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