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49 Cards in this Set

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drugs used for prevention of clots
antiplatelets
drugs used to act on clotting factors
anticoagulants
drugs used to destroys clots
fibrinolytic agents
Vichow's triad
(1) veinous stasis
(2) injury
(3) hypercoaguability
the formation of an unwanted clot w/in the blood vessels or heart
thrombus
small part of a clot that breaks off and travels to another part of the vascular system
embolus
red thrombus
venous
white thrombus
arterial
released by adhered platelets to stimulate additional platelet aggregation
TXA2 and ADP
serves as the binding ligand for platelet aggregation
fibrin (from fibrinogen)
what adheres to platelets, causing the release of mediators?
vWF
what inhibits release of granules containing aggregating agents?
cAMP
what binds to platelets and causes cAMP synthesis?
Prostacyclin (PGI2)
arachidonic acid is converted to ___ by ___.
PGG2; COX
PGG2 is metabolized into ___, which promotes platelet clumping.
thromboxane A2 (TXA2)
COX is irreversibly inhibited by ___
ASA
ASA dose for prophylactic use (no MI)
81mg or 325mg qd
ASA dose for prophylactic use (MI)
160mg or 325mg qd
noncompetitive COX inhibitor
ASA
noncompetitive platelet ADP antagonist
Clopidogrel (Plavix)
indications for clopidogrel (plavix)
- if pt has CI to ASA
- /p MI, stroke, peripheral artery dz, unstable angina
Abciximab (ReoPro)
Eptifibatide (Integrilin)
Tirofiban (Aggastat)
glycoprotein IIb/IIIa inhibitors
fragment of a monoclonal antibody that causes binding of the active GPIIb/IIIa receptor site
Abciximab (ReoPro)
natural inhibitors of coagulation
- protein C
- protein S
- antithrombin III
indications for anticoagulants
- DVT (Hx)
- artificial heart valves
- atrial fibrillation
- protein C/S deficiencies
- prophylaxis after surgery
MOA of Heparin (UFH)
binds to antithrombin III and speeds its ability to inhibit thrombin
SEs of Heparin (UFH)
- bleeding
- HIT
- osteoporosis
- hyperkalemia
monitor Heparin (UFH) with
activated partial thromboplastin time (aPTT)
goal of Heparin tx
1.5 - 2.5x nml aPTT w/in 24 hrs
which Heparin work mainly on Xa?
LMWH
which Heparin has better bioavailability and more predictability?
LMWH
Indications for LMWH
- prophylaxis and tx of venous thromboembolism, unstable angina, and non-Q-wave MI
- pregnancy (doesn't cross placenta)
- use w/ ASA and warfarin
antidote for Heparin overdose
protamine sulfate
dose of protamine sulfate for heparin od
1 mg PS:100 units of Heparin
anticoag which inhibits vit K
Warfarin (Coumadin)
5-7 day steady state of warfarin (coumadin) is based on ___
half life of clotting factors
CIs for warfarin (coumadin)
- pregnancy (crosses placenta)
- avoid used w/ NSAIDS (GI bleeding)
INR goal for warfarin (coumadin)
INR of 2.5 (3.0 for prosthetic valve replacement pts)
Warfarin (Coumadin) monitored by
INR levels
antidote for warfarin (coumadin) OD
Phytonadione (Vit K)
How long after phytonadione (vit K) dose will coumadin remain ineffective?
2 wks
replacement drug for Heparin if HIT
Bivalirudin (Angiomax)
specific Factor Xa inhibitor
Fondaparinux (Arixtra)
How soon after clot should thrombolytics be given
w/in 12 hrs (best if w/in 3 hrs)
Indications for thrombolytics
- acute MI
- acute ischemic stroke
- PE
- clear CV catheter
thrombolytics
"-ases"
Streptokinase (Streptase)
Urokinase (Abbokinase)
Anistreplase (Eminase)
Alteplase (Activase)
Reteplase (rPA, Retevase)
thrombolytics
MOA for thrombolytics
dissolve clots by activating the conversion of plasminogen to plasmin that hydrolyses fibrin
Tx for intermittent venous claudication
Pentoxifylline (Trental) or Cilostazol (Pletal)