Term
| Aspirin is what type of drug? |
|
Definition
|
|
Term
| Ticlopidine is what type of drug? |
|
Definition
|
|
Term
| Dipyridamole is what type of drug? |
|
Definition
|
|
Term
| Cilostazol is what type of drug? |
|
Definition
|
|
Term
| Pentoxifylline is what type of drug? |
|
Definition
|
|
Term
| Abciximab is what type of drug? |
|
Definition
|
|
Term
| eptifibatide is what type of drug? |
|
Definition
|
|
Term
| tirofiban is what type of drug? |
|
Definition
|
|
Term
| Clopidogrel is what type of drug? |
|
Definition
|
|
Term
| Warfarin is what type of drug? |
|
Definition
|
|
Term
| Heparin is what type of drug? |
|
Definition
|
|
Term
| Low MW Heparins are what type of drugs? |
|
Definition
|
|
Term
| Streptokinase is what type of drug? |
|
Definition
|
|
Term
| rTPA is what type of drug? |
|
Definition
|
|
Term
| Reteplase is what type of drug? |
|
Definition
|
|
Term
| APSAC is what type of drug? |
|
Definition
|
|
Term
| Urokinase is what type of drug? |
|
Definition
|
|
Term
| Thrombus is a blood clot; an aggregation of blood factors, primarily ____ and _____ with entrapped blood cells; |
|
Definition
|
|
Term
| A thrombus is ______ if it prevents injury and ______ if it causes thrombosis (inadequate blood flow due to a clot). |
|
Definition
|
|
Term
|
Definition
| a clot (or other plug) carried by the blood from one site to another, smaller vessel, that obstructs the circulation. |
|
|
Term
Normal Hemostasis: A set of well-regulated processes that
accomplish two important functions: |
|
Definition
1. Maintain blood clot-free in normal vessels
2. Induce a rapid and localized hemostasis by forming a clot at a site of vascular injury. A key point: the clot should not impair circulation. |
|
|
Term
| Thrombosis = _____ extension of _____ producing a clot that impedes blood flow. Inappropriate activation of normal hemostatic processes to form a blood clot (thrombus) in an _____ vessel or thrombotic occlusion of a vessel after minor or no ____. |
|
Definition
pathological
hemostasis
uninjured
injury |
|
|
Term
Steps in Normal Hemostasis:
_____ phase -> vasoconstriction
______phase -> platelet plug
______phase -> reinforce platelet plug with fibrin
______phase - dissolve clot, repair endothelium; phagocytosis of debris |
|
Definition
Vascular
Platelet (temporary unless significant Coagulation Phase occurs)
Coagulation
Repair |
|
|
Term
| In primary homeostasis, _________ is A mechanism to slow the rate of blood loss and Facilitates interaction of platelets with endothelium |
|
Definition
|
|
Term
| In primary homeostasis, Vasoconstriction of the blood vessel is mediated by ...(3) |
|
Definition
Prostacyclin (PI2)
Thromboxane A2 (TXA2)
serotonin (5-HT). |
|
|
Term
| In primary homeostasis, the platelet plug Facilitates interaction of platelets with endothelium. Adherence of platelets is to the _____ of damaged _____ cells. |
|
Definition
|
|
Term
Primary Homeostasis Platelet Plug Formation:
(1) ____ of platelets to collagen and vWF via ___ & ___ receptors
(2) ____ of Ca++, ADP, TXA2 , Epinephrine, 5-HT, others
(3) ____ -> ___ & ___ induce shape change and sticking
-> _____ complex expressed at surface
-> coagulation cascade anchored at platelet surface
-> _____ is generated |
|
Definition
Adhesion
GP 1a & Ib
Secretion
Aggregation
ADP & TXA2
phospholipid
thrombin |
|
|
Term
Fibrinogen:
binds to platelets via ______ complex
____ converts soluble fibrinogen to insoluble fibrin fibers
subsequently fibrin monomers are cross-linked to form very strong ___-___ clot |
|
Definition
GP IIb-IIIa
thrombin
platelet-fibrin |
|
|
Term
| The coagulation cascade of secondary hemostasis has two pathways, the _____ pathway (AKA the _____ Pathway) And the _____ pathway (AKA the _____ pathway) that lead to fibrin formation. It was previously thought that the coagulation cascade consisted of two pathways of equal importance joined to a common pathway. It is now known that the primary pathway for the initiation of blood coagulation is the _____ pathway. |
|
Definition
Contact Activation
Intrinsic
Tissue Factor
Extrinsic
Tissue Factor |
|
|
Term
| Heparin works on the _____ pathway |
|
Definition
intrinsic
Remember "heparintrinsic" |
|
|
Term
| Warfarin works on the ______ pathway. |
|
Definition
|
|
Term
| The intrisic and extrinsic pathway promote the conversion of _____ to _____ |
|
Definition
|
|
Term
| Intrinsic Pathway: All clotting factors are ___ the blood vessels |
|
Definition
|
|
Term
| Extrinsic Pathway: Initiating factor is ____ the blood vessels - tissue factor |
|
Definition
|
|
Term
| Clotting is slower with the _____ pathway and faster (w/in seconds) with the ____ pathway |
|
Definition
|
|
Term
| the intrinsic pathway is tested by the .. |
|
Definition
| Activated partial thromboplastin test (aPTT) |
|
|
Term
| The extrinsic pathway is tested by ... |
|
Definition
|
|
Term
| Thromboembolic Disorders: (6) |
|
Definition
Myocardial Infarction
Deep Venous Thrombosis
Stroke
Pulmonary Embolism
Thrombophlebitis
Peripheral Vascular Disease |
|
|
Term
Therapeutic Objectives
Prevent formation of pathological thrombus:
(1) Traditional approach is to use anticoagulant drugs: (2)
(2) Current approaches include prevention of arterial damage, i.e., atherosclerosis, and inhibition of platelet aggregation, e.g., with: (3 drugs) |
|
Definition
heparin & warfarin
aspirin or clopidogrel or abciximab |
|
|
Term
Therapeutic Objectives
Destroy formed pathological thrombus:
Dissolving preformed clots is difficult to achieve without causing bleeding, but fibrinolytic drugs like: (4) can be used in special situations. |
|
Definition
rtPA
reteplase
streptokinase
APSAC |
|
|
Term
Therapeutic Objectives
Prevent platelets from aggregating in the first place |
|
Definition
|
|
Term
| Platelets form initial ____ plug |
|
Definition
|
|
Term
| Platelets are associated with ____ plague deposits and _____ thrombi |
|
Definition
atherosclerotic
pathological |
|
|
Term
| A key activator of platelet aggregation is _____ which is a product of the arachidonic acid pathway that involves formation of _____ by the enzyme ____. |
|
Definition
Thromboxane A2 (TXA2)
prostaglandins
cyclooxygenase |
|
|
Term
| Why is aspirin the only NSAID used to inhibit platelet aggregation? |
|
Definition
| Only one used therapeutically?? this is what I had in my notes -> not really sure if this is the answer |
|
|
Term
low dose aspirin inhibits _____
which inhibits these 4 functions: |
|
Definition
TXA2
platelet aggregation
platelet shape change
platelet granule release
vasoconstriction |
|
|
Term
high dose aspirin inhibits ____
which inhibits these 2 functions:
and stimulates ______ |
|
Definition
PGI2
platelet aggregation
platelet secretion
vasodilation |
|
|
Term
| Aspirin, at very low doses, ____ inhibits cyclooxygenase in _____. High doses inhibit cyclooxygenase in ______ |
|
Definition
irreversibly
platelets
endothelial cells |
|
|
Term
| Since platelets cannot synthesize new cyclooxygenase enzyme, low dose aspirin inhibits ___ formation and platelet aggregation for the ___ of the platelet (7-10 days). In contrast with high dose aspirin, ____ cells can synthesize new cyclooxygenase. |
|
Definition
|
|
Term
| Only low doses of ASA are required to inhibit cyclooxygenase in ____. If the dose is pushed too high, not only is platelet cyclooxygenase inhibited, but now enough cyclooxygenase is inhibited in endothelial cells that it prevents the formation of _____, a compound that inhibits platelet ____ and stimulates ____ |
|
Definition
platelets
prostacyclin (PGI2)
secretion
vasodilation |
|
|
Term
| ASA Should be administered routinely to virtually all patients with _____ |
|
Definition
|
|
Term
| ASA is used as Secondary prevention of ___ & ___ |
|
Definition
|
|
Term
| ASA is used as a Primary prevention of ____ (benefits less clear) |
|
Definition
|
|
Term
| ASA is used for Reduction of thromboembolic complications in patient with ...(3) |
|
Definition
artificial heart valves
hemodialysis
coronary bypass grafts |
|
|
Term
| Use low dose ASAa to minimize problems like _____ |
|
Definition
|
|
Term
Allergy can limit use of ASA
Don’t give aspirin to what group of patients? (2) |
|
Definition
Gastric ulcers
pts who have a sensitivity to ASA |
|
|
Term
| Clopidogrel (Plavix) and Ticlopidine (Ticlid) are ______ drugs that Block ____ receptor -> Leads to irreversible blockade of ___ receptor on ____ cell membrane |
|
Definition
antiplatelet
P2Y12
ADP
platelet |
|
|
Term
Clopidogrel
Onset is ___ (__ hr)
Frequently used in combination with ___ in high risk situations:
___ b/c they cause rough surfaces which makes the platelets want to aggregate
____ syndrome |
|
Definition
slow (2 hr)
aspirin
Stents
Acute coronary |
|
|
Term
Clopidogrel:
Indicated for prevention of ischemic events in ____
Similar to ____
Better outcomes (marginal, but significant)
Cost: ____ |
|
Definition
atherosclerosis
aspirin
expensive |
|
|
Term
Ticlopidine:
inhibits ____ binding to platelets and blocks platelet ___.
approved for prevention of thrombotic ____ in patients who have experienced ___ |
|
Definition
fibrinogen
aggregation
stroke
TIAs (transient ischemic attack) remember "TIC & TIA" |
|
|
Term
Dipyridamole (Persantine):
inhibits platelet ____ & weak ____ (mechanism is complex)
may be useful in secondary prevention of ___ & ___, but disappointing clinical trials |
|
Definition
aggregation
vasodilator
MI and stroke |
|
|
Term
Abciximab (ReoPro) = ______
Prevents ____ binding to ____, thus inhibiting platelet aggregation
Greater antithrombotic activity than ___ or ___
Approved as antithrombotic during _____ |
|
Definition
monoclonal antibody
fibrinogen
glycoprotein GP IIb-IIIa
aspirin or heparin
angioplasty (ex. putting a stent in) |
|
|
Term
| eptifibatide & tirofiban approved for _____ |
|
Definition
|
|
Term
Cilostazol (Pletal):
Inhibits ____ (cyclic AMP)
Inhibits platelet _______
Stimulates ________
Indicated for reduction of symptoms of ______
Contraindicated in patients with ___ b/c causes fluid retention |
|
Definition
PDE III
aggregation
vasodilation
intermittent claudication -> (pain when walking – not due to an injury – it is b/c of vascular ischemia)
CHF |
|
|
Term
Pentoxifylline (Trental):
_____ Agent = improves blood flow
Mechanism enhances RBC ____, decreases blood _____
may decrease ____ levels and increase ___ levels |
|
Definition
Hemorrheologic
flexibility
viscosity
TXA 2
PGI2 |
|
|
Term
Pentoxifylline (Trental):
Indications: (2) |
|
Definition
intermittent claudication
chronic occlusive arterial disease of the limbs |
|
|
Term
Heparin
route of administration: _____
in hospital
____ onset |
|
Definition
|
|
Term
Warfarin
route of administration: _____
out patient
_____ onset |
|
Definition
|
|
Term
| Heparin is naturally occurring and is produced by ___ and ____ to prevent formation and progression of blood clots |
|
Definition
|
|
Term
| ____ does not destroy clots that already exist , but allows the body's natural clot lysis mechanisms, i.e. ____, to break down clots. |
|
Definition
|
|
Term
| ____ is the drug of choice for parenteral anticoagulant therapy |
|
Definition
|
|
Term
Heparin Mechanism:
heparin binds to _____
heparin-_____ complex binds to and inactivates coagulation factors including thrombin (IIa), Xa, IXa, XIa, XIIa
heparin prolongs both the ____ and the ____ |
|
Definition
antithrombin III
antithrombin IIII
aPTT (Partial Prothrombin Time = time it takes plasma to clot)
PTT |
|
|
Term
Heparin Dosing:
Dose is in ___
_____ IV (often preceded by IV bolus)
_____ Minidose for post-surgery prophylaxis
NOT GIVEN ___
NOT GIVEN ___
Extracorporal uses: for ___ anticoagulation (Hep-Lock solution) to clear i.v. lines, etc. |
|
Definition
Units
Continuous
Subcutaneous
IM
ORALLY
in vitro |
|
|
Term
Heparin Pharmacokinetics:
Onset
___ - immediate anticoagulant
___ - begins in 20 - 30 minutes
___ - 2 -3 hour delay for full effect unless an initial bolus injection is administered |
|
Definition
I.V.
S.C.
Continuous IV infusion |
|
|
Term
Heparin Pharmacokinetics:
Duration (of a single dose)
IV - __-___ hours
SQ - __-___ hours
Plasma t1/2 is dose-dependent, __-___ hours |
|
Definition
|
|
Term
Heparin Pharmacokinetics:
Termination: metabolized in ___ or excreted ____ |
|
Definition
|
|
Term
| Heparin is used for Prophylaxis of ____ |
|
Definition
|
|
Term
____ is used for Myocardial infarction and unstable angina
-> Get them on ____ to prevent primary hemostasis
-> Then ____ as a secondary prevention |
|
Definition
|
|
Term
| _____ is used for Deep venous thrombosis and pulmonary embolism |
|
Definition
|
|
Term
| _____ is used for Extra-corporeal circulation (hemodialysis or heart-lung machine |
|
Definition
|
|
Term
| _____ is used for Disseminated Intravascular Coagulation (DIC) |
|
Definition
|
|
Term
____ is used for TIA - probably effective, but very risky - not used if stroke-in-progress
Depends on stroke
Ex. Don’t use for ____ stroke |
|
Definition
|
|
Term
| ____ is used when rapid onset of anticoagulation is required |
|
Definition
|
|
Term
Small doses of heparin are used to prevent ____
Medium doses to prevent ______ of thrombus
Large doses to inhibit established ____________ |
|
Definition
thromboembolism
propagation
pulmonary embolus |
|
|
Term
| If prolonged anticoagulation is necessary, the initial heparin therapy is overlapped with and then replaced with oral anticoagulant, i.e., _____ |
|
Definition
|
|
Term
Heparin Toxicity:
______: from inadvertent overdose or from undiagnosed disease site
______ at site of injection
______– with long term administration |
|
Definition
Hemorrhage
Hematoma
Osteoporosis |
|
|
Term
| Less common side effects of heparin: (6) |
|
Definition
platelet aggregation
thrombocytopenia (heparin-induced thrombocytopenia or HIT) acute hypersensitivity
alopecia
osteoporosis
priapism |
|
|
Term
Heparin Contraindications:
Any site of active or potential ____
Severe _____ or known vascular aneurysm
Recent ___, ____ or ____ surgery
Head trauma
_____ or regional anesthetic block
Tuberculosis, visceral carcinoma, GI ulcers |
|
Definition
bleeding
hypertension
head, eye, or spinal cord
Lumbar puncture |
|
|
Term
Heparin-Induced Thrombocytopenia (HIT):
Most significant adverse effect of heparin after hemorrhage
Most common drug-induced thrombocytopenia
Look for drop in platelets <______
Two types
_____ – Type I
_____ – Type II (potentially serious)
Stop heparin in this case |
|
Definition
100,000 (150,000 is the normal amount)
Nonimmune HIT
Immune mediated |
|
|
Term
Monitoring Heparin Therapy:
aPTT tested prior to starting therapy
aPTT of ___-___ times control is the typical therapeutic goal |
|
Definition
|
|
Term
Treatment of Heparin Overdose:
____ administration
Give _________ b/c it binds to and inactivates heparin. It is _____ charged and heparin is ______charged. Must be given slowly IV
Infusion of _______ b/c it Has a lot of clotting factors |
|
Definition
Stop
Protamine sulfate
positively
negatively
fresh-frozen plasma |
|
|
Term
| Overdose of heparin would have bleeding and a really ___ PTT reading |
|
Definition
|
|
Term
| Enoxaparin is what type of drug? |
|
Definition
|
|
Term
| Dalteparin is what type of drug? |
|
Definition
|
|
Term
| Ardeparin is what type of drug? |
|
Definition
|
|
Term
| Danaparoid is what type of drug? |
|
Definition
|
|
Term
| LMW Heparin drugs are ____, ____ pieces of regular heparin |
|
Definition
|
|
Term
| LMW Heparins have Greater ____ activity, less ____ activity |
|
Definition
|
|
Term
| LMW Heparins are Used for prophylaxis of ___ associated with hip, knee, and abdominal surgery. Route of administration is __________. |
|
Definition
|
|
Term
| LMW Heparins have ____ duration, simpler kinetics, ___ not usually required |
|
Definition
|
|
Term
| Ardeparin is FDA approved for: |
|
Definition
|
|
Term
| Dalteparin is FDA approved for: |
|
Definition
general surgery
hip replacement |
|
|
Term
| Enoxaparin is FDA approved for: |
|
Definition
DVT-OPT
Tx DVT/PE
general surgery
hip replacement
knee replacement |
|
|
Term
| Tinzaparin is FDA approved for: |
|
Definition
|
|
Term
Monitoring of LMWH is ____ in majority of patients
May be useful in specific instances:
____ insufficiency (_____ >2.0 mg/dl)
____ patients with altered drug ___
major _____ risk factors
____ is not useful due to low _____ activity |
|
Definition
Unnecessary
renal
creatinine
obese
pK
bleeding
aPTT
anti-IIa |
|
|
Term
| LMWH have Decreased “_______ resistance” |
|
Definition
|
|
Term
LMWH have No need for ________
when given on a weight-adjusted basis, the LMWH anticoagulant response is ____ & ______ |
|
Definition
laboratory monitoring
predictable and reproducible |
|
|
Term
| LMWH have ____ bioavailability - ___% vs. __% |
|
Definition
|
|
Term
LMWH have ____ plasma half-life
__-__hr vs. ___-___ hour
renal (slower) vs hepatic clearance |
|
Definition
Longer
4 to 6 hours vs 0.5 to 1 |
|
|
Term
| LMWH do not need to given ___ – so can be outpatient. It comes in premeasured syringe = expensive |
|
Definition
|
|
Term
| LMWH have Less inhibition of ____ function = potentially less bleeding risk, but not shown in clinical use |
|
Definition
|
|
Term
| LMWH have Lower incidence of ____ and ___ (HIT syndrome) = less interaction with platelet factor __ and fewer ___-dependent IgG antibodies |
|
Definition
thrombocytopenia
thrombosis
4
heparin |
|
|
Term
|
Definition
|
|
Term
Warfarin Mechanism:
inhibits vitamin __ epoxide reductase
inhibits vitamin __-dependent post-translation modification of clotting factors: thrombin, VII, IX, X, Protein C and S
without addition of the gamma carboxyglutamic acid residue the clotting factors cannot bind ___ and are ____ |
|
Definition
|
|
Term
| Vitamin __ can be used to treat warfarin overdose |
|
Definition
|
|
Term
| The Vitamin K dependent clotting factors are carboxylated in a reaction that is linked to the oxidation of the reduced form of the vitamin . The ____ forms of these clotting factors are inactive because they cannot bind ____. When Vitamin K is deficient, non-carboxylated ____ is secreted and this protein is non functional. Carboxylation of terminal glutamic acid side chains (known as the Glu to Gla conversion) allows the clotting factors to bind calcium which in turn bridges the clotting factors to phospholipid surfaces, a necessary requirement for their activity. |
|
Definition
non carboxylated
calcium
prothrombin |
|
|
Term
Warfarin Onset: considerably delayed (__-__ hours)
delay in onset is due to long t1/2 of warfarin and the fact that pre-existing clotting factors are ___ cleared from the blood (t1/2 for VII = 6 hours) |
|
Definition
|
|
Term
Warfarin Duration: prolonged. Assume __-__ days to see steady state
proportional to the elimination t1/2 (__-__ hours) |
|
Definition
|
|
Term
Warfarin Distribution:
____ & ___ absorption
highly ___-soluble
___% bound to plasma albumin |
|
Definition
|
|
Term
Warfarin Termination: delayed (___-___ days)
___ & _____ metabolism
long elimination t1/2
new, active clotting factor must be ____ |
|
Definition
2 -5
liver and kidney
synthesized |
|
|
Term
| _____ (antibiotic) have a big interaction w/ warfarin. Why? |
|
Definition
Fluoroquinolones
b/c need to synthesize new VK that comes from enteric bacteria -> Antibiotics will kill bacteria that make VK so may mess up INR |
|
|
Term
Warfarin Toxicities:
*_______
Anorexia, nausea, vomiting, diarrhea |
|
Definition
|
|
Term
Warfarin Contraindications:
*_____ patients: congenital abnormalities
_______ patient
any recent bleeding
recent eye, brain, or spinal cord surgery; head injury
severe ____ or known vascular ___ |
|
Definition
pregnant
unreliable
hypertension
aneurysm |
|
|
Term
| What anticoagulant is particularly contraindicated in the 1st trimester of prengnacy? |
|
Definition
|
|
Term
Warfarin: Indications
Overlap with ___ therapy to avoid long delay in onset of action
_______
_______
_______
- Left atrial appendage-> get blood stasis if it is
just quivering
So if heart suddenly develps normal rhythm, we
squeeze out that clot
_____ heart disease
_____ |
|
Definition
heparin
Deep venous thrombosis
Pulmonary embolism
Atrial fibrillation
Rheumatic
Mechanical heart valves |
|
|
Term
| Warfarin is only given ___ |
|
Definition
|
|
Term
| Warfarin: Initial doses followed by ____ doses -> adjust according to ____ |
|
Definition
maintenance
PT time (INR) |
|
|
Term
| Determine PT time (INR) prior to starting warfarin therapy, daily until response ____, weekly until ____ dose established |
|
Definition
|
|
Term
| Warfarin is often administered concurrently with ___ until target ____ is achieved and then patient is maintained on warfarin. |
|
Definition
|
|
Term
Warfarin: Current Indications/Intensity
List the indications (7) for INR Range 2-3 and Target 2.5 |
|
Definition
Prophylaxis of venous thrombosis (high-risk surgery)
Treatment of venous thrombosis
Treatment of PE
Prevention of systemic embolism
AMI (to prevent systemic embolism)
Valvular heart disease
Atrial fibrillation |
|
|
Term
Warfarin: Current Indications/Intensity
List the indications (3) for INR Range 2.5-3.5 and Target 3 |
|
Definition
Mechanical valves (high risk)
Certain patients with thrombosis
and antiphospholipid syndrome |
|
|
Term
| Do need to be on warfarin w/ ______ valves but not with ____ valves. |
|
Definition
mechanical
prostetic (bovine or porcine) |
|
|
Term
| Individual patient variatibility of response is very high with _____ due to differences in absorption, elimination, liver function, and drug-drug interactions. |
|
Definition
|
|
Term
| Noncompliant and unreliable patients are not good candidates for ____ therapy |
|
Definition
|
|
Term
| ____ is a classic example for many types of drug-drug interaction |
|
Definition
|
|
Term
Warfarin: Drug-drug Interactions
Inhibition or acceleration of warfarin ____
______ from plasma protein binding sites
Interference with _____
Interference with ______ |
|
Definition
metabolism
Displacement
mechanism of action
absorption |
|
|
Term
Antibiotic interaction with warfarin:
Four mechanisms
(1) ______ of warfarin protein binding
(2) Reduction in ____(CYP 1&2) The vitamin-K dependent clotting factors include factors II, VI, IX, and X.
(3) Alteration _____ that produce menadiones (Vit K-related substances) This effect may be more significant if the patient has relatively poor nutritional habits and may be mildly-moderately deficient in vitamin K already.
(4) Warfarin also interferes with production of ___ & ____, which are the body's natural anticoagulants. |
|
Definition
Displacement
hepatic metabolism
in GI bacterial flora
Protein C and Protein S |
|
|
Term
| Clotting factors normally undergo an ezymatic ___ to be converted into their activated forms. _____ inhibits this reaction, and the reduction in amount and activity of these factors results in the anticoagulant response. |
|
Definition
|
|
Term
| Antibiotics that interact with warfarin (5) |
|
Definition
macrolides - especially erythromycin
quinolones: ciprofloxacin
metronidazole
sulfas (TMP-SMZ)
azoles: fluconazole, ketoconazole -> Has to do w/ CP450 |
|
|
Term
Recommendation:
There is no need to make immediate adjustment in the warfarin dosage just because a patient is on an antibiotic.
If you know a patient on warfarin is being placed on an antibiotic you should check an INR be obtained prior to starting antibiotics
Check the INR more frequently during antibiotic therapy. |
|
Definition
|
|
Term
Warfarin Relative Contraindications: Situations where the risk of hemorrhage is greater than the potential clinical benefits of therapy:
Uncontrolled _____ abuse
Unsupervised ____
Increased risk of falls – ex. _____, _______ |
|
Definition
alcohol/drug
dementia/psychosis
elderly, movement disorders |
|
|
Term
| Activated Partial Thromboplastin Time (aPTT or PTT) = ____ + ____ + "______”+ ____ |
|
Definition
Plasma
Ca++ ion
partial thromboplastin
charged surface (aluminum silicate) |
|
|
Term
| The aPTT measures the activity of the ____ coagulation pathway |
|
Definition
|
|
Term
| Normal aPTT = __-__ sec Compare sample to “____” |
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Definition
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Term
| The aPTT is used to monitor ___ anticoagulant therapy. |
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Definition
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Term
Platelet Count Test
(Normal Values = ______-______ per microliter) |
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Definition
|
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Term
platelet count test
Thrombocytopenia = low platelets (<_____/ ml, severe < _____/ml) |
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Definition
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Term
Bleeding Time (not often used!)
Spring-loaded device makes incisions on volar surface of the forearm with pressure cuff at 40 mm Hg
excess blood is blotted away every 30 sec.
Normal = ___ min (2-9 min)
Measures adequacy of platelet plugs
Highly variable results |
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Definition
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Term
Prothrombin Time (PT):
_____ + ____ + "____"
Normal = ____-____ seconds
Warfarin anticoagulant therapy leads to inactivation of several clotting factors (especially VII, X, and thrombin) and prolongs the clotting time in the PT test.
Normalize results with the ____ |
|
Definition
Plasma
Ca++
thromboplastin
10 to 14
INR |
|
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Term
INR: International Normalization Ratio
Used to standardize ___ times between different batches of thromboplastin and between different laboratories |
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Definition
|
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Term
Factors that can Influence INR:
Drug Interactions
Diet
Alteration of intestinal flora (increase INR)
Fever (increase INR)
Hepatic failure (increase INR)
Thyroid function (hypothyroidism decreases INR, hyper increase INR)
Stress (increase INR)
Smoking (may decrease INR)
Noncompliance (increase or decrease INR) |
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Definition
|
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Term
| Alteration of intestinal flora (____ INR) |
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Definition
|
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Term
|
Definition
|
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Term
| Hepatic failure (____INR) |
|
Definition
|
|
Term
| Thyroid function (hypothyroidism ___ INR, hyper ___INR) |
|
Definition
|
|
Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
Drug Interactions: Increased INR:
*know the ones w/ stars |
|
Definition
Thyroid products
Metronidazole
Fluconazole/azole antifungals
Alcohol* (high doses)
Amiodarone*
Any abx has potential
Statins
Omeprazole - PPIs
Phenytoin
Gemfibrozil
Fluoroquinolones*
Cimetidine |
|
|
Term
Drug Interactions: No INR Effect
*know the ones w/ stars |
|
Definition
lAspirin
lClopidogrel
lCOX 2 inhibitors
lGlycoprotein IIb/IIIa antagonists
lNSAIDs*
lTiclopidine
lSmall doses of alcohol |
|
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Term
| Thrombolytic Therapy Objective: dissolve ____ blood clots by injecting a fibrinolytic enzyme or an activator of endogenous fibrinolysis without causing uncontrolled ___. |
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Definition
|
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Term
| Thrombolytic Therapy Indications: (5) |
|
Definition
Acute myocardial infarction
Pulmonary embolism
Deep venous thrombosis
Ischemic stroke (special circumstances only)
CAT scan, MRI first
"Have a bout a 3 hour window after the event to get these in the pt and for them to work in pt" |
|
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Term
| rtPA is what type of drug? |
|
Definition
| Recombinant Tissue Plasminogen Activator (tPA) |
|
|
Term
| Alteplase is what type of drug? |
|
Definition
| Recombinant Tissue Plasminogen Activator (tPA) |
|
|
Term
| Activase is what type of drug? |
|
Definition
| Recombinant Tissue Plasminogen Activator (tPA) |
|
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Term
Recombinant Tissue Plasminogen Activator (rtPA, Alteplase, Activase)
tPA produced by genetic engineering
t1/2 = ___ min
IV ____ followed by IV ____
adverse effects: serious ____
expensive
advantages over less expensive streptokinase difficult to demonstrate |
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Definition
3
bolus
infusion
hemorrhage |
|
|
Term
____ A shorter, genetically engineered form of r-TPA
Diffuses more freely into clot than alteplase
Shorter half-life than alteplase |
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Definition
|
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Term
Streptokinase is a nonenzymatic activator of ____ extracted from hemolytic streptococci
a loading dose of streptokinase used to saturate pre-existing ____
serious _____ is a potential side effect |
|
Definition
plasminogen
antibodies
hemorrhage |
|
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Term
| Don’t use any clot buster after ____, if pt has ___, and in pts that have potential to ___ |
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Definition
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