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65 Cards in this Set

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Antidote for Warfarin?
Vitamin K
Antiplatelet COX-inhibitor?
Aspirin (ASA)
Antiplatelet ADP-R antagonists (3)?
Clopidogrel
Prasugrel
Ticlopidine
Antiplatelet GP IIb/IIIa
Receptor
Antagonists (3)?
Abciximab
Eptifibatide
Tirofiban
Antiplatelet Phosphodiesterase
Inhibitors (3)?
Anagrelide
Cilostazol
Dipyridamole
Miscellaneous Antiplatelet?
Pentoxifylline
Anti-coag Anti-Thrombin III
Enhancers (subtypes)?
Heparin
1. unfractionated heparin
2. LMWH's: Dalteparin
Enoxaparin
Tinzaparin
One subtype has three example drugs
(Anticoag) Vit. K Inhibitor?
Warfarin
(Anticoag) Thrombin inhibitors?
Argatroban
Bivalirudin
Desirudin
Lepirudin
Factor Xa Inhibitor?
Fondaparinux
Antidote for Heparins?
Protamine Sulfate!
Tissue Plasminogen Activators/Enzymes (thrombolytics)?
Alteplase
Reteplase
Streptokinase
Tenecteplase
Urokinase... just remember -ase!
Of the three "clotting" drug categories, which ones break up existing clots?
Thrombolytics only
What is the key platelet receptor for binding other platelets and fibrin?
GP IIb/IIIa receptor
Where does ASA work?
COX inhibition associated with ararchidonic acid
What group of drugs was developed from leech spit?
Thrombin inhibitors
What is the "natural clot buster"?
tissue plasminogen activator (tPA)
What is a big contraindication for thrombolytics?
active bleeding
When is anagrelide indicated?
thrombocythemia associated w/ myeloproliferative disorders
When is cilostazol indicated?
intermittent claudication associated w/ PVD
When is Dipryidamole idicated?
adjunctive prophylaxis of thromboembolism
What is the AA length req. for heparin to bind IIa and AT-III?
18 units
What state of clotting factors does warfarin interact with?
inhibits activation (not already activated) vit k-dependent factors
Where does warfarin work?
inhibits Vit K reductase and Vit. K epoxide reductase so Vit K can't carboxylate (and activate) thrombin
When is warfarin maximally effective?
after 5-7 days
Monitoring for ASA?
no common ones. can watch SCr
Life of platelets?
7-10 days
2 side effects of ASA?
GI effects and increased risk of bleeding
Who is ASA not recommended for?
asthma and bronchospasm
Warfarin/dicoumarol inhibit the activation of what 4 factors? How?
VII, IX, X, and thrombin via inhibition of a vit-k required enzymatic carboxylation in the liver.
What is the co-factor for AT-III?
heparin!
What lab test can measure the activity of AT-III?
TAT complexes (biochem question)
What lab test evaluates platelet function?
bleeding time
What factors require vit K to be activated?
2, 7, 9, 10
What lab test evaluates vit. k factors?
PT
What are normal and goal ranges for PT testing?
nl 10-13 sec, goal 15-26
How do you monitor warfarin therapy?
PT/INR
How do you monitor heparin therapy?
aPTT
What factors are monitored in aPTT?
2, 9, 10, 11, 12
What are normal and goal values for aPTT?
nl 30-50 sec, goal 50-70 (1.5-2 x normal)
What are the normal and goal values for INR? What about special circumstance pts.?
normal= 1.0, goal 2-3 (2.5 avg); in pts. w/ mechanical heart valve or not responding to 2.5 (still throwing clots), give 2.5-3.5 (3 avg).... boom
How do you monitor high dose heparin?
Activated clotting time (ACT)
What are normal and goal values for ACT?
nl 70-180 sec, goal 350-500
What drug blocks the formation of TxA2?
ASA
What 2 things often release arachidonic acid associated w/ clotting?
platelets and plasmas phospholipids
What is the MOA of clopidogrel?
inhibition of ADP binding to surface receptor resulting in irreversible inhibition of platelets
Pt. has an allergic rxn to your ASA therapy. What is a good alternative?
ADP antagonists
How do you monitor ADP-R antagonist therapy?
plts, CBC, LFT's
What is the MOA of abciximab?
inhibits GP IIb/IIIa receptor resulting in inhibition of receptor activation and binding w/ fibrinogen, vWF, and other platelets. nice
What antiplatelet drug is a monoclonal antibody?
abciximAB
how do you monitor CP IIb/IIIa antag therapy?
plts, Scr/BUN (renal excretion for eptifibatide & tirofiban)
What is the MOA for anagrelide, cilostzol, and dipyridamole?
inhibition of PDE3 resulting in decreased destruction of cAMP (inc. cAMP= vasodilation). each of these drugs has other effects of their own
How do you monitor PDE3 inhibitors?
AST/ALT for toxicity, SCr/BUN for dosing, and plts for efficacy (anag) or toxicity (cilost)
Cilostazol is not recommended in what setting?
CHF (exacerbate arrythmias)
What is the MOA of all forms of heparin?
binds AT-III, induces conformational change, enhancing binding to serine protease clotting factors (2, 9, 10, 11, 12, plasmin, kallikrein) ... and XIII inhibiting fibrin stabilization.... and higher MWUFH has anti-platelet effects
What should you give if you want to inhibit Xa and IIa equally?
UNFRACTIONATED heparin (LMWH cannot form tribond w/ IIa and AT-III)
Why is there a delay in the effects of warfarin (think what it effects)?
it inhibits ACTIVATION, not already activated factors
pt. is pregnant. warfarin or heparin?
heparin! (warfarin is in preg category x)
3 steps to treat warfarin toxicity?
hold dose (most likely... or low dose or who knows, it's up for debate), give vit k, give whole blood or FFP
What is the MOA for argatroban and leprirudin?
inhbit (irreversible in the case of lepridurin) thrombin and its effects.... so it also inhibits plts, V/VIII/XIII/ Prot C/ fibrin
How do you monitor thrombin-inhibitors?
H/H, plts, SCr/BUN or LFTs, but... it can effect allll coagulation tests
What is the MOA of fondaparinux?
SELECTIVE inhibition of AT-III mediated inhibition of factor Xa
How do you monitor Xa-inhibitors?
SCr/BUN, plts (for toxicity)
What is the MOA of streptokinase?
aids in the conversion of plasminogen to plasmin
How do you monitor tPA?
none routinely