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Pharm 2 > Class 8 Deck 1 > Flashcards

Class 8 Deck 1 Flashcards

1
Q

Heparin is an ________, ___________ glycosoaminoglycan found in the secretory granules of __________.

A
  • Anionic (charged)
  • Sulfated
  • Mast Cells
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2
Q

How does heparin work?

A
  • accelerate rate which ATIII neutralizes thrombin (IIa) and factor Xa
  • Prevents fibrinogen from converting to fibrin
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3
Q

When is heparin used?

A
  • Phophylaxis treatment of Embolisms
  • DIC
  • Anticoag during cardiac surgery
  • Management of angina, MI, PCI
  • Pregnancy complications
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4
Q

Heparin can only work on what type of factors?

A

-Unbound (not attached to platelet)

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5
Q

Heparin is cleared by what?

A

-Reticuloendothelial system

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6
Q

Does heparin cross the placenta? Warfarin?

A
  • Heparin does not cross placenta

- Warfarin does cross the placenta

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7
Q

What can cause heparin resistance?

A
  • Increased factor VIII
  • Accelerated clearance w/ massive PE
  • Inherited ATIII deficiency
  • Acquired ATIII deficiency
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8
Q

What causes acquired ATIII deficiency? and how to treat?

A
  • Cirrhosis, Nephrotic syndrome, DIC

- FFP or ATIII concentrate

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9
Q

What are some problems associated with heparin toxicity?

A
  • Bleeding
  • Thrombocytopenia (HIT)
  • Abnormal LFTs
  • Osteoperosis / vertebral fractures
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10
Q

What is protamine?

A
  • Low molecular weight, cationic, strongly basic protein
  • from Salmon sperm
  • Heparin antagonist
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11
Q

Protamine has what effect on LMWHs?

A

-Not as effective, only 65% neutralization

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12
Q

What are the doses of protamine?

A
  • 1-1.5mg per 100 units of heparin
  • 0.5-0.75 after 30-60 minutes
  • 0.25-0.375 after 2 hours
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13
Q

What are the adverse effects of protamine?

A
  • Histamine hypotension
  • Brady
  • Pulmonary HTN
  • Flushing
  • Dyspnea
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14
Q

What are the hypersenitivity reactions of protamine?

A
  • Uticaria
  • Angioedema
  • Pulmonary HTN
  • Anaphylactoid/Anaphylaxis
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15
Q

What groups of people are at risk for hypersensitivity to proatmine?

A
  • Fish allergy
  • Previous protamine reversal
  • Protamine containing insulin (NPH)
  • Previous vasectomy
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16
Q

How do you pretreat for protamine hypersensitivity?

A
  • Corticosteroids

- Antihistamine

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17
Q

What is heparin rebound?

A
  • Re-anitcoagulate after protamine reversal

- Usually 8-9 hours (reported 30min to 18hrs post CPB)

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18
Q

What can happen with protamine OD?

A
  • Bleeding

- Has anticoags and antiplatelets when given alone or in excess of heparin

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19
Q

Name 3 LMWH

A
  • Dalteparin
  • Enoxaparin
  • Tinzaparin
20
Q

How do LMWH work?

A

-Inhibition of factor Xa by antithrombin

21
Q

What are the advantages of LMWH?

A
  • Fixed dose sub Q

- Not dose monitoring or adjustments

22
Q

What are LMWH uses

A
  • Post op DVT/Embolisms

- Angina, MI, AFib

23
Q

Can dosages of LMWH and Heparin be used interchangeably?

A

No

24
Q

What are the adverese effects of LMWH?

A
  • Thrombocytopenia
  • Do not use with HIT
  • Decrease dose in renal patients
25
Q

What does Fondaparinux (Arixtra®) do?

A
  • Synthetic inhibitor of factor Xa
  • ATIII mediated
  • No effect on IIa or platelets
26
Q

Advantages of Fondaparinux (Arixtra®)?

A
  • Fixed dose / Once daily
  • No monitoring or dose adjustments
  • No HIT (stop use if platelets fall below 100,000)
27
Q

When is Fondaparinux (Arixtra®) used?

A

-Prevention / treatment of DVT/Embolism

28
Q

What 2 anticoags can cause spinal or epidual hematomas?

A
  • LMWH

- Fondaparinux (Arixtra®)

29
Q

What kind of drug is Danaproid Sodium (Orgaran ®)?

A

Heparinoid

  • anti-factor Xa
  • Contains no Heparin
30
Q

What is Argatroban (formerly Acova®) and what does it do?

A
  • Direct / reversible thrombin inhibitor

- Works on bound and unbound thrombin

31
Q

Argatroban (formerly Acova®) is used for what?

A

-Thrombus in patients w/ HIT or HITTS (those that can’t use heparin)

32
Q

Name 2 Hirundin Analogs (leech saliva)

A

Bivalirudin (Angiomax ®)

Lepirudin (Refludin®)

33
Q

How does Lepirudin (Refludin®) work?

A
  • direct thrombin inhibitor

- Binds irreversibly to bound and unbound thrombin (IIa)

34
Q

When is Lepirudin (Refludin®) used and how is it excreted?

A
  • thrombosis associated with HIT

- Kidneys

35
Q

How does Warfarin work?

A
  • indirect anticoagulant

- Alters factors II, VII, IX, and X by interfering with vitamin K.

36
Q

What is the treatment for warfarin bleeding?

A
  • Vitamin K (Takes 24hrs)

- FFP (immediate)

37
Q

Warfarin is what kind of pregnancy drug?

A

Category X

38
Q

Warfarin interacts with what other drugs?

A
  • ABX
  • Acetaminophen
  • Antiepiletics
  • Blood thinners
  • NSADIS
  • Supplements
39
Q

Name 3 Novel Oral Anticoags

A

Dabigatran (Pradaxa®): Oral direct thrombin inhibitor
Apixaban (Eliquis®): Oral direct Factor Xa inhibitor
Rivaroxaban (Xarelto®): Oral factor Xa inhibitor

40
Q

Dabigatran (Pradaxa®) is eliminated how?

A
  • 80% by kidneys

- Dose adjustments needed for CKD

41
Q

Dabigatran (Pradaxa®) should be held for how long prior to surgery?

A
  • CrCl >50 1-2 days

- CrCl < 50 3-5 days

42
Q

ApiXaban (Eliquis®) is used when?

A
  • Reduce stroke and embolization in patients w/ non-valvular AFib
  • DVT after total hip
43
Q

RivaroXaban (Xarelto®) is used when?

A
  • Reduce stroke and embolization in patients w/ non-valvular AFib
  • DVT after total hip / Knee
44
Q

Should be used with caution in what type of patients?

A

-Renal failure

45
Q

Apixaban should be used with caution in what type of patients?

A

-Liver failure

46
Q

Novel Oral Antigcoags should not be used with what other drugs?

A
  • Strong inhibitors/inducers of CYP3A4 or P-Glycoproteins
  • NSAIDS
  • Anitplatlet

Pharm 2 (23 decks)

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