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Pharmacology > Wk 14 Anti-Coagulants and Anti-Platelets > Flashcards

Wk 14 Anti-Coagulants and Anti-Platelets Flashcards

1
Q
  1. What are the two stages of hemostasis?
A

Formation of platelet plug, reinforcement of platelet plug with fibrin (Coagulation)

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2
Q
  1. How does heparin work as an anticoagulant?
A

Assists antithrombin in inactivating thrombin & factor Xa

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3
Q
  1. How does warfarin work as an anticoagulant?
A

Decreases synthesis of clotting factors dependent on vitamin K

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4
Q
  1. How do thrombolytic drugs work?
A

Promote conversion of plasminogen to plasmin

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5
Q
  1. Arterial thrombi cause what kind of injury?
A

Local injury

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6
Q
  1. Venous thrombi cause what type of injury
A

Distal injury

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7
Q
  1. Name the three categories of drugs for thromboembolic disorders? Where in the vascular system do they work?
A

Anticoagulants - veins
Antiplatelet agents - arteries
Thrombolytics – veins or arteries

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8
Q
  1. What factors does heparin deactivate? What does this prevent?
A

Assists antithrombin in deactivating thrombin & factor Xa to prevent more venous thrombi.

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9
Q
  1. What factor do low molecular weight anticoagulants deactivate?
A

Factor Xa

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10
Q
  1. Which anticoagulant can be given during pregnancy?
A

Heparin

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11
Q
  1. What is the antidote for heparin?
A

Protamine sulfate

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12
Q
  1. Which lab is used to monitor heparin? What is the recommended range?
A

aPTT 1.5-2X the control

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13
Q
  1. What potentially-fatal disorder occurs with heparin?
A

Heparin induced thrombocytopenia (HIT)

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14
Q
  1. List contraindications to heparin.
A

Thrombocytopenia; uncontrollable bleeding; surgery of eye, brain, or spinal cord; lumbar puncture or regional anesthesia

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15
Q
  1. List signs and symptoms indicative of bleeding?
A

Decreased BP, increased HR, bruises, petechiae, hematomas, red or black/tarry stools, discolored/cloudy urine, pelvic pain from ovaries, headache or faintness, lumbar pain from adrenal gland

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16
Q
  1. Discuss the proper administration of heparin SubQ.
A

Lower abdomen, rotate sites; no rubbing; no aspiration; 2” from umbilicus; 25-26 gauges, ½ to 5/8 needle; gentle, firm pressure for 1-2 min after.

17
Q
  1. List drugs which may increase bleeding with heparin.
A

ASA, antiplatelet drugs, NSAIDS, glucocorticoids

18
Q
  1. What is the antidote for low molecular weight anticoagulants?
A

Protamine sulfate

19
Q
  1. How does warfarin work?
A

Interferes with synthesis of Vitamin K-dependent clotting factors

20
Q
  1. Where in the vascular system does warfarin work?
A

Veins

21
Q
  1. How is warfarin distributed? Can it enter the placenta or breast milk?
A

Highly-protein bound, crosses placenta and enters breast milk

22
Q
  1. What lab is used to monitor warfarin therapy? What is the suggested range?
A

PT & INR; INR 2-3 (3-4.5 if mechanical heart valve or recurrent systemic embolism)

23
Q
  1. Which anticoagulant is Pregnancy Category X?
A

Warfarin (Coumadin)

24
Q
  1. What is the antidote for warfarin?
A

Vitamin K (phytonadione)

25
Q
  1. List contraindications to warfarin.
A

Active bleeding; severe thrombocytopenia; decreased synthesis of vitamin K (alcoholism, Vitamin K deficiency, liver disease); surgery of eye, brain, & spinal cord; lumbar puncture or regional anesthesia; pregnancy & lactation

26
Q
  1. What would you tell a patient on warfarin who wants to take Tylenol?
A

Need to monitor INR - 4 tablets a day for one week can increase risk of elevated INR by 10X (May need to lower warfarin dose)

27
Q
  1. What two drugs increase the synthesis of Vitamin K dependent clotting factors?
A

Vitamin K, oral contraceptives

28
Q
  1. What foods are high in vitamin K?
A

Spinach, kale, lettuce, turnips, greens, cabbage, watercress, peas, asparagus, broccoli, oats, whole wheat, green tea, mayonnaise, canola oil, soybean oil.

29
Q
  1. How does dabigatran (Pradaxa) work?
A

Directly binds thrombin, which prevents fibrin formation and activation of factor VIII.

30
Q
  1. What are the advantages of dabigatran (Pradaxa) over warfarin? Disadvantages?
A

Less bleeding, faster onset, no blood work, fewer food interactions, dosing not based on lab or weight. GI distress, no antidote, less experience, BID dosing.

31
Q
  1. How does rivaroxaban (Xarelto) work?
A

Directly inhibits Factor Xa, which prevents fibrin formation.

32
Q
  1. In what part of the vascular system do antiplatelet agents work?
A

Arteries

33
Q
  1. List three classes of antiplatelet agents.
A

ASA, P2Y12ADP receptor antagonists, glycoprotein IIb/IIIa receptor antagonists

34
Q
  1. How does aspirin work? How long are platelets affected?
A

Inhibits COX-1, decreasing platelet aggregation and vasoconstriction. 7-10 days

35
Q
  1. How do ADP receptor antagonists work? How long are platelets affected?
A

Block ADP receptors and prevents platelet aggregation (clopidogrel- Plavix). 5 days.

36
Q
  1. What is a significant adverse blood dyscrasia that may be caused by the ADP receptor antagonist, clopidogrel (Plavix)? What drugs may prevent its action?
A

Thrombotic thrombocytopenia purpura (TTP). Proton inhibitors may inhibit CYP2C19, which activates Plavix.

37
Q
  1. How do GP IIb/IIIa receptor antagonists work? Size of effect?
A

Blocks GP IIb/IIIa receptors & prevents fibrinogen bridges. Large effect, because final step in platelet aggregation.

38
Q
  1. What is the major adverse effect of thrombolytic therapy?
A

Serious bleeding

Pharmacology (25 decks)

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