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68 Cards in this Set
- Front
- Back
When a blood vessel is injured it release chemicals (NO) which cause platlets to be active and release ADP, and stick to injuried site and each other, and what else happens |
factor X becomes active, which converts prothrombin to thrombin
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What role of thrombin?
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Converts fibrinogen to fibren (clot)
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What is fibrinolysis
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Process of dissolving a clto
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Where are clots normally formed
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LIVER
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What are the vitamin K dependent clottting factors
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II, VII, IX, X, and protein C&S
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What does it mean they are Vitamin K dependent clotting factors
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non-function without presence of Vitamin K
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What is risk factors for Thrombosis
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Surgeries, immbobility, age, obesity, pregnancy, estrogen use, cancer, trauma
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What factors increase risk of DVT/PE from oral contraceptives
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Dose of estrogen >50mcg
smoking status, age |
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What are the oral anti-coagulant medications
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warfarin/ dibigatran
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What are the available anti-coagulants parerteral
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UFH, LMWH, Factor X inhibitors, DTI
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What are the anti-platlet drugs
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ASA, Aggrenox, Thienopridines (Plavix, Prasugrel, Ticlopidine), GIIB/IIa--Abcimax, Eftifibatide, Tirfiban
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What are the Thrombolytics
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Alteplase, Reteplase, Stretokinase, TNK, Urikinase
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What is the only Vitamin K Antagoinst
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Warfarin
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What is the more active enatimoner of Warfarin
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S-Warfarin
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What is major pathway for warfarin for metabolism
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CYP 2C9
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What are the minor metabolic pathways
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CYP1A1, CYP1A2, and CYP3A4
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What are the MAJOR DI with warfarin
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amidoarone, bactrim, metronidazole
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What is the GOAL INR of warfarin
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2-3
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IF a patient has a clot, what should be given PRIOR to warfarin
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UFH, LMWH, or DTI
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Why does it take 5-7 days to achieve INR 2-3 for most patients
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half life of clotting factors vary
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Why must wafarin be bridge with other therpies for at least 2 days
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becuase the shortest half life of Vitamin K dependent clotting factors is Protein C &S and they are inhibit clots
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What is SE if you do NOT bridge thearpy and pt has clot
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warfarin induced skin necosis
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What is the reversal agent of warfarin
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Vitamin K (Mephyton, Phytonadione
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What is the prefered source of Vitamin K
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ORAL--due to less variable response
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What is BAD about giving vitamin K IV
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rarely given b/c of risk of anaphylaxis
NOT give > 1mg/min |
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What are food interactions with vitamin K
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Dark green leafy vegetables, spinach, green
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Why do antibiotics interact with warfarin
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bacteria in gut make vitamin K, and they are killed, so less vitmain K, higher INR
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WARFARIN IS PREGNACY CATEGORY
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X
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What is MOA of UFH (Herparin
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binds to ATIII, increases activity, and inhbits 1:1 ratio of factors Xa:IIa
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What is dosing of Heparin for DVT prophylaxis
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5000 Units q 12h or q8h
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What is monitoring of Heparin
What are contraindications? |
PTT, platets, Hgb/HCt, Renal function, BUN, Scr
Contraindications: Active bleedings, Uncontrolled HTN, History of HIT |
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How do you reverse UFH
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FFP (50%)
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What is the other reversal agents of UFH
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protamine sulfate
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What is protamine sulfate ratio
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1mg will neutralize about 100 U of UFH
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When is the ideal time to administered protamine sulfate
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within 30 minutes
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What is MOA of LMWH
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Binds to ATIII increase activity, and inihbits factors Xa, and II a, inhibits factors Xa MORE!!
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How are LMWH primarly administered
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SC
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What is the expection LMWH, that can be given IV
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Lovenox during STEMI
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Can LMWH be given IM
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NEVER
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Why is major reason to avoid use of LMWH in patients
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CrCL <30
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What is advantage of LMWH
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LESS monitoring (aPPT not accurate)
only platlets Hgb/Hct, Renal function |
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Should you use extreme cautions of LMWH in patients with anesthesia/post-operative indewlling eipdural catheters
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YES--result in a spinal hematoma, and result in long-term paralysis
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What are risk factors for HIT
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Source of Heparin (UFH), duration of expsoure (>4 days), past exposure, dose, and gender
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What is treatment of HIT
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STOP UFH/LMWH, until platlets above 100,000, and give DTI
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What is the reversal agents for LMWH
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FFP, and protamine
1mg will neutralize about 100U |
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What is different about administration of protramine for LMWH
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give 1st 25-50 mg of protamin over slow IV infustion, and give remain over 8 hours infusion
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What is the factor Xa inhibitor
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Fondaparinux (Arixtra)
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What is MOZ of Fondaparinux (Arixtra)
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bind to ATIII, increases acitivty and selectivly inhibits factor Xa
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What CrCl is Fondaparinux contraindicated in
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CrCl <30
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What is benefit of Fondaparinux
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Like LMWH, less monitoring no PT, or ApTT
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What are Direct Thrombin inhibitors
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Argatroban, Bivalrudin, Lepirudin, Dabigatran, Lepirduin
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What is MOA of DTI
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directly inhibit Thrombin
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What is BENFIT of DTI
MUST KNOW*** |
used in patients with ATIII deficiency or HIT
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What is monitoring of DTI
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aPPT, Hbg, HCt, Renal fxn
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What is ROLE OF Dabigatran
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used as an anticoagulaant in A-Fib
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IS Dabigatran a pro-drug
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YES
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Does Dabigratran have as many drug interactions as warfarin, why or why not
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NO--metabolized by glucoronidation
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What is MOA of ASA
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irrebersbile inhibiton COX, and inhibitrs prostalandin synthesis and inhibits platlet aggregation
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What are major SE of ASA
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bleeding, GI upset, ulcers, exacerbation of asthma, ACID-BASE disordres, and Reye's syndrome
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What are the ADP inhibitors
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Clopidogrel, Prasugrel, ticlopidine
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What are irrversible platelet inhibitors (ADP), and why issue
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Clopidorgrel, prasugrel, issue when surgery needed
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Why is Ticlopdine not used much in practice
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bone marrow suppresion
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What ADP inhibitor has drug with PPI and why
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Plavix (pro-drug need CYP2C19 to be active) and PPI inhibit CYP 2C19
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What is main ROLE OF ADP inhbtiors
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ACS, and post-sent
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What is Plavix usually always given with
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ASA
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What is the most potent way to inhbit platelt aggreations
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GPIIb/IIIa inhibitors
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What are the GPIIb/IIIa inhibitors
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Abcximab, eptifibatide, tirofiban
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What is the irreversible GPIIb/IIIa inhibitor
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Abxiximab (antibody)
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