) hypOproThrombinemia
2) Gastrectomy and Intestinal Disorder
3) Reverses Warfarin (IV Vitamin K)

D: HEMOLYSIS IN INFANTS from IV Vitamin K

20
Q

A: Name the 3 [Anti-10A Oral Anticoagulants] and a brief description of their indication

B: MOA

C: Side Effects (3)

A

A: “ban the X (factor 10)”

  • RivaroXaban = [DVT px and tx] and stroke px in aFib pts
  • ApiXaban = stroke px in aFib pts
  • EdoXaban = stroke px in aFib pts

B: Inhibits [Factor 10A]

C:

(x) Bleeding
(x) Hepatotoxicity
(x) Rivaroxaban = 65% Renal Clearance = potential nephrocomplications in ESRD

21
Q

Dabigatran

A: MOA

B: Indications

C: Adverse Effects (4)

A

A: Oral AntiThrombin that inhibits [Thrombin Factor 2A]

B: stroke px in aFib pts

C:

  • Bleeding
  • Hepatotoxicity
  • 100% Renal Clearance = potential nephrocomplications in ESRD
  • Interacts with [Proton Pump Inhibitors]
22
Q

Heparin vs. Warfarin

A: Which inhibits coagulation in vitro?

B: Which Crosses Placenta

C: Which uses the Blood as [site of action]

D: Which is used for ACUTE situations

A

A: Heparin inhibits coagulation in vitro

B: Warfarin

C: Heparin

D: Heparin

23
Q

Tx for Warfarin OVERDOSE (3)

A
  1. IV Vitamin K
  2. [Factor 7A]
  3. Fresh Frozen plasma

🄼💊 CARDIO PATH/RX (22 decks)

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