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7 Cards in this Set
- Front
- Back
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Mechanisms of warfarin |
-Antagonist of vitamin K, vit K needed to synthesise clotting factors in the liver. In order to be reused it must be reduced by vit K epoxide reductase -Warfarin inhibits this enzyme, vit K gets used up, no further synthesis of the clotting factors can occur -Inhibits factors VII, IX, and II (inhibits vit K dependent factors) -Takes 3-5 days to have full effects whilst prev synthesised factors are used -Also inhibits protein C, an anticoagulant which requires epoxide reductase, effects more rapid so can have initial increased clotting |
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What does INR stand for and what are the target values |
-International normalised ratio, ratio of a persons clotting time to a standardised control clotting time. Looks at prothrombin time -Values untreated normally around 1.0, with warfarin aim is 2-3 sometimes 2-4 |
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Outline mechanisms for increased risk of VTE |
-Brianna has a history, hxt increases risk 3-4 fold -Pregnancy also increases risk compared to non-pregnant state by 4-5 fold. Pregnancy has: Hyper-coagulation, vascular damage and venous stasis. Progesterone relaxes veins and there is vasodilation especially in the legs causing pooling of blood. Also decreased mobility in pregnancy which can damage endothelial cells -This leads to relative increased risk for VTE due to hypercoagulation -P/N risk if smoking/obese/ had c/s and decreased mobility |
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Consequences of VTE for brianna and baby |
-Can lead to placental vascular thrombosis which can result in early-onset hypertensive disorders:PET, and SGA infants. Reduced perfusion to baby= IUGR -DVT 2nd most common cause of maternal death (in developed world) -Preg consequences: obstetric review and multidisciplinary care -Increased risk of pulmonary embolism and pulmonary hypertension which can lead to mortality -Venous insufficiency: will cause chronic pain, cramps, oedema, itchiness, staining of skin, venous ulcers |
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Main risks of anticoagulants |
-Main risks: haemorrhage, heparin induced thrombocytopenia, heparin known to cause osteoporosis, labour complications (bleeding) -Anticoagulants can produce placental haemorrhage and subsequent prematurity and fetal loss -Some anticoagulants can be teratogenic: warfarin embryopathy between 6-12wks (enoxaprin is category C) -Cross placenta can cause fetal bleeding and teratogenicity mainly in 1st trimester --Epidural not advised |
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Rationale for not using NSAID postnataly |
-Combining discouraged risk of increased bleeding due to drug interactions |
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Drug phase two trials, Brianna wants it, your response |
-Can't have it as in trial phase tested on limited numbers of people -Trial can continue for several years -High chance of failure -Funding not guaranteed -Risks de to possible unidentified adverse reactions putting her and baby at risk -Continue with current regime |
