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62 Cards in this Set
- Front
- Back
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what are the 2 clotting systems?
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thrombin system cascade, platelets
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where is platelets made?
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bone marrow
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what is the primary clotting mech in the veins? arteries?
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thrombin in veings, platelets in arteries
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know the clotting cascade
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k
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heparin onset of ation IV?
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immediate
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heparing mech of action,
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potentiates the action of antithrombin thereby inactivating Xa, IIa, 9a, 11a, 12a
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half life heparin?
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1.5hours
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about what percentage of heparin are able to inactivate?
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33%
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CI to heparin?
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uncontrolled bleeding, thrombocyto, intracranial hemmhorage, HIT hx, hemophilia, malignant htn
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when should APTT be checked?
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6 hours post dose, q6h until therapeutic
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what baseline measures should be taken for heparin?
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plt, hgb, hct
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what meds mentioned as increased bleeding risk for hepain?
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asa, nsaids, clopidogrel, ticlopidine, prasugrel, warf, gingko, garlic, red clover, green tea, ginseng, MTT cephs
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type 1 vs type 2 HIT
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type 1: non immune, transient clumping, occurse withing first few days of therapy, can continute...type 2: IgG mediated, antibody hep complex, clinical consequences MI, stroke, skin necrosis, happens 5-15 days later, 50% fall or under 100k, cross reactivity with LMWH
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what is the antidote for hep overdose? dose?
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protamine sulfate, 1mg IV for 100units hep, max dose 50mg
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hep dosing, institution specific
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k
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what is the change in activity from hep to LMWH
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more 10a than 2a
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half life lmwh?
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4-6 hours
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when giving lmwh what is something to consider?
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dont give the air bubble first
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what is the dosing weight for hep and lmwh?
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actual
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name the 3 lmwh?
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dalt (fragmin, enox (levenox), tinz (innohep
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CI to lmwh?
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hypersens to port, active bleed, hx of HIT
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what is the monitoring of lMWH?
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aptt not usefull, antiXa for certain populatin, baselines hgb, hct, plt
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what is the BBW of lmwh and fonda?
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if recent or anticipated neuraxial anesthesia (epidural or spinal anesthesia) at risk of hematoma or paralysis
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pt counseling for lmwh
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self injection instructions, may take longer than usual to stop bleeding, ask healthcare provider prior to starting new medications (increased bleeding), you may bruise more easily, tell doctors and dentists you are taking this....wash and dry hands, poke left or right of naval (2 inches from), clean with alcohol swab, air bubble issues, holf syringe like a pencil, press on plunger until empty, pull out straight, dont rub the injection site (more bruising), put used syringe in sharps container
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fonda MOA?
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pentasaccharide that inhibits factor Xa vit ATIII
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fonda clearence?
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renal
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brand of fonda
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arixtra
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CI to fonda arixtra
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crcl under 30, active bleed, bacterial endocarditis, thrombocyto, body weight under 50kg for prophy
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what are 5 advantages with DTI?
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inh thrombin directly, inh clot bound and free thrombin, no cross reactivity with HIT, not inactivated, less likely to cause rebound coag after D/C
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what is the antidote of DTI?
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none konwn
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what are the 3 DTI?
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lepirudin, argatroban, bivalirudin
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brand of argatroban? vivalirudin
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novastan, angiomax
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elimination of lepirudin? argatroban?
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renal, hepatic
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Half life of argatroban, lepirudin
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arg: 0.5-1hr...lepirudin: 1-2
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what populations does the ACCP guidelines rec starting at 5mg or lower?
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elderly, debilitated, malnourished, interacting meds, liver disease, recent major surgery, CHF
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half life of warfarin?
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40hours
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BBW of warfarin?
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can cause bleeds
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AE of warf?
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bleeding, necrosis (onset 3-10 days), purple toe syndrome, preg cat X
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genetics of warfarin?
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cyp2c9 2 or 3 allele of VKORCI increases risk of bleeding
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what bacterial infectoin is CI for DTI and war and hep?
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bacterial endocardiits
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inxns?
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S isomer is 2c9 sup...lots
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warf pt counseling
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k
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process if overcoagulated
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k
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perioperative management, when to stop the warf?
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5 days prior to major surg
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bridging guidelines if periop stop the warf?
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if mod to high embolic risk, bridge to LMWH or UFH IV...
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periop of LMWH?
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stop 24 hours prior to surg
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periop of UFH?
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stop 4 hours prior
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when to resume warf after surg?
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12-24hours later, when adequate hemostasis
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when to resume LMWH fter surg
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24 hours for minor, 48-72 after major
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when to stop antiplat prior to surg?asa, clopidogrel, praugrel
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5-10 days prior,
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what should asa or warfarin pts do if going for dental, derm or cataract surg?
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nothing, continue...cont prasugrel or clopidogrel only in high risk pts
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reveiw the chest guidelines for afib pg 192
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pg 192
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intrinsic vs extrinisic
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ext: trauma...intrin: damaged surface
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common pathway of coagulation?
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prothromgin (II) to Thrombin IIa....which helps fibrinogen go to fibrin...cross linked fibrin clot
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which factors are effected by heparin?
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potentiates antithrombin (III) which inactivated thrombin IIA and Xa and 9a,11a, 12a
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lmwh is same moa as hep except more Xa action
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l
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what to do if INR supratherapeutic but under 5?
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lower dose or ommit
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INR 5-9 no sig bleeding
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omitt 1-2 doses OR give vit K 1-2.5mg ORAL
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INR over 9 NO significant bleeding
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hold war and give ORAL vit K 2.5-5mg, resume when therapeutic
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if elevated INR and BLEEDING what do do?
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hold warf, give vit K 10mg IV, poss FFP, poss prothrombin complex concentrate, possible factor 7a, repeat q12 hours as needed
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if life threatening bleeding and elevated INR?
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ffp, prothrombin complex, or recomb factor 7a with vit K 10mg slow IV infusion
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what dosage administratiosn should vit K get?
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only IV and oral...SC bad due to variable absorption....IM is hematoma risk
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