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34 Cards in this Set

  • Front
  • Back
Mechanism of heparin
Catalyzes activation of antithrombin III, decr thrombin and Xa
Clinical use of heparin
Immediate anticoag for PE, stroke, acute coronary symptom, MI, DVT
What lab test do you use when you are following heparin?
Is heparin safe to use in pregnancy?
Yes (can't cross placenta)
Toxicity of heparin
Thrombocytopenia (HIT)
Drug drug interactions
What do you use for reversal of rapid heparanization?
Protamine sulfate (positively charged molecule) acts by binding to negatively charged heparin
Difference b/w low molecular weight heparins and older hepatins
Act more on Xa
Have better bioavailability and 2-4x longer half life
Can be administered subq without monitoring
Not easily reversible
Heparin induced thrombocytopenia (HIT)
Heparin binds to platelets causing autoantibody production that destroys platelets and overactivates remaining ones, resulting in thrombocytopenic, hypercoagulable state
Lepirudin, bivalirudin
(a) mechanism
(b) clinical use
(a) directly inhibit thrombin
(b) used as an alternative therapy fro HIT patients
Warfarin (coumadin) mechanism
Interferes with normal synthesis and gamma carboxylation of vitK dependent clooting factors (II, VII, IX, X, protein C, S)
Which test is more affected by warfarin?
PT (follow INR as well)
Clinical use of warfarin
Chronic anticoagulation
Can you use warfarin in pregnancy?
No-crosses placenta
Toxicity of warfarin
Skin/tissue necrosis
Drug drug interactions
Alteplase mechanism
t-PA derivative
Convert fibrin bound plasminogen, thus targeting clots
Urokinase mechanism
Activates plasminogen to plasmin
Streptokinase mechanism
Activates plasminogen to plasmin
Clinical use for thombolytics
Early MI, early ischemic stroke
Thrombolytics (give major examples)
Streptokinase, urokinase, tPA (alteplase), APSAC (anistreplase)
Mechanism of thrombolytics (in general)
Directly or indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots
Incr PT and incr PTT
No change in platelet count
Toxicity of thrombolytics
Thrombolytics contraindicated in who?
Active bleeding
Hx of intracranial bleed
Recent surgery
Known bleeding disease
Severe HTN
Treatment for thromblytic toxicity
Aminocaproid acid (inhibits fibrinolysis)
Aspirin mechanism of action
Acetylates and irreversibly inhibits COX 1 and 2 preventing conversion of arachidonic acid to thromboxane A2
Bleeding time
PT/PTT don't change
Bleeding time incr
Clinical use of aspirin
Anti inflammatory
Antiplatelet drug
Toxicity of aspirin
Gastric ulcers
Reye's syndrome (in children)
Tinnitus (CN VIII)
Clopidogrel mechanism
Inhibit platelet aggregation by blocking ADP receptors; inhibit fibrinogen binding by preventing glycoprotein Iib/IIIa expression
Clinical use of clopidogrel
Acute coronary syndrome
Decr incidence or recurrence of thrombotic stroke in coronary stent
Ticlopidine mechanism
Inhibit platelet aggregation by blocking ADP receptors; inhibit fibrinogen binding by preventing glycoprotein Iib/IIIa expression
Ticlopidine toxicity
Abciximab mechanism
Monoclonal Ab that binds to glycoprotein receptor Iib/IIIa on activated platelets, preventing aggregation
Clinical use of abciximab
Acute coronary syndromes; percutaneous transluminal coronary angioplasty
Toxicity of abciximab
Bleeding, thrombocytopenia