Term
| Types of VTE(venous thromboembolism) |
|
Definition
PE(pulmonary Embolism)-deadly in mins
DVT(deep vein thrombosis)-rarely fatal
[result from clot formation in vein circ] |
|
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Term
|
Definition
-orthopedic procedures
-multiple traumas
-stroke pt,MI,Spinal cord injury
-Estrogen oral contraceptives
-pregnancy |
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Term
| most common genetic disorder of hypercoagulability |
|
Definition
Activated protein C (aPC) resistance
[mutation is known as factor V Leiden.mutation on factor V that renders it resistant to degradation by aPC] |
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Term
| PE typically presents with |
|
Definition
chest pain
SOB
tachypnea
tachycardia |
|
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Term
| long-term complication of DVT presents with |
|
Definition
| lower extremity swelling, pain, tenderness, skin discoloration, and, in the most severe cases, ulceration |
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Term
|
Definition
| A normal full leg ultrasound or highly sensitive D-dimer |
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Term
|
Definition
| Formation of plaque that occludes blood flow |
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Term
|
Definition
-Binds factor III via pentasacharide sequence
-binds and inhibits thrombin(factr 2a)
-anti Xa:anti 2a inhibition in 1:1 ratio
FROM PORCINE |
|
|
Term
| Heparin not used therapeutically bc---- |
|
Definition
Poor absorption
(1.5 hr 1/2 life) |
|
|
Term
| aPTT range determined by anti-Xa conc between |
|
Definition
0.3-0.7
can change if diff reagent used |
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Term
|
Definition
-same as heparin but Anti-Xa:anti 2a inhibiton ratio 4:1
(Lovenox,Fragmin) |
|
|
Term
Lovenox (enoxaparin) Requires ____
LMWH |
|
Definition
renal adj
(prolonged)
FROM PORCINE |
|
|
Term
|
Definition
Requires renal adj
renal dysf 3.7-7.7 hrs
Therapeutic:0.5-1.5 D
Prophylaxis:0.2-0.6
FROM PORCINE |
|
|
Term
Arixtra(fondaparinux)
SYNTHETIC |
|
Definition
Chain length too short to inhibit 2a.only inhibits only Xa
(renal adj)
SYNTHETIC |
|
|
Term
| Peak levels of LMWH shud be acheived at about---- |
|
Definition
|
|
Term
Angiomax (Bivalrudin) Metabolized by
IV |
|
Definition
plasma proteases
(immediate onset)
monitored by ACT if undergoing pci
aPTT 1.5-2.5x initial pt baseline |
|
|
Term
Acove (argatroban) Metabolised by
IV |
|
Definition
liver
Hepatic adj
aPTT 1.5-3 initial pt baseline
monitored by ACT if undergoing pci |
|
|
Term
Pradaxa (dabigatran etexilate)
PO |
|
Definition
has bad absorption
(dont open capsule_>inc absorp 75%!)
Hepatic glucuronidation |
|
|
Term
| DTI (direct thrmbin inhibtors) can cause FALSE..... |
|
Definition
| elevation in INR especially ARGATROBAN |
|
|
Term
| Do not use this DTI in hepatic dysfunction |
|
Definition
|
|
Term
Warfarin (COUMADIN) MOA
Wisconsin alumni research foundation |
|
Definition
-Racemic mixture inhibits production of vitamin K by inhibiting vitk epoxide reductase
-tyopically start w/ another anticoag to allow for clotting factors to go away due to warf acting only on new factors
-1948 approved as rat poison(FDA 1954) |
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|
Term
|
Definition
HEPATIC
(peak effect 5-7 days) |
|
|
Term
|
Definition
-Antibiotics
-Aspirin (compete for binding sites)
-amiodarone
-Nafcillin, rifampin,carbamazepine (dec effect of Warf) |
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|
Term
| WARFARIN Drug disease interxn |
|
Definition
INC EFFECT
Fever,acute ill
-hyperthyroid - AHF
Hypoalbuminemia
DEC EFFECT=smoking,alcoholism |
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Term
|
Definition
| XARELTO (rivaroxaban) ELIQUIS (apixaban) SAVAYSA (edoxaban) BEVYXXA (betrixaban) |
|
|
Term
|
Definition
reversibly inhibits free & clotbound factor Xa
(PT may or may not be monitored) |
|
|
Term
| Xarelto give with food for doses |
|
Definition
Greater than or equal to 15mg
[hepatic metab] |
|
|
Term
|
Definition
| (INC EFFCT) -AZOLES -Non-DHP CCBs -Atorvastatin -Digoxin -amiodarone |
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Term
|
Definition
Bleeding(GI,Intraranial[warf>DOACs],bruising]
-GI Sxs(dabigatran)
-HITT(hep induced thrombocytopeniaw/ thrombosis) |
|
|
Term
Reversal Agents [Test to confirm]
Heparin= |
|
Definition
|
|
Term
| Reversal Agents [Test to confirm] Warfarin= |
|
Definition
| Vitamin K, four-factor PCC(2,7,9,10), FFP PT/INR |
|
|
Term
Reversal Agents [Test to confirm] DTIs=
Direct Thrombin Inhibitors |
|
Definition
| Idarucizamab(Praxbind®):dabigatran Note: reversal typically not necessary for IV products due to short half-life [Thrombin Time,aPTT] |
|
|
Term
Reversal Agents [Test to confirm]
FActor Xa Inhibitors= |
|
Definition
PCC, andexanetalfa (pending FDA-approval)
[PT,chromogenic factor Xa] |
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|
Term
| Glycoprotein IIb/IIIaInhibitors MOA |
|
Definition
| MOA: blocks the platelet glycoprotein IIb/IIIareceptor, the binding site for fibrinogen, von Willebrandfactor, and other ligands; reversibly blocks platelet aggregation and prevents thrombosis |
|
|
Term
| Glycoprotein IIb/IIIaInhibitors USE |
|
Definition
|
|
Term
| Integrilin (eptifibatide) |
|
Definition
|
|
Term
|
Definition
| Irreversibly inhibits cyclooxygenase(COX)-1 by acetylation; decrease in thromboxane production (decreased platelet aggregation) |
|
|
Term
|
Definition
NSAIDs compete for COX and by the time they reversibly leave not enough Aspirin is LEFT to bind
(Major intrxn) |
|
|
Term
|
Definition
| MOA: block the P2Y12 component of the ADP receptor on platelets which prevents conformational change (activation) of the GP-IIB/IIIA complex, reducing platelet activation/ aggregation |
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|
Term
| Fibrinolytics / Thrombolytics MOA |
|
Definition
Binds to thrombin in a clot and converts plasminogen to plasmin
–Plasmin responsible for clot lysis |
|
|
Term
| Fibrinolytics / Thrombolytics USE |
|
Definition
–STEMI
–Acute ischemic stroke
–Acute pulmonary embolism |
|
|
Term
|
Definition
Lovenox(ENoxaparin)
Fragmin(Dalteparin)
Arixtra(fondaparinux) |
|
|
Term
|
Definition
| aPTT,ANti Xa, ACT(during hi dosing) |
|
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Term
|
Definition
| non renal at therapeutic dosing |
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|
Term
|
Definition
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Term
|
Definition
HIT
Heparin induced thrombocytopenia |
|
|
Term
DTIs
(use aPTT to monitor) |
|
Definition
ANgiomax(Bivalrudin)
Acova(argatroban)
Pradaxa(Dabigatran) |
|
|
Term
| DTI that cant be used with hep dysfunc |
|
Definition
|
|
Term
| DTI cant be used in renal dysf |
|
Definition
|
|
Term
| Xa factor inhibitors and Pradaxa require |
|
Definition
|
|
Term
|
Definition
Dronedarone
Azoles
Rifampin,st jon wrt
HIV protease(xarelto) |
|
|
Term
| HITT is not associated with |
|
Definition
|
|
Term
| Reversal is not needded in IV.... |
|
Definition
DTI
direct thrombin inhibitors due to short half life |
|
|
Term
|
Definition
Integrilin(eptifibatide)
Reopro(Abciximab)
Aggrastat (tirofiban) |
|
|
Term
| only nonreversible G IIb/IIIa inhibitor |
|
Definition
|
|
Term
| G IIb/IIIa inhibitors can cause |
|
Definition
| Thrombocytopenia and bleeding |
|
|
Term
|
Definition
Plavix (Clopidogrel)
Effient (Prasugrel)
Brilinta (Ticagrelor) |
|
|
Term
| Ticagrelors inhibition is |
|
Definition
|
|
Term
| Max aspirin dose with Ticagrelor |
|
Definition
|
|
Term
|
Definition
Activase (alteplase)
Retevase (reteplase)
TNKase (tenecteplase) |
|
|
Term
|
Definition
plasminogen to plasmin
use STEMI
acuteischem stroke
acute pulm embolism |
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