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18 Cards in this Set
- Front
- Back
- 3rd side (hint)
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UFH
MOA Forms/monitor(why?) Metab/clearance size(why?) |
increased binding of antithrombin III to heparin like receptors (leads to inactivation of what?)
IV/SC only, and monitor using aPTT. -- no GI absorption Mainly renal first order kinetics 3,000-30,000 daltons (prevents absorption in preggers.. so safe) |
Increased Antithrombin III via Heparin like receptors inhibits clotting factors 2, 9, 10, 11, and 12. (mostly on intrinsic side)
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Heparin Sulfate uses:
Class? |
UFH class
Surgery hemodialysis DVT prophylaxis Venous thromboembolic DX Arterial thromboembolic DX Acute phase unstable angina Stroke evolution (while the clot is forming) Post MI arterial embolism of end organs. |
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UFH SE's
First choice for what condition? |
Bleeding! (reversed by?)
Heparin induced thrombocytopenia (platelett count for this?) Hypersensitivity (fever, chills, uticaria, vomiting/shock with HIT) First choice in PREGNANCY |
Protamine Sulfate
<150,000 = risk for heparin induced thrombocytopenia. |
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What are LMWH?
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fragments of UFH and approx. 1/3 the normal size of UFH.
What size are they then? |
1,000-10,000 daltons
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Advantages of LMWH over UFH?
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more predictable anticoag dose response.
improved SC bioavailability. Dose INdependent clearance Longer half life lowered risk of thrombocytopenia reduced need for lab testing (once level is set, it's normally stable) |
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LMWH Drugs
Generic and brand MOA? (third side) Contraindication? |
Enoxaparin - lovenox
Dalteparin - fragmin Tinzaparin - Innohep |
Increased antithrombin III activity leading to inactivate II, IX, X, XI, XII.
Avoid in those allergic to pork! |
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LVWH pharmacokinetics
why more predictable? Why better 1/2 life/clearance? Monitor what? (third side) |
bind less avidly than heparin = more predictable.
no endothelial cell binding (longer half life/dose independent clearance) |
monitor Hb, platelets, and FOBT.
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Fondaparinux
Brand/MOA/metab/form of admin Contraindications (third side) antidote? |
arixtra
selective factor Xa inhibitor (common pathway) Renal clearance (unchanged) SC only (NO IM!) |
X in...
renal impairment pts <50kg (110pnds) active major bleeds (duh) bacterial endocarditis thrombocytopenia PROTAMINE is NON effective as antidote. |
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indications for Arixtra
generic name? |
thromboprophylaxis after. .
-hip/knee fracture/replacement surgery. -abdominal surgery Tx of . . . -Acute DVT -Acute PE fondaparinox |
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Danapariod
Brand - info... |
Orgaran
like Avixtra but no longer avail. in the US. |
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Warfarin
Brand - potency of isomers - metab - absorp. 1/2 life - antidote - MOA. |
Coumadin
S isomer if 5x more potent metab by P450 - 2C9 GI absorption (oral) 36-42 hour half life Vit k, or products that contain vit. K. interferes with Vit. K interconversion to Vit K. Epoxide leading to dysfunctional clotting factors. (what are they? - side 3) |
II, VII, IX, X
& protein C/S |
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Misc. that potentiate warfarin
attenuate warfarin (side 3) |
acute alcohol intox.
cimetidine chloramphenicol contrimoxozole disulfiram metronidazole phenylbutazone |
attenuation
carbamazepine chronic alochol barb iturates glutethimide griseofulvin rifamipin cholestyramine |
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Normal therapeutic INR for warfarin.
exception and new target |
normal is 2.0-2.5
2.5-3.0 for anterior myocardial infacrtction (prevent recurrent infarct) 2.5 - 3.0 for mechanical prosthetic valves (high risk) |
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Warfarin indications
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prophylaxis and/or tx of...
-Venous thrombosis -pulmonary embolism -thromboembolic complications from AF or cardiac valve replacements reduce risk in MI, stroke. reduce risk of systemic embolization after MI. |
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Contraindications for Warfarin
part 1... |
pregnancy***
hemorrhagic tendencies or blood dyscrasias(cancer of blood cells) traumatic surgery with large open areas. surgery of CNS or eye |
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warfarin contraindictaions part 2....
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active ulceration/overt bleeding
senile, alcoholism, psychosis lack of cooperative pt. spinal pncture/procedures with severe bleeding potential. inadequate labs bacterial endo carditis |
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SE of warfarin
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hemorrhage fro any tissue/organ
necrosis of skin/other tissues systemic cholesterol microembolization alopecia purple toe urticaria gi intolerance. |
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Vitamin K (two types)
Form, when to use, and normal dialy intake. |
phytonadione/mephyton
avoid IV, especially with high INR. use when INR >5 normal dialy intake is 90mcg for females and 120 mcg for males. |
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