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Pharmacology > coagulation > Flashcards

coagulation Flashcards

1
Q

Time to begin forming a clot

A

R time

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2
Q

time until clot has achieved fixed strength

A

K time

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3
Q

speed of fibrin accumulation

A

alpha angle

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4
Q

Highest verticle amplitude on the Teg. measured clot stength

A

MA

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5
Q

height of vert amp at 60 min after MA

A

A60

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6
Q

binds to antithrombin, accelerating anticoagubility

A

Heparin

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7
Q

Normal 25-35 s

A

aPTT
heparin: 1.5-2.5x normal

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8
Q

normal 90-120s

A

ACT

> 400s cardiac surgery

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9
Q

ACT is affected by 4 things

A

1 Hemodilution
2 Hypothermia
3 Thrombocytopenia
4 Deficiency of F1, F7, F12

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10
Q

Fibrinogen levels is affected by

A

hemorrhage
hemodilution

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11
Q

SE Heparin

A

HIT
allergy
hypotension
decrease AT concntration

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12
Q

contraindications of heparin

A

neurosurgery
HIT
regional anesthesia

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13
Q

reverses heparin

A

protamine (+)
1u per 100u heparin

SLOWLY to prevent anaphylaxis and pulmonary vasoconstriction

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14
Q

half life of heparin

A

1 hour

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15
Q

Warfarin Inhibits Factors

A

2,7, 9,10 (Vit K antagonist!)

Also, protien c & s

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16
Q

time for warfarin to achieve therapy

A

36-72 hours

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17
Q

antidotes for warfarin

A

kaycentra (prothrombin complex concentrate)
Vitamin K and FFP 1-2u
Recombinant Factor 7a

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18
Q

risk of vit K deficiency

A

diet
antibiotic kills GI flora, reducing synth
malabsorption
hepatic disease
neonates (give after delivery “phytonadione”)

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19
Q

anesthesia and vitamin k administration

A

-requires a functional liver
-takes 4-9 hours to work
-antidote for warfarin

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20
Q

warfarin MOA

A

ibhibits vit K epoxide reductase complex 1 enzymes

this enzyme produces K dep factors 2, 7, 9 10, Pc&S

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21
Q

pt/INR on warfarin

A

2-3x normal

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22
Q

p2y12 antagonists

A

Plavix

antiplatelet

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23
Q

Lovenox MOA

A
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24
Q

abciximab

A

g2b3a antagonist

antiplatelet

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25
Q

cox 2 inhibitors

A

rofecoxib
celecoxib

antiplatelet

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26
Q

non specific cox inibitors

A

ASA
NSAIDS

antiplatelet

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27
Q

thrombin inhibitors

A

bivalirudin
argatroban
Pradaxa

BAP- born a pussy

anticoagulants

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28
Q

plasminogen activators

A

tPA
Streptokinase

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29
Q

stimulates edogenous F8 release and vWF release

A

DDVAP

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30
Q

What carries F 8 in the plasma

A

vWF

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31
Q

labs that increased with vWF disease

A

ptt
bleeding time

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32
Q

replacing factor 8 before surgery

A

FFP
cryro
factor 8 concentrate
DDAVP
Recombin F 7
TXA and Aminocapric acid

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33
Q

hemophilia A

A

F8 deficiency
prolonged PTT

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34
Q

Hemophilia B deficiency

A

F 9
prolonged PTT

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35
Q

hemophilia a and B lab

A

prolonged PTT
normal INR/PT
nromal bleeding time

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36
Q

disorganized clotthing and fibrinolysis causing hemorrhage AND thrombosis

A

DIC

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37
Q

S/S DIC FAPD

fibrinogen and antithrombin decreased

A

eccymodid
petechia
mucosal bleeding
bleeding at IV sites
increased d dimer and fibrin Pt and ptt
decrease fibringogen platelets and antothombin

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38
Q

DIC common in STOM

A

sepsis #1
obstetric complications
malignancy
trauma

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39
Q

DIC treatment

A

replace blood with FFP, plts, cryro
IV heparin or LMWH
IV fluids

“feed the beast”

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40
Q

HIT

A

clot formation throughout the body

immune response against heparin

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41
Q

HIT type 2

A

IgG attack F 4 –> platelet aggregation

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42
Q

HIT 2 S/S

A

5-14d after heparin
plt <50,000

43
Q

treatment of HIT

A

bivalrudin
argatroban
xarelto

44
Q

liver synthesises all coag factors except

A

3 and 4 vwf

45
Q

4 steps of clotting

A

1 vasoconstriction
2 primary hemostasis
3 secondary hemostasis
4 clot dissolution/ retraction

46
Q

causes vasoconstriction

A

endothelin
vWF

47
Q

3 Primary hemostasis steps

A

1 adhesion
2 activation
3 aggregation

48
Q

adhesion of plts formula

A

PLT + GP1B + vWF

49
Q

reason for Shape change of platelet

A

+ F2 (prothrombin)

50
Q

Activation

A

+ F2 to platelet with vWF & GP1b
–> shape change
Granule release of ADP and TXA2

51
Q

Aggregation

A

1 TXA2 and ADP uncover fibrinogen receptors
2 Fibinrogen attaches to plt
3 Links platelets
4 GP2B/3a binds platelet to fibrinogen

52
Q

what protein binds platelets to fibrinogen

A

GP2B/3a

53
Q

intrinsic pathway

A

12 –> 11 –> 9 (+8) (+4) –> 10

54
Q

extrinsic pathway

A

3 –> 7 (+4) –> 10

55
Q

common pathway

A

10 (+5) –> 2–> 1

56
Q

Endothelial cells produce these 2 for clot retraction and dissolution

A

tPA (fibrinolysis)
thrombomodulin (blocks cascade)

57
Q

converts plasminogen to plasmin

A

tpa

58
Q

What is plasmin?

A

enzyme that breaks down fibrin

59
Q

Thrombomodulin activates what protein

A

protein C

60
Q

Protein C inactivates what?

A

inactivates F5 and F8

61
Q

Thrombomodulin ultimately bind to inhibit what factor?

A

8&5 —> thrombin F2

62
Q

plasminogen –> plasmin

A

fibrinolysis (by tPA)

63
Q

strongly binds to inhibit F2a and F10a

A

antithrombin (AT)

64
Q

Cofactor for heparin made in liver

A

Antithrombin (AT)

65
Q

deficiency of antithrombin causes

A

cirrhosis
nephrotic syndrome

renders pt unresponsive to heparin

66
Q

a serious side effect of TXA

A

seizures

67
Q

SE Protamine

A

anaphylaxis
hypotension
RV failure

heparin rebound

68
Q

causes of sensitization to protamine

A

previous exposure
vasectomy
NPE insulin exposure (diabetics

69
Q

what is fibrinogen made of

A

2a
13a
plasmin

70
Q

what infusions have fibrinogen in them

A

Most: Fibrinogen concentrate (15-20g/L)
Middle: Cryro (15-17g/L)
Least: FFP (1.5-4g/L)

71
Q

MOA DDAVP

A

releases vWF from endothelium
0.3mg/kg 15-30m

72
Q

DDAVP uses

A

hemophilia A or VWF disease

30 m before OR
may cause hypotension due to inflammatory mediators

73
Q

heparin MOA

A

binds to antithrombin
which inhibits 2, 10, 9, 11, 12

74
Q

vit K dependent factors

A

2, 7, 9, 10

75
Q

Xarelto MOA

A

10a inhibitor

use in HIT
Stroke, DVT, MI
epidural removal: 18 hours
6 hours following removal.

76
Q

Direct Thrombin 2a inhibitors

A

Useful in high-risk of in HIT

Bivalirudin: ACT –> bivalent
Argatroban: aPTT –> univalent
Pradaxa: aPTT

77
Q

Pradaxa and renal function?

A

adjust with renal dysfunction

78
Q

how long does argatroban (DTI) last?

A

4 hours

79
Q

How does Pradaxa affect anesthesia?

A

Give 2 hours after epidural catheter removal and monitor neuro status.

80
Q

Platelet Inhibitors

A
  1. Cox Inhibitors
    –> ASA
    –>NSAID
  2. P2Y12 Antagonists
    –> plavix
81
Q

What drugs are thienopyridines (P2y12 antagonists)?

A

clopidogrel (plavix)
prasugrel (effient)
ticagrelor

82
Q

How does cox 1 work?

A

inhibits thromboxane A2

83
Q

when to stop aspirin before surgery

A

7-10 days
resume 24 hours after surgery

84
Q

how to immediately reverse aspirin in an emergency

A

platelet transfusion

85
Q

absolute contraindications of tPA

A
  1. vascular lesion
  2. SBP >165/>110
  3. Neurosurgery/trauma
  4. Brain tumor
  5. Stroke <3m ago
  6. Bleeding
86
Q

Aspirin with stents delay

A

BM: 6 weeks
DES: 6 months

87
Q

PT/INR works on what pathway

A

extrinsic and common
warfarin
12-14s normal PT
1 INR

88
Q

aPTT/ACT works on what pathway?

A

intrinsic & common pathway
monitors heparin
24-35s aPTT
80-120s ACT

89
Q

ACT is sensitive to 4 things

A

1 hemodilution
2 hypothermia
3 thrombocytopenia
4 platelet dysfunction

90
Q

Why fibrinogen over FFP?

A

Will raise levels faster without giving too much volume.
rapid administration

at 200mg/dl? –> FFP wont work, cryro and fibrinogen are the better option

91
Q

if the fibrinogen level is 200, what would you give?

A

cryoprecipitate
fibrinogen concentrate

92
Q

Recombinant factor 7a is used in:

A

1 hemophilia patients
2 life-threatening hemorrhage off label

used for impaired coagulation in cardiac surgery

93
Q

Risk of recombinant factor 7a in off label use?

A

thromboembolic events

can normalize INR and PT values without actually correcting deficit

94
Q

what med is a prothrombin complex concentrate?

A

Kaycentra

95
Q

what is kaycentra made of

A

f 2, 7, 9, 10

K-antagonists

96
Q

What fibrinogen value (mg/dL) would warrant administration of cryoprecipitate?

A

100

97
Q

What is a normal value for prothrombin time (PT) in seconds?

A

12-14

98
Q

what is heparin rebound?

A

occurs when not enough protamine is given.

99
Q

emergency surgery and your patient is on warfarin.. what do you give?

A

prothrombin complex concentrate (Kaycentra)
Vitamin K

100
Q

dual antiplatelet therapy

A

BMS: 6w
DES: 6m

101
Q

name 2b3a inhibitors

A

THOSE ARE EDDIES
abcixmab
efitabitide
tirofiban

102
Q

how do 2b3a inhibiots work

A

They block fibrinogen from binding to platelets

103
Q

se of 2b3a inhibitors

A

thrombocytooenia

104
Q

tPA Side effects

A

hemorrhage
angioedema

Pharmacology (10 decks)

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