anti coag drugs

Question 1

heparin, what does it potentiate?

Answer 1

ATIII, immediate effect

Question 2

unfractioned binds?

Answer 2

thrombin

Question 3

LMWH binds?

Answer 3

factor xa

Question 4

heparin potentiates anti thrombin III

Answer 4

either binds xa or thrombin

Question 5

how do you monitor unfractioned?

Answer 5

APTT

Question 6

LMWH?

Answer 6

don’t usually need to monitor

Question 7

complications?

Answer 7

heparin induced thrombocytopaenia (low platelets)

osteoperosis in very long use

Question 8

to reverse heparin?

Answer 8

usually just stop

Question 9

occasionally in severe bleeding, what can you give?

Answer 9

protamine sulphate

Question 10

what is the effect of protamine sulphate on unfractioned heparin and LMWH

Answer 10

complete reversal for unfractioned, partial reversal for LMWH

Question 11

how does warfarin work?

Answer 11

inhibits vitamin K

Question 12

what does vitamin K do to factors 2,7,9,10?

Answer 12

carboxylates them

Question 13

where are clotting factors produced?

Answer 13

liver

Question 14

antagonism of vitamin K

Answer 14

y

Question 15

when should dose be taken?

Answer 15

same time every day

Question 16

how long does it take to get the full effect of warfarin?

Answer 16

3-5 days

Question 17

may need what to cover this period?

Answer 17

heparin

Question 18

what is prothrombin time?

Answer 18

patients pt in seconds/mean normal pt in seconds to the power of international sensitivity index

Question 19

warfarin - beware of drug interactions!!!

Answer 19

y

Question 20

skin bruising, epistaxis, haematuria

Answer 20

severe - gastrointestinal, intracerebral, significant drop in hb

Question 21

warfarin reversal - pathway?

Answer 21

no action - omit dose - administer oral vitamin K, administer clotting factors

Question 22

how long does vitamin k take to work?

Answer 22

6 hours

Question 23

clotting factors?

Answer 23

immediate effect

Question 24

what is factor 2?

Answer 24

prothrombin

Question 25

heparin - what can it do to platelets and bone?

Answer 25

causes thrombocytopenia and long term use can cause osteoporosis

Question 26

how can obstructive jaundice cause bleeds?

Answer 26

bile salts are needed to absorb vitamin K in the upper intestine. Vitamin K carboxylises prothrombin, 7,9 and 10

Question 27

to reverse warfarin, what are the steps?

Answer 27

do nothing --> omit warfarin dose --> give vitamin K --> give activated clotting factors

Question 28

how long does administered vitamin K take to work?

Answer 28

6 hours

Question 29

how long does activated clotting factor take to work

Answer 29

immediate effect

Question 30

what is dabigatran?

Answer 30

thrombin inhibitor

Question 31

name two factor Xa inhibitors?

Answer 31

rivaroxaban and apixaban

Question 32

in arterial clots, what do platelets release that cause further aggregation?

Answer 32

thromboxane A2

Question 33

HOW DO YOU MONITOR PATIENTS ON HEPARIN?

Answer 33

fbc (thrombocytopenia and osteoporosis)

Question 34

what does heparin help?

Answer 34

helps anti thrombin III bind to thrombin and factor 10 a

Question 35

most common thrombophilia?

Answer 35

factor V leidig