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21 Cards in this Set
- Front
- Back
Primary hemostasis? Secondary?
How does uninjured epithelium resist platelet aggregation? White clot = ? Red clot = ? |
ii. Primary Hemostasis: first phase of the hemostatic response in which the platelet plug is formed at the site of vessel injury.
iii. Secondary Hemostasis: hemostatic plug is strengthened through the addition of fibrin. production of PGI2 and NO Arterial thrombus: Plt rich Venous: fibrin-rich |
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What goes the platelet receptor GPIba-V-IX do?
TXA2, P2Y12, PAR-1? GPIIb-IIIa? |
b/vWF factor for adhesion
They are activating receptors (TXA2, ADP, and Thrombin) This converts fibrinogen post-activation. |
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What are the three major classes of antiplatelet drugs? What do they do?
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Cyclooxgenase inhibitors
ADP receptor antag GPIIb-IIIA antag Inhibit platelet aggregation |
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Aspirin (ASA)
- mech? - uses? - side effects? - relative contraindications? |
*irreversible* COX1&2 inhibitor
unstable angina, MI, following TIA (ministroke) rash, bruising, tinnitus, gastritis use caution if administered w/ other anti-coags (omega-3 is an anticoag), GI irritants, or drugs w/ ototoxicity |
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Clopidogrel (Plavix)
- mech? - form? - uses? - reversible? - side effects? - resistance? |
inhibits P2Y12 (ADP receptor)
pro-drug: req liver metabolism *drug of choice w/ stenting* ACS pts that are at moderate-->high risk of MI no bleeding; use caution w/ other platelet inhibitors. 16% might be non-responsders |
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Abciximab, Eptifibatide, Tirofiban
- class/mech - uses? - administered how? - side effects? |
GPIIb-IIIA antag
PCI, unstable angina, MI IV only Bleeding |
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What is Aggrenox? purpose? uses?
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Aspirin (25mg) + dipyridamole (200mg) = aggrenox
"clot buster" reduces risk of stroke i/pts w/ TIA or those w/ previous strokeb |
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What are the requirements for clot formation? (4)
What assays are used to monitor the following: UFH, Warfarin, DTI D-dimer does what re: DVT? How do you detect a PE? |
Activator (TF or neg charged surface)
clotting factors (plasma) Phospholipid surface (platelet) Ca++ UFH & DTI: aPTT Warfarin: PT, INR Can rule out, not in. V/Q scan, CT, MRI, etc. |
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Place the following anti-coags in class 1, 2, or 3:
Warfarin Heparin LMWH Bivalirudin Fondaparinux |
1: LMWH, heparin, Fondaparinux
2: Warfarin 3: Bivalirudin |
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Heparins, the first stage of DVT tx, should be continued along with warfarin until INR has increased from ~1 to what? What should be done at that point?
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discontinue heparin, continue warfarin.
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What is Fondaparinux? What makes it unique? Side effects?
All heparins actv _____ by doing what? What does it do then? |
a class 1 (heparin) anticoag. It is smaller than even LMWH.
Makes AT that only targets FXa, it doesn't do anything to thrombin bleeding, fever, nausea, constipation, edema Antithrombin (AT) by providing a negative surface. AT then attacks thrombin and FXa (depending on the heparin) |
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Heparin
- mech - admin? - side effects? reversible? - given to whom? - monitored by what? |
provides a negatively charged actv for AT.
IV bleeding; yes, w/ protamine sulfate (+ charged) - HIT is bad, mmkay? DVT pts, and those undergoing CABG surgery. aPTT |
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LMWH
- uses? - monitored? - upsides re: heparin? - side effects? |
prevent DVT in hip/knee surgery
not routinely, but can use anti-Factor Xa assay. less HIT bleeding |
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Enoxaparin (Lovenox), Dalteparin (Fragmin), and Trizaprin (Innohep) are what?
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LMWH
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When are Class 2 (antiVit-K) anti-coags used? (2)
- admin? - target INR? - biggest effect on individual variation in dosing? - OD on warfarin occurs how? (2) - underdose? (3) - side effects? reversible? |
long-term prevention/tx of VTE
Stroke prevention in a.fib - mostly oral - b/t 2.0 and 3.0 - polymorphisms in cytoCh P450 blocking met/clearance low Vit-K increased clearance: - barbiturates blocking oral abs: - cholestryamine antagonism: - vit K supplements bleeding; yes, slowly with FFP |
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If a pt is on warfarin and needs elective surgery, what do we do?
What about emergency surgery? |
move to heparin and stop injections before surgery
use prothrombin complex concentrate (PCC) - a single dose recerses effects of warfarin w/i 30 minutes. |
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What is happening in HIT?
How do you anticoag pts with HIT? |
Ab development against the heparin-PF4 complex --> reduction in platelet #
DTIs |
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Bivalirudin, Peirudin, and Argatroban are which class of anti coags?
How soon is a therapeutic aPTT achieved with these drugs? mechanism? Does it affect clot-bound or free thrombin? Is it reversible? Does it depend on AT? Does it activate platelets? |
Class 3: DTIs
w/i 3 hours. Direct thrombin inhibitor Both! Yes. No. No. |
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Is thromboprophylaxis well-used? Current recommendations?
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No, underutilized, and when used isn't used long enough.
All hospitalized pts (medical) should reveive thromboprophylaxis. |
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Ticlopidine?
- mech - form - uses - reversible? - side effects? - resistances? |
inhibits P2Y12 (ADP receptor)
pro-drug: req liver metabolism ACS pts that are at moderate-->high risk of MI maybe stenting too, but that is more clopidogrel no bleeding; use caution w/ other platelet inhibitors. 16% might be non-responsders |
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Prasugrel
- mech - form - uses - reversible? - side effects? - resistances? |
inhibits P2Y12 (ADP receptor)
pro-drug: req liver metabolism ACS pts that are at moderate-->high risk of MI maybe stenting too, but that is more clopidogrel no bleeding; use caution w/ other platelet inhibitors. 16% might be non-responsders |