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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
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ADP stimulates _______ aggregation
_____ ____ activates the extrinsic pathway which initiates _____ formation common pathway activates factor _____ |
platelet; tissue factor; fibrin; X (ten)
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in the clotting cascase factor _____ has shortest half life and factor ____ has the longest half life
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VII; X
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predisposing conditions to clot formation
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proglonged immboilization
surgery/post op period trauma to lower limb preg/contraceptives heredity CHF, MI, A-fib (turbulatory flow) clotting factor deficiency |
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indications for anticoag therapy
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PE, DVT, A-Fib, heart valve prosthesis, Acute MI, TIA, hip fx
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MOA of heprin:
binds to antithrombin ____ and inactivates factors ____a, ____a, adn _____a which results in _____ of clotting factor |
III, X; XI, XII
depletion |
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route of admin for heparin
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IV or SQ (prophylactic)
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All heparins are excreted via
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kidneys
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loading dose for heparin
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70-100 units/kg
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maintenance dose for heparin
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18 units/kg/hr
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adjust dose based on
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APTT (activated partial prothombin time)
want btwn 60-90 (test Q 6 hr) |
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monitor ____, look for signs of _____
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CBC; blleding
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adverse effects of heparin
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hemorrhage; HIT (heparin induced thrombocytopenia); paradoxical thrombosis
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tx for overdose:
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protamine (antidote)
whole blood fresh frozen plasma |
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examples of LMWH
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Enoxaparin (Lovenox)
Dalteparin (Fragmin) Ardeparin (Normiflo)(never used) Tinzaparin (Innohep) (minimal use) |
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LMWH decreases the chances of _____
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HIT
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Fondaparinux (Arixtra)is a _____ and reults in no _____, it is indicated for prophylaxis of _____
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heparinoid; TCP; DVT
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LMWH is used in ___ tx by dosing 1mg/kg SQ Q 12 hours (Enoxaparin). No monitoring of ____ is needed. You must check _____-factor ___ assay
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DVT; PTT; anti; X
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Vit K is a ______ in the clotting cascade and is synthesized in the _____
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cofactor; liver
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Warfarin antagonizes _____, ____ vit K dependent coag factors (II, VII, IX, X, protein ____ and ____)
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Vit K; depletes; C; S
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Onset of action of warfarin is
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1-2 days
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True coag is obtained in ___-___ days
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2-7
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Warfarin is ____ absorbed, highly ____ bound, and metabolized in the _____
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well; protein; liver
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The therapeutic goal of warfarin is based on
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dz your treating
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test to assess anti-coag of warfarin
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INR
(pt's PT(s)/mean normal PT (s))^ISI isi= international sensitivity index |
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Dosing
NEVER _____ warfarin |
load
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warfarin should not be used for ____ pts; heparin is used instead
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pregnant
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smoking _____ metabolism of warfarin resulting in _____ clotting
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increases; increased
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start warfarin ____ day after initiating heparin
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one
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starting dose for warfarin
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5-7.5mg/day
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side effects of warfarin
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bleeding; thrombocytopenia
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drug interactions
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enzyme inducers (antiepileptics); enzyme inhibitors (Cimetidine (Tagamet) antibiotic)
protein displacement (dig) |
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food interactions with warfarin
other interactions |
vit k containing foods
antacids smoking |
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signs of warfarin overdose
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any unusual bleeding
blood in stools excessive menses bruising excessive nose bleeds persisent oozing from superficial wounds bleeding from tumor, ulcer, lesion |
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tx for bleeding secondary warfarin
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fresh frozen plasma
Vit K (small dose)(not fast enough for active bleeding) |
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some things that potentiate warfarin
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I-etoh, amiodorone, ees
II-tylenol cipro, tcn, flu vaccine III-asa, nalidixic acid IV-cefamandole, cefazolin |
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things that inhibit warfarin
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I-barbiturates, carbamazepine,
II-dicloxacillin III-cyclosprine, trazadone |
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a derivate of hirudin (snake venom)
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Lepirudin (Refludan)
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Lepirudin can be used as an alternative to ______, it works in the prescence of ____, requires less _____
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heparin; HIT; monitoring
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examples of antiplatelet agents
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asa
Thienopyridines GPIIb/IIIa inhibitors |
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asa prevents platelet aggregation by blocking _____
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TxA2
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introduction of asa reduces relative risks of death by ___ by about 35-50%
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MI
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Thienopyridines inhibit ____ dependent activation of _____
examples of these are |
ADP; GP IIb/IIIa complex
Ticolopidine-slow Cloidogrel- (plavix) more active, better SE profile |
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these are useful in pts who are ______ to asa or predisposed to ___ bleeding
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hypersenstive; GI
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