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Clinical Therapeutics > Thromboembolic Disease > Flashcards

Thromboembolic Disease Flashcards

0
Q

This is a naturally occurring inhibitor of thrombin (factor IIa)

A

Anti thrombin

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1
Q

This is a rapid acting anticoagulant that exerts it’s effect in antithrombin

A

Heparin

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2
Q

Antithrombin inhibits what activated clotting factors that have a serine residue in at their enzymatically active centers

A

IXa
Xa
XIa
XIIa

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3
Q

Heparin binds at the ____ group of the AT that allows increase access of the ___ residue to the ___ group on the activated clotting factors

A

Lysine
Arginine
Serine

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4
Q

Commercial heparin is obtained from ____ or _____

A

Hog mucosa

Bovine lung

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5
Q

What is the average molecular weight of an unfractionated heparin

A

12000-15000 Dalton’s

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6
Q

What is the ideal route for heparin administration

A

Parenterally

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7
Q

Unfractionated heparin must not be administered ___ because of the risk of hematoma

A

Intramuscular

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8
Q

What cause the variation in heparin response and heparin resistance

A

Being bound to plasma proteins

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9
Q

Heparin resistance occurs when a patient requires greater than ____ units of heparin in a ___ hour periodto achieve a therapeutic aPTT

A

40,000

24 hour period

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10
Q

In the condition of a heparin resistance, heparin therapy should be adjusted to maintain the anti-factor Xa heparin concentrations of ___ to ___ IU per ml

A

0.4-0.7

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11
Q

Heparin is metabolized in the ___ and in the ___

A

Liver

Reticuloendothelial system

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12
Q

Heparin is excreted in the ___

A

Urine

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13
Q

The half life of anticoagulant effect of heparin in normal patients and in those with VTE is approximately ___ hours

A

1.5 hours

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14
Q

Even with a limited studies, patients with PE have a ___ heparin clearance and ____ in those with VTE

A

Greater

Shorter

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15
Q

What are the indication of UH treatment (7)

A 
Prevention and Treatment of VTE
Early treatment of unstable angina or acute MI
During a cardiac bypass surgery
Vascular surgery
During and after coronary angioplasty
Coronary stent
DIC
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16
Q

What is the starting dose of IV UH for the treatment of VTE and followed by:

A

80 units per kg

18 units per kg per hour

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17
Q

The UH dose should thereafter be adjusted to achieve and maintain a prolongation of the aPTT that corresponds to plasma heparin levels from ____ by the amidolytic assay

A

0.3-0.7 IU per mL anti-Xa activity

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18
Q

Heparin may also be given ____ in patients with VTE

A

Subcutaneously

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19
Q

What is the initial bolus of heparin given IV and it is followed by ___ units subcutaneously given ___ daily.

A

5000 units

17500 units

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20
Q

What therapy is initiated along heparin therapy

A

Warfarin therapy

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21
Q

Heparin therapy may be discontinued after __ to __ days when the INR is stable and greater than ___

A

4-5 days

Greater than 2

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22
Q

Before the initiation of heparin, these are the baseline clotting studies to be requested:

A 
PT
aPTT
Platelet count
Hemoglobin
Hematocrit
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23
Q

This is the standard test used to monitor heparin therapy:

A

aPTT

24
Q

This test is primarily used to measure of the competence of the intrinsic and common clotting pathways

A

aPTT

25
Q

aPTT is sensitive to the inhibitory effects of heparin on (3)

A

Antithrombin
Factor Xa
Factor IXa

26
Q

The aPTT is performed with a _____ plasma and so doesn’t reflect the activity of platelets

A

Platelet-poor

27
Q

The normal values if aPTT is between ____ seconds

A

24 - 36 seconds

28
Q

Historically, an aPTT of ____ times control was considered to be the therapeutic range for heparin

A

1.5-2.5 times

29
Q

The aPTT should be monitored ___ hours after the first dose, and subsequent doses should be adjusted accordingly.

A

6 hours

30
Q

The major adverse effect of heparin therapy is ___

A

Bleeding

31
Q

He risk of bleeding in heparin therapy increases with: (6)

A 
Dose
Concomitant thrombocytes therapy 
Recent surgery
Trauma
Invasive procedure
Hemostatic defects
32
Q

Other adverse effects of heparin therapy:

A

Osteopenia

Thrombocytopenia

33
Q

Osteopenia in heparin therapy is due to the binding of heparin into the ____ which release factors that activate _____

A

Osteoblasts

Osteoclasts

34
Q

Osteopenia in heparin therapy will cause reduction in bone density up to ___% of the patients and vertebral fractures occur in ___% of patients who take heparin for ___ month or longer

A

30%
2-3%
1 month

35
Q

Heparin induced thrombocytopenia is caused by an antibody to the ______ which is produced by ___

A

Heparin-platelet factor 4 complex

Activated platelets

36
Q

HIT typically occurs ____ days after the initiation of heparin therapy in patients with no previous exposure to heparin; may occur sooner within ____ of exposure in patients with previous exposure to heparin

A

4-10 days

Hours

37
Q

HIT is characterized by a ____% decreased in platelets from baseline and a platelet count of _____ or less in patients with or without VTE and a development of ____

A

30-50% decreased in baseline
50 x 10^3/mm3
New VTE in the presence of UH or LMWH

38
Q

Management if HIT includes (4)

A

Discontinuation of heparin
Alternative anticoagulant therapy (Lepirudin, Argatroban)
Avoidance of primary anticoagulant with WARFARIN
Avoidance of platelet transfusion

39
Q

At dose of nitroglycerin greater than ____ micrograms per minute and a ___ dose of heparin was required to achieve the same prolongation of the aPTT

A

350 micrograms

Higher dose

40
Q

This is given to neutralized heparin

A

Protamine sulfate

41
Q

If administered immediately after an IV bolus of heparin, ___ mg of protamine will neutralize approximately ___ units of heparin

A

1mg:100units

42
Q

Patients with ____ administration of heparin may require prolonged infusion of protamine

A

Subcutaneous

43
Q

This should be requested to assess the effectiveness of protamine therapy

A

aPTT

44
Q

In order to avoid hypotension and bradycardia this must be the infusion of protamine:

A

Infused slowly over 1-3 minutes (max 50mg within 10 minutes)

45
Q

In patients with allergic reaction to fish or previous exposure to protamine containing insulin this should be given:

A

Antihistamine

Corticosteroids

46
Q

These are glycosaminoglycans which are 1/3 the molecular weight of UH

A

Low molecular weight heparin

47
Q

The average molecular weight of a low molecular weight heparin

A

4000 to 5000 daltons

48
Q

Similar to UH, LMWH binds to ___ which enhances its activity against activated clotting factors especially factor ____

A

Antithrombin

Factor Xa

49
Q

LMWH has less affinity than UH for (6)

A 
Factor IIa 
Plasma protein
Macrophage
Endothelial cells
Platelets
Osteoblasts
50
Q

This characteristics gives LMWH a more predictable anticoagulant response

A

Less affinity

51
Q

This drug’s anticoagulant effect routine monitoring is unnecessary

A

LMWH

52
Q

The bioavailability of LMWH approaches around 100% after ____ administration

A

Subcutaneous

53
Q

The LMWHs are eliminated ___ and have a half life that ranges from ___ hours

A

Renal

3-7 hours

54
Q

Name the three LMWH

A

Enoxaparin
Dalteparin
Tinzaparin

55
Q

Enoxaparin and Dalteparin are indicated for: (3)

A
  1. Prevention of VTE in patients undergoing abdominal and hip replacement surgery
  2. Medical patients at risk of having VTE due to prolonged immobility
  3. Prevention of ischemic complications due to unstable angina or non-Q wave MI in conjunction with aspirin therapy
56
Q

These two drugs are implicated in the treatment if patients with DVT with or without PE in conjunction with Warfarin

A

Enoxaparin

Tinzaparin

57
Q

This drug is given in the prevention of VTE among patients undergoing knee replacement therapy

A

Enoxaparin

58
Q

The administration of LWMH is done ___ every ___

A

Subcutaneously

2-24 hours

Clinical Therapeutics (2 decks)

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