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Flashcards in 3 Anticoag HH Deck (42):
1

Complications of UFH use

Osteoperosis Heparin induced thrombocytopenia (HIT)

2

What are the two types of HIT

type 1 - platelet aggregation type 1 - platelet activating - a more rapid drop in platelet count, paradoxically causes THROMBOSIS. Seen 5-7days after initiation.

3

Action of coumarins?

Vit k epoxide reductase inhibitor - LEARN THE CYCLE

4

What is vit K used for?

gamma-carboxylation of Gla residues essential to activate clotting factors.
This converts vit K into vit K epoxide (and this is transformed back using vit K epoxide reductase)

5

How are platelets activated?

when unactivated there is an asymmerical distribution of phospholipids in hte membrane, this scrambles when activated. Becomes anionic allowing Ca binding

6

PT time tests the extrinsic or intrinsic pathway

exctrinsic

7

S/e warfarin

BLEED
alopecia
skin rash
skin necrosis
teratogenic
agranulacytosis

8

Why do we give vit K as well as clotting factors in high INR?

short half life of clotting factors

9

Name the NOACs

rivaroxiban
apixiban
dabigatran

10

Mechanism of action of dabigatran

anti-IIa inhibitor

11

Mechanism of action of riv and apixaban

anti-Xa inihibitor

12

Warfarin: why is time in therapeutic range important?

under 50% of the time in therapeutic range actually shows worse survival than no warfarin

13

Look at the diagram of where anticoagulants work!

ssdfsdfjsdlkfjsldfj

14

Major advantages of NOACs? 4

Reproducible PK
No monitoring

Rapid onset
Oral

15

All NOACs are licensed for... (4)

VTW prophylaxis in hip/knee surgery
SPAF
treatment and secondary prevention of VTE

16

Disadvantages of NOACs

-Cost
-Extra care in some circumstances (see other card)
-unlicensed in preg and kids
-not reversible

-difficulty measuring effect
-drug interactions still possible

17

Care using NOACs with (4)

peri-op
epidural anesthesia
renal impairmen
wight 12kg

18

Reversal agents for NOACs are being investigated such as

MAB fragments and modified antifXa vairent

19

Which NOAC has OD dosing

Rivarox

20

NOAC to choose in high risk of stroke/bleed/renal impairment

Riv or Apix

21

NOAC to choose in previous MI or ACS

Riv

22

NOAC to choose for high GI bleed risk

Apix

23

NOAC to choose for high tisk of ischemic stroke

Dabigatran

24

Choice of anticoagulant:
Cr

Warfarin

25

Choice of anticoagulant:
Cr 15-30

riv 15mg od
or
apix 2.5mg bd

26

Choice of anticoagulant:
extremes of weight

Warfarin

27

Choice of anticoagulant:
children

Warfarin

28

Choice of anticoagulant:
heart valve prosthesis

Warfarin

29

Choice of anticoagulant:
cancer associated thromosis

LMWH

30

Choice of anticoagulant:
high GI bleed risk

warfarin or apixiban

31

Choice of anticoagulant: previous MI

warfarin or riv (maybe apix)

32

Thrombolytic agents

- Streptokinase (Kabikinase®, Streptase®)
- rt-PA, Alteplase (Actilyse®)
- Reteplase (Rapilysin®)
- Tenecteplase (Metalyse®)

33

Contraindications to fibriolysis in acute MI

Recent haemorrhage
Trauma
Surgery
Coagulation defects
Peptic ulceration
Severe hypertension
Acute pulmonary disease esp cavitation
Acute pancreatitis
Severe liver disease
Previous allergic reaction

34

You can put a creepy spider device itno your .... to prevent PE

vena cava

35

There is evidence suggesting ..... and ... should be used in combo for PE/DVT

anticoagulants and thrombolytics

36

Pharmacists role in anticoagulation

-Patient decision re-anticoagulation of choice?
-VTE risk assessment / management
-Initiation and dosing of anticoagulant drugs
-Monitoring and managing results
-Drug interactions
-Counselling patients

37

Non-pharmacological ways of avoiding VTE?

mobility and hydration
stockings
foot pumps

38

APTT measure intrinsic or extrinsic clotting time?

Intrinsic

39

APTT is normall

27-35 sec

(don't confuse APTT ratio with INR. APTT raio is APTT/control)

40

LMHW doses are ..... adusted
UFH doses are .... adjusted

LMWH - weight
UFH - APTT

41

Name some LMWH

Dalteparine
Enoxaparin
Tinzaparin

42

How do you reverse heparin?

Protamine (it's uncommonly needed) - more effective on UFH that LMW