Shared Flashcard Set

Details

Anticoagulant Drugs
Creighton University School of Medicine
62
Medical
Professional
09/12/2013

Additional Medical Flashcards

 


 

Cards

Term
Heparin (moa)
Definition
Activates antithrombin (which inhibits Factors 9, 10, 11, 12, and thrombin)
End result being inhibition of prothrombin to thrombin and fibrinogen to fibrin
Term
Heparin (pharmacokinetics)
Definition
Administered IV, or SC
Term
Heparin (toxicities)
Definition
Bleeding
HIT
osteoporosis
drug-drug interactions
Reverse with: protamine sulfate
Term
Heparin (monitoring)
Definition
Monitor by partial thromboplastin time (PTT, or aPTT)
Term
Heparin (clinical use)
Definition
Pulmonary embolism, evolving stroke, DVT, MI, DIC (I guess...)
Can be used during pregnancy
Term
LMWH (examples)
Definition
enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep)
Term
LMWH (moa)
Definition
Works with antithrombin to inhibit Factor X, but not thrombin
Term
LMWH (pharmacokinetics compared to heparin)
Definition
Longer half-life
Higher bioavailability
Can be self-administered subcutaneously w/o lab monitoring
Term
LMWH (downsides)
Definition
Not easily reversible like heparin
Term
LMWH (clinical use)
Definition
Approved for DVT prevention following hip/knee replacement, but also used to treat established DVT, ischemic stroke, PE, and thromboembolism in cancer patients
Term
Fondaparinux (type of drug)
Definition
Synthetic LMWH derivative
Term
Fondaparinux (moa)
Definition
Works with antithrombin to inhibit Factor X, but not thrombin
Term
Fondaparinux (side effects)
Definition
Bleeding, and can lower platelets, but will not cause HIT
Term
Antithrombin (moa)
Definition
Inhibits thrombin, Factor X, and some other coag factors
Term
Antithrombin (indication)
Definition
Patients with antithrombin deficiencies during child birth or surgery to prevent thrombosis
Term
Rivaroxaban (type of drug and route)
Definition
Direct Xa Factor inhibitor administered orally
Term
Rivaroxaban (pharm)
Definition
Interacts with CYP3A4 and a substrate for P-glycoprotein
Term
Rivaroxaban (clinical use)
Definition
DVT prophylaxis for hip and knee replacement surgery, and strokes in a-fib patients
Term
Lepirudin (moa)
Definition
Reversible direct thrombin inhibitor
Term
Lepirudin (indication)
Definition
Used for HIT
Term
Bivalirudin (indication)
Definition
Given in combination with aspirin to prevent clots with unstable angina undergoing coronary angioplasty
Term
All heparins, Xa, and thrombin inhibitors (contraindications)
Definition
Hemophilia
Peptic ulcer
Aneurysm
Severe liver/kidney diseae
Thrombocytopenia
Hemorrhaging
Lumbar Puncture
Surgery on eye, brain, or spinal cord
Term
Warfarin (moa)
Definition
Competitive inhibitor of Vitami-K epoxide reductase, interfering with normal synthesis and gamma-carboxylation of Factors II, VII, IX, X, Proteins C and S.
Term
Warfarin (most sensitive factor)
Definition
Factor VII
Term
Warfarin (time to peak onset)
Definition
3 days before peak anticoagulant effect
Term
Warfarin (pharm)
Definition
High bioavailability
99% bound to plasma proteins
35 hour half-life
Term
Warfarin (side effects)
Definition
Hemorrhage
Skin necrosis
terratogenic
Term
Warfarin (monitoring)
Definition
Monitor by prothombin time (PT) or INR
Term
Warfarin (synergists)
Definition
Aspirin - reduced platelet aggregation and displaces warfarin from albumin
Gemfibrozil (fibric acid derivatives)
Broad spec antibiotics - gut flora make vit. K, killing them, warfarin more potent
Thyriod - increases metabolism of clotting factors
Acetaminophen and Miconazole - inhibits warfarin degradation
Term
Warfarin (antagonists)
Definition
Barbiturates - increases warfarin metabolism
Rifampin - increases warfarin metabolism
Vitamin K - direct competition
Estrogens - Increases Factor VII and X, but decreases antithrombin
Cholestyramine - eliminates warfarin if given concurrently
Term
Warfarin (reversal)
Definition
Vitamin K (oral, IV, or SC)
Fresh frozen plasma (depending on who you ask...)
Term
Warfarin (clinical use)
Definition
Chronic anticoagulation (after STEMI and to prevent VTE, and stroke in a-fib)
Rheumatic heart valves
Prosthetic heart valves
Term
Warfarin (contraindications)
Definition
Hemorrhage
Thrombocytopenia
LP
Surgery of eye, brain or spineal cord
LIVER DISEASE
ALCOHOLISM
PREGNANCY OR LACTATION
Term
Streptokinase (moa)
Definition
Forms non-enzymatic complex with plasminogen and converts it to plasmin which digests circulating fibrinogen and fibrin thrombin.
Lacks fibrin or clot specificity
Term
Streptokinase (source)
Definition
Strep culture
Term
Streptokinase (adverse reactions)
Definition
Allergic reactions -> yes
Bleeding -> yes
Hypotension
Term
Alteplase (tPA) (moa)
Definition
Forms complex with fibrin bound plasminogen and catalyzes the conversion of plasminogen to plasmin directly on the clot
Fibrin and clot specific
Term
Alteplase (tPA) (source)
Definition
From human tissue-type plasminogen activator via recombinant DNA technology
Term
Alteplase (tPA) (adverse reactions)
Definition
Allergic reactions -> no
Bleeding -> yes
No hypotension, but higher intracranial bleeding risk
Term
Urokinase (indication)
Definition
From human kidney cells, and only indicated for pulmonary embolism
Term
Alteplase derivatives
Definition
Reteplase and Tenecteplase
Term
Reteplase and tenecteplase (advantages over tPA)
Definition
Long half-life thus shorter infusion times for acute MI (only approved indication)
Term
General indications for thrombolytics
Definition
Cardiac arrhythmias, ischemic stroke, MI, central deep venous thrombosis, massive pulmonary embolism
Term
General contraindications for thrombolytics
Definition
Active bleeding, hemorrhagic stroke, neoplasms, aneurysms
SEVERE HYPERTENSION
recent surgery
intracranial arterial/venous malformations
ANTICIPATED ANGIOPLASTY
Term
Reversing thrombolytics
Definition
Aminocaproic acid (an inhibitor of fibrinolysis)
Term
Fibrin specificity levels
Definition
tenecteplase > alteplase > reteplase
Term
Aspirin (moa)
Definition
Irreversible inhibition of cyclooxygenase in platelets thus inhibiting TXA2 synthesis in platelets.
Platelets cannot make new enzyme, so effect lasts until new platelets are produced
Term
Aspirin (general lab effects)
Definition
Bleeding time: increased
TXA2 and prostaglandins: decreased
PT: no effect
PTT: no effect
Term
Aspirin (side effects)
Definition
Low dose increases uric acid levels
80-90% bound to plasma albumin -> synergistic with warfarin
Crosses placenta
Term
Aspirin (overdose)
Definition
Salicylism
Metabolic respiratory acidosis
Reye's syndrome
Term
Aspirin (clinical use)
Definition
Prophylaxis for heart attacks and ischemic strokes
Term
ADP Receptor inhibitors
Definition
Clopidogrel, ticlopidine, ticagrelor
Term
ADP Receptor inhibitor (moa)
Definition
Blocks ADP receptor on platelet surface preventing expression of the GpIIb-IIIa receptor and binding by fibrinogen
Term
Clopidogrel (clinical use)
Definition
Acute coronary syndrome
Coronary stenting
Pts allergic to aspirin
Term
Ticagrelor (side effects)
Definition
Neutropenia
Term
Ticagrelor (co-administration)
Definition
Administer aspirin (<100mg) with ticagrelor
Term
GpIIb-IIIa inhibitors
Definition
Abciximab (irreversible)
Eptifibatide, Tirofiban (both reversible antagonists)
Term
GpIIb-IIIa inhibitors (moa)
Definition
Bind GpIIb/IIIa receptors on activated platelets and prevent aggregation
Term
GpIIb-IIIa inhibitors (clinical use)
Definition
Acute coronary syndrome
Preceeding coronary artery revascularization (angioplasty)
Term
GpIIb-IIIa inhibitors (side effects)
Definition
Bleeding, thrombocytopenia
Term
Cilostazol, Dipyridamole (moa)
Definition
Inhibit phosphodiesterase III -> increase in cAMP -> vasodilation and decreases platelet aggregation
Term
Cilostazol, Dipyridamole (clinical use)
Definition
Intermitten claudication
Prevention of stroke or TIAs
Supporting users have an ad free experience!