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44 Cards in this Set

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step 1 for clot formation
______ damage
contact activation results in activation of ______ pathway, which is involved in ____ growth and maintenance
endothelial; intrinsic; fibrin
ADP stimulates _______ aggregation
_____ ____ activates the extrinsic pathway which initiates _____ formation
common pathway activates factor _____
platelet; tissue factor; fibrin; X (ten)
in the clotting cascase factor _____ has shortest half life and factor ____ has the longest half life
VII; X
predisposing conditions to clot formation
proglonged immboilization
surgery/post op period
trauma to lower limb
preg/contraceptives
heredity
CHF, MI, A-fib (turbulatory flow)
clotting factor deficiency
indications for anticoag therapy
PE, DVT, A-Fib, heart valve prosthesis, Acute MI, TIA, hip fx
MOA of heprin:

binds to antithrombin ____ and inactivates factors ____a, ____a, adn _____a

which results in _____ of clotting factor
III, X; XI, XII

depletion
route of admin for heparin
IV or SQ (prophylactic)
All heparins are excreted via
kidneys
loading dose for heparin
70-100 units/kg
maintenance dose for heparin
18 units/kg/hr
adjust dose based on
APTT (activated partial prothombin time)
want btwn 60-90 (test Q 6 hr)
monitor ____, look for signs of _____
CBC; blleding
adverse effects of heparin
hemorrhage; HIT (heparin induced thrombocytopenia); paradoxical thrombosis
tx for overdose:
protamine (antidote)
whole blood
fresh frozen plasma
examples of LMWH
Enoxaparin (Lovenox)
Dalteparin (Fragmin)
Ardeparin (Normiflo)(never used)
Tinzaparin (Innohep) (minimal use)
LMWH decreases the chances of _____
HIT
Fondaparinux (Arixtra)is a _____ and reults in no _____, it is indicated for prophylaxis of _____
heparinoid; TCP; DVT
LMWH is used in ___ tx by dosing 1mg/kg SQ Q 12 hours (Enoxaparin). No monitoring of ____ is needed. You must check _____-factor ___ assay
DVT; PTT; anti; X
Vit K is a ______ in the clotting cascade and is synthesized in the _____
cofactor; liver
Warfarin antagonizes _____, ____ vit K dependent coag factors (II, VII, IX, X, protein ____ and ____)
Vit K; depletes; C; S
Onset of action of warfarin is
1-2 days
True coag is obtained in ___-___ days
2-7
Warfarin is ____ absorbed, highly ____ bound, and metabolized in the _____
well; protein; liver
The therapeutic goal of warfarin is based on
dz your treating
test to assess anti-coag of warfarin
INR
(pt's PT(s)/mean normal PT (s))^ISI
isi= international sensitivity index
Dosing

NEVER _____ warfarin
load
warfarin should not be used for ____ pts; heparin is used instead
pregnant
smoking _____ metabolism of warfarin resulting in _____ clotting
increases; increased
start warfarin ____ day after initiating heparin
one
starting dose for warfarin
5-7.5mg/day
side effects of warfarin
bleeding; thrombocytopenia
drug interactions
enzyme inducers (antiepileptics); enzyme inhibitors (Cimetidine (Tagamet) antibiotic)
protein displacement (dig)
food interactions with warfarin

other interactions
vit k containing foods
antacids

smoking
signs of warfarin overdose
any unusual bleeding
blood in stools
excessive menses
bruising
excessive nose bleeds
persisent oozing from superficial wounds
bleeding from tumor, ulcer, lesion
tx for bleeding secondary warfarin
fresh frozen plasma
Vit K (small dose)(not fast enough for active bleeding)
some things that potentiate warfarin
I-etoh, amiodorone, ees
II-tylenol cipro, tcn, flu vaccine
III-asa, nalidixic acid
IV-cefamandole, cefazolin
things that inhibit warfarin
I-barbiturates, carbamazepine,
II-dicloxacillin
III-cyclosprine, trazadone
a derivate of hirudin (snake venom)
Lepirudin (Refludan)
Lepirudin can be used as an alternative to ______, it works in the prescence of ____, requires less _____
heparin; HIT; monitoring
examples of antiplatelet agents
asa
Thienopyridines
GPIIb/IIIa inhibitors
asa prevents platelet aggregation by blocking _____
TxA2
introduction of asa reduces relative risks of death by ___ by about 35-50%
MI
Thienopyridines inhibit ____ dependent activation of _____

examples of these are
ADP; GP IIb/IIIa complex

Ticolopidine-slow
Cloidogrel- (plavix) more active, better SE profile
these are useful in pts who are ______ to asa or predisposed to ___ bleeding
hypersenstive; GI