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42 Cards in this Set
- Front
- Back
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What are the anticoagulents that antagonize vitamin K?
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Warfarin
Phenindiones |
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What are the anticoagulents that inhibit serineproteases Xa and IIa via ATIIII?
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Unfractionated heparin
Low MW heparins |
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What are the anticoagulents that inhibit only factor Xa?
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Fondaparinux
Ritorixidan |
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What are the anticoagulents that inhibit only inhibit thrombin (factor IIa)?
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hirudin
Bivalirudin Argatroban |
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What are the anticoagulents that inhibit Va and VIIIa?
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Zygris (activated protein C concentrate)
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What is the mechanism of warfarin?
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Antagonize vitamin K:
Reduced II, VII, IX, X |
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What is the metabolism of warfarin?
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CYPs
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What are the targets for the vitamin K inhibitors?
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II
VII IX X |
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What is the effect of giving a vitamin K inhibitor on PT? PTT?
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Both will be increased
PTT is increased less. |
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How long does it take for the INR to readjust after a dose change of warfarin?
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2-3 days
It takes a while for the vitamin K levels to change |
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Who are particularly vulnerable to skin necrosis from warfarin?
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People with deficiencies in protein C, S
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What are some other factors that can effect prothrombin time?
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Liver disease
CHF Fever Hyperthyroidism Poor nutrition Vitamin K deficiency |
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What pathways are mutated that can cause differential responses to warfarin?
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VKOR
CYP2C9, 3 30% of caucasians carry a mutation in the C2 variants-->2-3x the risk of hemorrhage!!! |
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What ethnic groups are more likely to have mutations in VKOR?
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Asians
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What are the non-warfarin anticoagulents that require antithrombin 3?
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Heparin
LMWH Fondaparinux They're all derivatives of unfractionated heparin. |
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What are the different non-warfarin anticoagulents that don't require ATIII?
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Direct thrombin IIa inhibitor
Direct Xa inhibitor |
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Where does unfractionated heparin act?
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On factors:
Xa IIa |
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LWMH is more effective at inhibiting what type of factor?
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Xa
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What are the pharmacologic properties of LMWH vs heparin?
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Longer half life
Doesn't bind to plasma protiens Stable levels; not affected by other proteins No monitoring = less work! (unless kidney problems) |
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What's the mechanism of fondaparinus?
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Terminal pentasaccharide sequence
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What factor does fondaparinux target?
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Xa!
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What agent are you able to give to people with heparin-induced thrombocytopenia?
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Fondaparinux
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What are the pharmacologic properties of fondaparinux?
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1x/day
Sub q Don't need to monitor Not altered by plasma proteins, other meds Contraindicated in renal insufficiency |
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What are the direct thrombin inhibitors?
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Bivalirudin
Hirudin Lepirudin Argatrooban |
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What are the direct thrombin inhibitors?
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Hirudin
Argatroban |
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What is the mechanism of hirudin?
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Direct inhibitor of thrombin
BINDS IRREVERSIBILITY |
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What are the pharmacokinetis of hirudin?
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Long, non-linear plasma half life
Renally disposed of |
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What is the mechanism of bivalirudin? How was this achieved?
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Direct inhibitor of thrombin
Reversible binding They introduced into the drug the site that is cleaved by thrombin! Wouldja look at that |
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What is the use of bivalirudin?
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Angioplasty
Stents |
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What is argatrobn?
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Competitive inhibition of thrombin
Reversible |
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What are the pharmacokinetics of argatroban?
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Metabolized by the liver
Levels not affected by P450 inhibitors You MAY use it in people with renal dysfunction |
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What are contraindications for argatroban?
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Liver sisease
Hepatitis |
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What are indications for argatroban?
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Heparin induced thrombocytopenia
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What is the mechanism of dabigatran?
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Orally taken
No monitoring! Inhibition of thrombin |
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What are indications for dabigatran?
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Stroke prophylaxis
AFib prophylaxis DVT prophylaxis in Europe |
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What is the mechanism of rivaroxaban and apixaban?
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Inhibition of factor Xa
It's right in the name...how convenient! |
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What are indications for rivaroxaban?
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VTE prophylaxis
Stroke, embolization prevention in non-valvular Afib DVT, PE treatment |
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What are some meds that can be used on peopel who have renal dysfunction?
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Warfarin
Heparin Argabotran |
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What are the problems with rivaroxaban and pradaxa?
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You can't monitor them!
If the patient overdoses, there's no way to fix the problem. |
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What's the half-life of asprin?
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LOOOONG
You irreverisibly inhibit their platelet function |
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What are ADP blockers?
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Ticlopidine
Clopidogrel |
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What are the COX inhibitors?
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Aspirin
Sulfinpyrazone Aggrenox |
