Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/95

Click to flip

95 Cards in this Set

  • Front
  • Back
Primary hemostasis

Secondary hemostasis
Platelet plug formation

Fibrin formation
Thrombi that form in arteries (high flow conditions)
Platelets predominate
Relatively little fibrin
“White thrombi”
Thrombi that form in veins (slow flow conditions)
Rich in fibrin and trapped red blood cells
Relatively few platelets
“Red thrombi”
2 types of antithrombotic drugs
Anticoagulant

Antiplatelet
Interfere with platelet plug formation
Effectiveness may be measured by a test known as a bleeding time
Antiplatelet drugs
Platelet plug formation consists of 3 processes
-Platelet adhesion
-Platelet activation and secretion
-Platelet aggregation
Responsible for platelet adhesion
Von Willebrand factor
Two pathways - extrinsic and intrinsic converge on _
Factor Xa
Measures the integrity of the extrinsic (tissue factor) and common pathways
PT + INR
Measures the integrity of the intrinsic (contact activation) and common pathways
aPTT- activated partial thromboplastin time
Test for low-molecular- weight heparin
Factor Xa inhibition assay
Test for unfractionated heparin
aPTT
Test for warfarin
PT + INR
Interfere with fibrin formation
Anticoagulant drugs
Irreversibly acetylates cyclooxygenase, thus inhibiting production of thromboxane A2 (TXA2) from arachidonic acid
Aspirin
Aspirin should be avoided in which conditions?
Avoid in patients with known allergy to ASA or history of asthma and nasal polyps
Inhibit ADP-mediated platelet activation
Thienopyridines - clopidogrel, ticlopidine
Side effects characteristic of ticlopidine
Severe neutropenia
Thrombotic thrombocytopenic purpura
-Proven to be slightly superior to ASA for secondary prevention following MI
-Also used following coronary stenting, and in combination with ASA in treating non-ST-elevation acute coronary syndromes
-Superior side effect profile (over ticlopidine)
-Once daily dosing
-Expensive (>$3.00 per 75 mg tablet)
Clopidogrel
-Worse side effect profile than clopidogrel
-Severe neutropenia
-Thrombotic thrombocytopenic purpura
-Twice daily dosing
Ticlopidine
Most effective antiplatelet drugs
GP IIb - IIIa inhibitors
Bind to receptors preventing fibrinogen-mediated platelet aggregation
GP IIb- IIIa inhibitors
Monoclonal antibody against receptors
Extended duration of antiplatelet action – bad if need to go to OR
Abciximab
GP IIb/IIIa inhibitors side effects
Bleeding

Thrombocytopenia (esp abciximab)
-Increases platelet cAMP levels
-Lowers cytosolic Ca++ concentration
-Reduces platelet aggregation
-Weak antiplatelet effect
-No proven clinical benefit as an antithrombotic when used alone
-May enhance effect of some other antithrombotics
Dypiridamole
Combine with antithrombin III, allowing to inhibit factor Xa
Heparin
Selectively inactivates factor Xa (not thrombin)
LMWH
Side effects heparin
Bleeding
Thrombocytopenia (HIT)
Osteoporosis (cumulative dose-dependent)
Skin necrosis
Alopecia
Hypoaldosteronism
Immediately reverses the anticoagulation effect of heparin
Protamine sulfate
- Binds to anti thrombin III
-Specifically inhibits factor Xa
-Does not inactivate formed thrombin
-Does not interfere with platelet function
-Does not cause HIT
-No known antidote – protamine wont work
Synthetic analog of heparin- Fondaparinux
Anticoagulant used for:

-Deep venous thrombosis (DVT) prophylaxis for hip and knee orthopedic surgery
-Treatment of DVT and pulmonary embolism
Fondaparinux
-Inhibit thrombin activity independently of antithrombin III
-Effective against circulating and clot-bound thrombin
-Do not cause heparin-induced thrombocytopenia (HIT)
-Primary indication is anticoagulation in patients with HIT, or a history of HIT
Direct thrombin inhibitors

Lepirudin
Bivalirudin
Argatroban
Main adverse effect of direct thrombin inhibitors
Bleeding
Inhibits formation of the reduced form of vitamin K (inhibits epoxide reductase)
Warfarin
Reduced form of vitamin K is necessary for conversion of coagulation factors _ into functional forms
II, VII, IX, X
has the shortest half-life of all of the vitamin K-dependent proteins
Protein C
Adverse effects warfarin
-Skin necrosis (rare) – penis in males, breast tips in females
-Bleeding (most common)
-Embryopathy (teratogenic)
Reverses warfarin’s effect within hours
Vitamin K
For emergencies/serious bleeding caused by warfarin
Transfusion of fresh frozen plasma (replenishes functional clotting factors)
Patient w/out "compelling indications" with HTN
Thiazide diuretics
Previous MI + HTN
-Beta blockers
-ACE inhibitors (if LV systolic dysfunction)
-ARB (if LV systolic dysfunction)
Exertional angina + HTN
Beta blockers, Ca channel blockers
Prinzmetal variant angina + HTN
Ca channel blockers
CHF + HTN
-ACE inhibitors OR ARB (if ACE inhibitor intolerant)
-Diuretics
-Aldosterone antagonist
- Beta blockers (if stable)
Dyslipidemia + HTN
-Alpha blockers
-ACE inhibitors
-ARB's
-Ca channel blockers
-Indapamide
Diabetes + HTN
ACE inhibitors
ARB's
Non-dihydropyridine Ca blockers
Thiazide diuretics
Beta blockers
Chronic kidney disease + HTN
ACE inhibitors, ARB's - DO NOT give in patients with bilateral renal artery stenosis, caution in hyperkalemia
Osteoporosis + HTN
Thiazide diuretics
BPH + HTN
Alpha 1 blockers
Migraine cephalgia + HTN
Beta blockers (non cardioselective), non-dihydroperidine Ca channel blockers
Avoid in gout + HTN
Thiazide diuretics
Avoid in asthma and severe COPD + HTN
Beta blockers
Avoid in depression + HTN
Central alpha agonists, reserpine, beta blockers
Pregnancy + HTN
Hydralazine + Alpha methyldopa
Avoid in pregnancy + HTN
ACE inhibitors
ARB
Caution in physical active athletes + HTN
High dose diuretics, beta blockers
Caution in sexually active men + HTN
Beta blockers
Thiazide diuretics
Avoid in truck drivers + HTN
Central alpha agonists
diuretics
African American + HTN
Thiazide diuretics, Ca channel blockers
Elderly with isolated systolic HTN
Diuretics

Dihydropyridine Ca channel blockers
Avoid in elderly with orthostatic HTN
Alpha blockers
Side effects Ca channel blockers
Cardiac arrest, bradycardia, AV block, constipation, PERIPHERAL EDEMA
Indication: LVH, diastolic dysfunction and/or arrhythmias

MOA: Negative inotropic, chronotropic, decreased AV node conduction

DI: reduce therapeutic dose of cyclosporine
Benzothiazepine- Diltiazem
Indication: Ca channel blocker of choice in CHF

MOA: Smooth muscle SELECTIVE, adjunct to beta blocker or ACE inhibitor

SE: Acute MI - reflex sympathetic activation

DI: GRAPEFRUIT JUICE --> increases bioavailability of the drug, less first pass effect
Dihydropyridine- Nifedipine
Indication: LVH, diastolic dysfunction and/or arrhythmias

MOA: Negative inotropic, chronotropic, decreased AV node conduction

SE: Constipation, DO NOT give to patients with heart block or CHF
Phenylalkylamine- Verapamil
Indication: PREGNANCY INDUCED HTN and HF with ACE inhibitors intolerance, severe HTN

SE: Headache, nausea,anorexia, palpitation, sweating, flushing and SLE LIKE FEVER
Hydralazine
Indication: REFRACTORY HTN

MOA: Opens K channels in smooth muscle membrane - inhibits contractions by hyperpolarization

SE: HIRSUTISM
Minoxidil
Indication: PHEOCHROMOCYTOMA (in operation)

MOA: Direct and indirect stimulation of cGMP -relaxation of smooth muscle in both arterioles and veins, increase CO in patients with HF

SE: CYANIDE ACCUMULATION, hypotension, metabolic acidosis, arrhythmia (reflex sympathetic activation)

Note: LIGHT SENSITIVITY - decomposes with light
Nitroprusside
Indication: Occasionaly hypertensive emergencies, HYPOGLYCEMIA

MOA: Increase K conductance in smooth muscle

SE: EXCESSIVE HTN, renal salt and water retention
Diazoxide
Indication: POST OP HTN + HTN emergencies

MOA: D1 agonist - DOPAMINE - relaxation of smooth muscle

C/I: DO NOT give in glaucoma
Fenoldopam
Indications: CONCOMITANT BPH, adjunct to Ca channel blockers or ACE inhibitors for resistant HTN

MOA: Decrease TPR, less tachycardia than phentolamine or phenoxybenzamine

SE: Fluid retention, tachycardia, fatigue, ORTHOSTATIC HYPOTENSION
Peripheral alpha 1 antagonists - PRAZOSIN, Doxazosin, Terazosin
Indication: Pheochromocytoma

SE: Tachycardia and postural hypotension
Combined alpha 1 and alpha2 antagonists - PHENOXYBENZAMINE + PHENTOLAMINE
Indication: Mild to moderate HTN

MOA: Decrease TPR and decrease in renal vascular resistance

SE/CI: DO NOT give in mental depression. Sedation, nightmares, mental depression, vertigo, LACTATION (in MEN)
Central alpha 2 agonists - ALPHA METHYLDOPA
Indication: LABILE HTN needing multiple drugs, MAINSTAY in HTN urgencies


SE: Dry mouth and WITHDRAWAL SYNDROME- DO NOT discontinue abruptly
Clonidine
Indication: Mild to moderate HTN

MOA: Inhibits VMAT - catecholamine depletion

SE: Sedation, nightmares and severe mental depression, diarrhea, GI cramps
Reserpine
Indication: Outpatient SEVERE HTN - long T 1/2

MOA: Displaces NE at the nerve ending

SE: Postural hypotension, delayed or RETROGRADE EJACULATION
Guanethidine
Indication: PRE OP MANAGEMENT OF PHEOCHROMOCYTOMA, chronic kidney disease, HTN emergencies, clonidine withdrawal


SE/CI: DO NOT give in people with asthma, COPD. Postural HTN, bronchospasm, heart block and heart failure
Combined alpha and beta blockers - LABETALOL, CARVEDILOL
Indications: 2nd or 3d line, concomitant HF or angina, HIGH RENIN HTN


MOA: Decrease CO --> decrease BP, inhibit renin production


SE: DO NOT give in patients with asthma or insulin dependent diabetes. Bradycardia, asthma, increased TG and decreased HDL
Beta blockers
Indications: CONCOMITANT ASTHMA, ISCHEMIC HEART DISEASE, CARDIAC ARRHYTHMIAS

SE: Bradycardia, heart block and asthma at high doses
Cardioselective beta blockers - METOPROLOL, BETOXOLOL
Indication: CONCOMITANT MIGRAINES, essential tremors and adjunct for reflex tachycardia

SE: Bronchospasm, heart block. DO NOT give in patients with bronchospastic pulmonary disease and insulin dependent diabetes
Non cardioselective beta blockers - PROPRANOLOL
Indication: First or 2nd line drugs. Concomitant HF, KIDNEY DISEASE, diabetes, adjunct in resistant HTN


MOA: Decrease TPR, no reflex sympathetic activation and save in ischemic heart diseases


SE: DO NOT give in 2nd/3d semesters of pregnancy. Initial dose hypotension, dry cough, angioedema, developmental defects and renal insufficiency.
ACE INHIBITORS
Indication: HTN

MOA: INHIBITS RENIN - similar to ACE inhibitors
Aliskiren
Indication: Resusciation from cardiac arrest, restoration of spontaneous circulatory function, ANAPHYLACTIC SHOCK

MOA: Increased inotropic and chronotropic effects + alpha mediated vasoconstriction --> raise BP, relax smooth muscle

SE: TACHYCARDIA, HTN crisis, CNS stimulation, angina pectoris, hyperglycemia

DI: Effects increased by cocaine, TCA's, MAO inhibitors, thyroid hormones
Epinephrine
Indication: CARDIAC ARREST, hypotension

MOA: Acts on ALPHA1, ALPHA2, BETA1 receptors
Norepinephrine
Indication: AV block, bradycardia, in emergency situations in anticipation of insertion of artificial pacemaker

MOA: Acts on BETA 1 and BETA2 receptors
Isoproterenol
Indication: Increase GFR, sodium diuresis

MOA: Dose dependent receptor specificity --> D1 >BETA1>ALPHA1, rapid metabolism by MAO/COMT
Dopamine
Indication: Severe HTN

MOA: D1 agonist
Fenoldopam
Indication: HEART FAILURE (IV)

MOA: Synthetic beta 1 agonist, can activate alpha 1 receptors, increases CO w/out effect on heart
Dobutamine
Indication: Postural hypotension

MOA: Stim alpha 1 - cause vasoconstriction - increase BP
Midodrine
Indication: hypotensive emergencies

MOA: Stim alpha 1 - cause vasoconstriction - increase BP
Phenylephrine
Methoxamine
Indication: Hypertension

MOA: Stimulate alpha 2 in CV control centers of CNS, decrease sympathetic outflow

SE: Sedation, sex dysfunction, DO NOT withdraw suddenly - REBOUND HTN
Clonidine, Alpha methyldopa
Indication: Pregnancy related HTN


MOA: Stimulation of alpha 2 receptors


SE: HEPATOTOXICITY, + COOMBS TEST - problem matching blood if need transfusion, hemolytic anemia
Alpha methyldopa
Indication: HTN

MOA: Decrease TPR

SE: 1st DOSE HYPOTENSION, tachycardia, Na/H2O retention
Prazosin, Doxazosin, Terazosin
Indication: Pheochromocytoma

MOA: IRREVERSIBLE BLOCKADE

SE: Reflex tachycardia, GI
Phenoxybenzamine
Indication: Prevent HTN when removing pheochromocytoma, diagnostic

MOA: REVERSIBLE BLOCKADE

SE: Reflex tachycardia, GI
Phentolamine