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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
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.
What are the three major classes of antiplatelet drugs? What do they do?
Cyclooxgenase inhibitors
ADP receptor antag
GPIIb-IIIA antag

Inhibit platelet aggregation
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
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
Abciximab, Eptifibatide, Tirofiban
- class/mech
- uses?
- administered how?
- side effects?
GPIIb-IIIA antag

PCI, unstable angina, MI

IV only

Bleeding
What is Aggrenox? purpose? uses?
Aspirin (25mg) + dipyridamole (200mg) = aggrenox

"clot buster"

reduces risk of stroke i/pts w/ TIA or those w/ previous strokeb
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.
Place the following anti-coags in class 1, 2, or 3:
Warfarin
Heparin
LMWH
Bivalirudin
Fondaparinux
1: LMWH, heparin, Fondaparinux
2: Warfarin
3: Bivalirudin
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?
discontinue heparin, continue warfarin.
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)
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
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
Enoxaparin (Lovenox), Dalteparin (Fragmin), and Trizaprin (Innohep) are what?
LMWH
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
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.
What is happening in HIT?

How do you anticoag pts with HIT?
Ab development against the heparin-PF4 complex --> reduction in platelet #

DTIs
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.
Is thromboprophylaxis well-used? Current recommendations?
No, underutilized, and when used isn't used long enough.

All hospitalized pts (medical) should reveive thromboprophylaxis.
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
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