Anticoagulants/thrombolytics 547

Front 1

What three things does antithrombin III inhibit?

Back 1

Thrombin, Factor IX, Factor X

Front 2

___ performs clot dissolution.

Back 2

Plasmin

Front 3

Factor II is also known as what?

Back 3

Prothrombin; IIa is thrombin

Front 4

What factors in the coagulation cascade are vitamin K dependent?

Back 4

10, 9, 7 and 2

1972**

Front 5

The extrinsic pathway of the coagulation cascade is activated by what?

Back 5

Tissue/Vessel injury

Front 6

The intrinsic pathway of the coagulation cascade is activated by what?

Back 6

Blood coming into contact with collagen

Front 7

Describe the common pathway of the coagulation cascade

Back 7

Factor X > Prothrombin > Thrombin > Fibrinogen > Fibrin (clot)

Front 8

___ is required for most steps of the coagulation pathway

Back 8

Calcium

Front 9

___ and ___ inactivates factors V and VIIIa

Back 9

Protein C and Protein S

Front 10

Lab test that measures the extrinsic and common pathway function (vitamin K dependent factors)

Back 10

PT (INR) or prothrombin time

Front 11

Lab test that measures the intrinsic and common pathways. It is used to look at the efficacy of heparin.

Back 11

Activated partial thromboplatin time (aPTT)

Front 12

___ is used to monitor the function of warfarin or coumadin.

Back 12

INR

Front 13

Anticoagulant that potentiates antithrombin III in order to prevent growth and formation of formed thrombus and facilitates fibrinolysis. Prevents thrombus propagation but does not lyse existing thrombi. It must be given IV or subcutaneously.

Back 13

Unfractionated Heparin (UFH)

Front 14

Half life of UFH?

Back 14

30-90 minutes

Front 15

Elimination of UFH?

Back 15

Hepatic/renal

Front 16

Indications for heparin therapy

Back 16

DVT, PE, Acute coronary syndrome, venous thromboembolism prophylaxis

Front 17

UFH side effects

Back 17

Bleeding, thrombocytopenia (heparin-induced), hypersensitivity

Front 18

UFH antidote

Back 18

Protamine sulfate

Front 19

Indications for LMWH

Back 19

Same as UFH: DVT, PE, acute coronary syndromes

Front 20

Anticoagulant with a longer half life and better bioavailability than UFH. Works by inactivates factor Xa and potentiates antithrombin III (3)

Back 20

Low molecular weight heparin (LMWH)

dalteparin, enoxaparin, tinzaparin

Front 21

___ is less common when using LMWH when compared to UFH.

Back 21

Thrombocytopenia

Front 22

Factor Xa inhibitor that binds to antithrombin indirectly inhibiting the conversion of prothrombin to thrombin. It is used for DVT prevention for orthopedic procedures and acute coronary syndromes. It is given subcutaneously.

Back 22

Fondaparinux (arixtra)

Front 23

Oral factor Xa inhibitor. Initially used to prevent thrombosis after hip or knee replacement surgery. Also used for prevention of stroke in patients with atrial fibrillation. Bleeding is an adverse effect.

Back 23

Xarelto

Front 24

Factor X inhibitor used for stroke prevention in a-fib pts and used for post operation hip/knee replacement VTE prevention. It has some drug interactions so caution must be used in liver pts.

Back 24

Apixaban (eliquis)

Front 25

Direct factor X inhibitor used for thromboembolism prevention in nonvalvular a-fib pts with CrCl <95 mL/min. Also used for DVT/PE treatment.

Back 25

Edoxaban (savaysa)

Front 26

Anticoagulant agent that inhibits thrombin directly. Used for the management of pts with heparin-induced thrombocytopenia.

Back 26

Dabigatran, argatroban, bivalirudin

Front 27

Most widely prescribed oral anticoagulant

Back 27

Warfarin/coumadin

Front 28

Anticoagulant that functions by inhibiting the enzymes necessary for vitamin K activation. Used for the prevention and treatment of VTE as well as to prevent the embolic complications of atrial fibrillation, heart valve replacement and MI.

Back 28

Warfarin/coumadin

Front 29

Warfarin is category ___.

Back 29

X - teratogenic

Front 30

Warfarin binds extensively to what blood protein?

Back 30

Albumin

Front 31

What is the target INR for warfarin? How often should INR be tested?

Back 31

2.5 (2-3 range) - determined every 7-14 days

Front 32

Warfarin adverse effects

Back 32

Bleeding, purple toe syndrome, skin necrosis in areas of subcutaneous fat, GI issues

Front 33

Warfarin antidote

Back 33

Vitamin K PO

Front 34

This enzyme derived from beta-hemolytic strep activates plasminogen. When it is used, a loading dose is required.

Back 34

Streptokinase - can only be used once as body will create antibodies for the drug

Front 35

These drugs are tissue plasminogen activators. They bind to fibrin and activates plasminogen bound to fibrin (3).

Back 35

Alteplase, reteplase, tenectaplase

Front 36

When are thrombolytics used?

Back 36

Acute MI with ST elevation, ischemic stroke, some cases of massive pulmonary embolism

Front 37

Thrombolytic contraindications (4)

Back 37

Previous hemorrhagic stroke, known intracranial neoplasm, active internal bleeding, suspected aortic dissection

Front 38

These drugs are glycoprotein IIb/IIIa inhibitors used with heparin for PCTA and medical management of acute coronary syndrome (3)

Back 38

Abciximab, eptifibatide, tirofiban

Front 39

Medication that blocks cyclooxygenase in platelets (which synthesizes thromboxane A2, a platelet aggregator). Used for treatment of stroke and heart attacks.

Back 39

Aspirin

Front 40

How long is the action of aspirin

Back 40

Permanent for the life of a platelet

Front 41

Aspirin adverse effects

Back 41

GI upset, vomiting, tinnitus

Front 42

Antiplatelet that blocks platelet ADP receptors. Used in the prevention of thrombosis in PTCA, reduce atherosclerotic events in pts with recent MI, CVA, PAD. Its activation is inhibited by proton-pump inhibitors.

Back 42

Clopidogrel (Plavix)

Front 43

AE of clopidogrel

Back 43

Purpura, GI upset

Front 44

Clopidogrel is a prodrug that must be activated by what?

Back 44

The liver

Front 45

Antiplatelet for use in pts who undergo angioplasty. Often used for pts who are unable to take clopidogrel. It is an ADP inhibitor.

Back 45

Prasugrel (effient)

Front 46

Antiplatelet indicated for the prevenetion of cardiovascular events (stent, thrombosis, cardiovascular death, heart attack) in adults with ACS. Increases the risk of bleeding, dyspnea and bradycardia. It is an ADP inhibitor.

Back 46

Ticagrelor (brilinta)

Front 47

First injectable P2Y12 platelet receptor inhibitor to be approved by the FDA. Given for pts getting PCI for ACS.

Back 47

Cangrelor (Kengreal)

Front 48

Antiplatelet medication that is a reversible antagonist of the protease-activated receptor expressed on platelets. It is used in the prevention of thrombotic cardiovascular events in patients with a history of MI or with peripheral artery disease, with aspirin and/or clopidogrel at their usual doses. It is used for pts who don't respond to aspirin or ADP receptor blockers

Back 48

Vorapaxar (zontivity)

Front 49

Treatment for megaloblastic or pernicious anemia

Back 49

Vitamin B12 - cyanobalamin

Folic acid for megaloblastic anemia