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Anticoagulants
Part 4
24
Nursing
Graduate
11/10/2014

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Term
HOW DOES INDIRECT THROMBIN INHIBITORS WORK?
Definition
BIND TO AND ENHANCE ANTITHROMBIN TO PRODUCE ANTITHROMBOTIC EFFECTS. INCLUDES THE HEPARINS: UNFRACTIONATED (STANDARD) AND LOW-MOLECULAR WEIGHT)
Term
IN THE BEGINING OF HEPARIN ACTIVATION WHAT DOES HEPARIN FORM A BOND WITH?
Definition
ANTITHROMBIN AND CAUSES A CONFORMATIONAL CHANGE. THE HEPARIN ACCELERATES THE ACTIONS OF THE ANTITHROMBIN TO 1000 TIMES FASTER THAN NORMAL.
Term
WHAT FACTORS DOES ANTITHROMBIN INHIBIT?
Definition
IIA, IXA, XA, XIA, XIIA. IIA AND XA ARE BIGGEST.
Term
WHAT PATHWAY DOES HEPARIN WORK ON?
Definition
INTRINSIC AND COMMON PATHWAY. ONCE THE HEPARIN CAUSES THE CONFORMATIONAL CHANGE AND THE ANTITHROMBIN HAS INTERACTED WITH THE PROTEASES AND CLOTTING FACTORS, THE HEPARIN CAN DISSOCIATE FROM THE ANTITHROMBIN AND BE RELEASED INTACT TO BIND TO NEW ANTITHROMBIN.
Term
EXOGENOUS HEPARIN IS FOUND IN WHAT TYPE OF CELLS (X2) AND IN WHAT ORGAN?
Definition
BASOPHILS, MAST CELLS, AND THE LIVER
Term
ONLY ABOUT __ OF THE HEPARIN IN COMMERCIAL PREPARATIONS BIND TO ANTITHROMBIN.
Definition
1/3
Term
WHERE DOES EXOGENOUS HEPARIN TYPICALLY COME FROM?
Definition
BOVINE LUNG, OR BOVINE OR PORCINE GI MUCOSA (INCREASED R/O ALLERGENIC POTENTIAL).
Term
IS HEPARIN LIPID OR FAT SOLUBLE? + OR - CHARGE?
Definition
POORLY LIPID SOLUBLE. HEPARIN IS HIGH MOLECULAR WEIGHT. HIGHLY NEGATIVELY CHARGED PARTICLES. THESE 3 RELATE IN POOR DISTRIBUTION.
Term
ELIMINATION OF HEPARIN IS BY WHAT? EXCRETION IS THROUGH WHAT ORGAN?
Definition
RETICULOENDOTHELIAL SYSTEM AND SOME HEPATIC. EXCRETION IS RENAL (ABOUT 50% UNCHANGED)
Term
WHAT 3 THINGS CAN GREATLY PROLONG ELIMINATION?
Definition
HYPOTHERMIA, HEPATIC, AND RENAL DYSFUNCTION
Term
WHAT IS THE DOSE OF HEPARIN FOR DVT PROPHYLAXIS?
Definition
5000 UNITS SQ
Term
WHAT IS THE DOSE OF HEPARIN FOR VASCULAR SURGERY?
Definition
100UNITS/KG IV
Term
WHAT IS THE DOSE OF HEPARIN FOR CARDIOPULMONARY BYPASS?
Definition
300UNITS/KG IV
Term
WHAT IS THE ONSET OF HEPARIN IV AND SQ?
Definition
IMMEDIATE FOR IV (GIVE AND WAIT 3 MINUTES FOR CIRCULATION). SQ USUALLY 1-2 HRS
Term
WHAT IS THE HALF-LIFE OF HEPARIN?
Definition
1-2 HRS
Term
WHEN SHOULD HEPARIN BE DISCONTINUED PRIOR TO SX?
Definition
6 HRS
Term
WHAT 4 SIDE EFFECTS ARE ASSOCIATED WITH HEPARIN?
Definition
BLEEDING, HYPOTENSION, ALLERGIC REACTIONS, AND HEPARIN-INDUCED THROMBOCYTOPENIA (HIT)
Term
WHAT IS THE HYPOTENSION R/T WITH HEPARIN?
Definition
RAPID IV ADMINISTRATION OF LARGE DOSES, AS USED IN CPB CAN CAUSE A DECREASE IN MAP AND PAP (R/T SOME HISTAMIN RELEASE).
Term
DESCRIBE HOW HIT WORKS?
Definition
ANTIBODIES DEVELOP THAT TARGET PLTS AND REMOVE THEM FROM CIRCULATION. PLT COUNT DECREASES BY 50-75% BY 5 DAYS INTO HEPARIN THERAPY. PLTS ARE ALSO ACTIVATED, LEADING TO AGGREGATION AND THROMBOSIS (BECOMES HITT AT THIS POINT). NEARLY ALWAYS REQUIRES PREVIOUS EXPOSURE TO HEPARIN.
Term
DESCRIBE WHAT ESTROGEN DOES TO HEPARIN?
Definition
ESTOGEN CONTAINING CONTRACEPTIVES DECREASE CIRCULATING ANTITHROMBIN. LESS EFFECT FROM HEPARIN D/T LESS TARGET SITES FOR IT TO WORK ON.
Term
DESCRIBE THE INTERACTION WITH NTG AND HEPARIN.
Definition
NTG MAY INCREASE THE DOSE OF HEPARIN REQUIRED.
Term
WHAT 5 THINGS CAUSES HEPARIN RESISTANCE?
Definition
ANTITHROMBIN DEFICIENCY, LIVER DISEASE, HEMODILUTION, CPB, PRIOR HEPARIN THERAPY (RECENT).
Term
WHAT IS THE TREATMENT OF HEPARIN RESISTANCE?
Definition
FFP TO ALLOW MORE SITES FOR HEPARIN TO WORK.
Term
WHAT LAB DOES SHOULD BE MONITORED FOR HEPARIN?
Definition
APTT, ACT, H&H, AND PLTS. PT/INR MEASURE EXTRINSIC AND COMMON PATHWAY. PTT AND ACT MEASURE INTRINSIC AND COMMON PATHWAY
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