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