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Oral Anticoagulant Overview
Pharmacotherapy Fall 2013 Exam 3
26
Pharmacology
Professional
11/30/2013

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Cards

Term
virchow's triad
Definition
endothelial injury/ dysfunction, hypercoagulation, hemodynamic changes
Term
two general mechanism of clotting
Definition
platelet aggregation, and thrombin activation (coagulation cascade)
Term
platelets
Definition
endothelial damage and inflammation activates platelets; forms "white clot"
Term
thrombin system
Definition
extrinsic and intrinsic converge to "common pathway" by activating factor X to factor Xa
Term
extrinsic pathway
Definition
tissue factor pathway
Term
intrinsic pathway
Definition
contact activation pathway
Term
anti-platelet agents
Definition
aspirin, thienopyridines, GpIIb/IIIa receptor blockers
Term
anti-thrombin agents
Definition
heparin, Vit K antagonists, direct thrombin inhibitors, factor Xa antag
Term
anti-platelet agent action
Definition
act on or within platelets to inhibit activation and aggregation
Term
Thienopyridines
Definition
bind to P2Y (12) ADP receptor on platelet surface
Term
indications for anticoagulation
Definition
coronary artery Dx, acute coronary syndrome, valvular heart disease, AFib, venous thromboembolism treatment and prevention, hypercoagulable states
Term
prothrombin time
Definition
test measures activity of fibrinogen and factors II, V, VII and X or the extrinsic pathway
Term
international normalizied ratio (INR)
Definition
standardizes the wide variability in commercial PT testing reagents which heps prevent variation in test results
Term
increased PT
Definition
Vitamin K antags
Term
increased intake of Vit
Definition
decreases warfarin effect, vice versa
Term
hepatic impairment and warfarin
Definition
decreased synthetic function of the liver, increased baseline INR, no analogues to effect warfarin--NOT auto-anticoagulated
Term
nephrotic syndrome and warfarin
Definition
hypoproteinemia leads to increased vol of distribution; increased warf clearance and decreased half-life
Term
hypermetabolic states and warfarin
Definition
increased catabolism of vit K dependent clotting factor; increased antocoag effect of warf
Term
heart failure exacerbations and warfarin
Definition
hepatic congestion may acutely decrease synthesis of clotting factors; increased anticoag effect of warf
Term
higher doses of warfarin
Definition
lead to rapid decrease in factor VII, rapind increase in INR, rapid decrease of protein C
Term
adequate anticoagulation with warf not achieved after 5 days
Definition
require significant reduction in factor II
Term
adjustments for warfarin
Definition
are made according to total weekly dose
Term
direct thrombin inhibitors
Definition
Pradaxa (dabigatran)
Term
Factor Xa inhibitors
Definition
Xarelto (rivaroxaban), Eliquis (apixaban)
Term
warfarin pros and cons
Definition
frequent monitoring, dose adjustable based on effect, drug and dietary interactions, reliably reversible, years of clinical experience
Term
newer agent pros and cons
Definition
no monitoring, fewer drug interactions and no dietary restrictions, no reliable reversal agents, less experience and much more expensive
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