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68 Cards in this Set

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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
What role of thrombin?
Converts fibrinogen to fibren (clot)
What is fibrinolysis
Process of dissolving a clto
Where are clots normally formed
LIVER
What are the vitamin K dependent clottting factors
II, VII, IX, X, and protein C&S
What does it mean they are Vitamin K dependent clotting factors
non-function without presence of Vitamin K
What is risk factors for Thrombosis
Surgeries, immbobility, age, obesity, pregnancy, estrogen use, cancer, trauma
What factors increase risk of DVT/PE from oral contraceptives
Dose of estrogen >50mcg
smoking status, age
What are the oral anti-coagulant medications
warfarin/ dibigatran
What are the available anti-coagulants parerteral
UFH, LMWH, Factor X inhibitors, DTI
What are the anti-platlet drugs
ASA, Aggrenox, Thienopridines (Plavix, Prasugrel, Ticlopidine), GIIB/IIa--Abcimax, Eftifibatide, Tirfiban
What are the Thrombolytics
Alteplase, Reteplase, Stretokinase, TNK, Urikinase
What is the only Vitamin K Antagoinst
Warfarin
What is the more active enatimoner of Warfarin
S-Warfarin
What is major pathway for warfarin for metabolism
CYP 2C9
What are the minor metabolic pathways
CYP1A1, CYP1A2, and CYP3A4
What are the MAJOR DI with warfarin
amidoarone, bactrim, metronidazole
What is the GOAL INR of warfarin
2-3
IF a patient has a clot, what should be given PRIOR to warfarin
UFH, LMWH, or DTI
Why does it take 5-7 days to achieve INR 2-3 for most patients
half life of clotting factors vary
Why must wafarin be bridge with other therpies for at least 2 days
becuase the shortest half life of Vitamin K dependent clotting factors is Protein C &S and they are inhibit clots
What is SE if you do NOT bridge thearpy and pt has clot
warfarin induced skin necosis
What is the reversal agent of warfarin
Vitamin K (Mephyton, Phytonadione
What is the prefered source of Vitamin K
ORAL--due to less variable response
What is BAD about giving vitamin K IV
rarely given b/c of risk of anaphylaxis

NOT give > 1mg/min
What are food interactions with vitamin K
Dark green leafy vegetables, spinach, green
Why do antibiotics interact with warfarin
bacteria in gut make vitamin K, and they are killed, so less vitmain K, higher INR
WARFARIN IS PREGNACY CATEGORY
X
What is MOA of UFH (Herparin
binds to ATIII, increases activity, and inhbits 1:1 ratio of factors Xa:IIa
What is dosing of Heparin for DVT prophylaxis
5000 Units q 12h or q8h
What is monitoring of Heparin
What are contraindications?
PTT, platets, Hgb/HCt, Renal function, BUN, Scr

Contraindications: Active bleedings, Uncontrolled HTN, History of HIT
How do you reverse UFH
FFP (50%)
What is the other reversal agents of UFH
protamine sulfate
What is protamine sulfate ratio
1mg will neutralize about 100 U of UFH
When is the ideal time to administered protamine sulfate
within 30 minutes
What is MOA of LMWH
Binds to ATIII increase activity, and inihbits factors Xa, and II a, inhibits factors Xa MORE!!
How are LMWH primarly administered
SC
What is the expection LMWH, that can be given IV
Lovenox during STEMI
Can LMWH be given IM
NEVER
Why is major reason to avoid use of LMWH in patients
CrCL <30
What is advantage of LMWH
LESS monitoring (aPPT not accurate)

only platlets Hgb/Hct, Renal function
Should you use extreme cautions of LMWH in patients with anesthesia/post-operative indewlling eipdural catheters
YES--result in a spinal hematoma, and result in long-term paralysis
What are risk factors for HIT
Source of Heparin (UFH), duration of expsoure (>4 days), past exposure, dose, and gender
What is treatment of HIT
STOP UFH/LMWH, until platlets above 100,000, and give DTI
What is the reversal agents for LMWH
FFP, and protamine
1mg will neutralize about 100U
What is different about administration of protramine for LMWH
give 1st 25-50 mg of protamin over slow IV infustion, and give remain over 8 hours infusion
What is the factor Xa inhibitor
Fondaparinux (Arixtra)
What is MOZ of Fondaparinux (Arixtra)
bind to ATIII, increases acitivty and selectivly inhibits factor Xa
What CrCl is Fondaparinux contraindicated in
CrCl <30
What is benefit of Fondaparinux
Like LMWH, less monitoring no PT, or ApTT
What are Direct Thrombin inhibitors
Argatroban, Bivalrudin, Lepirudin, Dabigatran, Lepirduin
What is MOA of DTI
directly inhibit Thrombin
What is BENFIT of DTI

MUST KNOW***
used in patients with ATIII deficiency or HIT
What is monitoring of DTI
aPPT, Hbg, HCt, Renal fxn
What is ROLE OF Dabigatran
used as an anticoagulaant in A-Fib
IS Dabigatran a pro-drug
YES
Does Dabigratran have as many drug interactions as warfarin, why or why not
NO--metabolized by glucoronidation
What is MOA of ASA
irrebersbile inhibiton COX, and inhibitrs prostalandin synthesis and inhibits platlet aggregation
What are major SE of ASA
bleeding, GI upset, ulcers, exacerbation of asthma, ACID-BASE disordres, and Reye's syndrome
What are the ADP inhibitors
Clopidogrel, Prasugrel, ticlopidine
What are irrversible platelet inhibitors (ADP), and why issue
Clopidorgrel, prasugrel, issue when surgery needed
Why is Ticlopdine not used much in practice
bone marrow suppresion
What ADP inhibitor has drug with PPI and why
Plavix (pro-drug need CYP2C19 to be active) and PPI inhibit CYP 2C19
What is main ROLE OF ADP inhbtiors
ACS, and post-sent
What is Plavix usually always given with
ASA
What is the most potent way to inhbit platelt aggreations
GPIIb/IIIa inhibitors
What are the GPIIb/IIIa inhibitors
Abcximab, eptifibatide, tirofiban
What is the irreversible GPIIb/IIIa inhibitor
Abxiximab (antibody)