anticoagulant

Question 1

what are the anti-coagulants that cleave factors Va and VIIIa to inactivate them?

Answer 1

protein C

Question 1

what are the pro-coagulants that cleave down-stream factors to activate them?

Answer 1

XII, XI, X, IX, VII, II
12, 11, 10, 9, 7, 2

Question 2

what are the cofactors that activate proteases?

Answer 2

VIII, V, III (Tissue factor), protein S
8, 5, 3

Question 3

what factor bings to and inhibits thrombin?

Answer 3

anti-thrombin III

Question 4

what is the function of fibrinogen?

Answer 4

substrate protein for factor IIa (thrombin) that polymerizes to form a clot

Question 5

how does the liver affect coagulation?

Answer 5

all clotting factors beside vWF is made in the liver
liver disease can unpredictable effects as a result

Question 6

when does convergence occur with the intrinsic pathway?

Answer 6

factor IXa binds to factor VIIIa on the surface of platelets and activates factor X

Question 7

what does thrombin do?

Answer 7

activates factor V and VIII
enhances platelet activation
increases coag

Question 8

what does antithrombin do?

Answer 8

neutralizes procoagulant serine proteases
reaction is accelerated by heparin
decreases coag

Question 9

what does the protein c system do?

Answer 9

activate by thrombin binding to thrombomodulin
decreases coag

Question 10

what does factor Xa do?

Answer 10

activates tissue factor pathway inhibitor (TFPI) to block initial activations of factor VII
decrease coag

Question 11

what are common hemostatic function tests?

Answer 11

platelet count
prothrombin (PT/INR)
aPTT
fibrinogen
D-dimer

Question 12

what does too low platelet count signal?

Answer 12

thrombocytopenia
bone marrow malfunction, nutritional deficiency

Question 13

what is too high platelet count called?

Answer 13

thrombocytosis

Question 14

what does prothrombin time measure?

Answer 14

time is takes to clot

Question 15

what is a fibrinogen test?

Answer 15

less common test of hemostatic function
ranges from 200-400 mg/dL

Question 16

what is a D-dimer test?

Answer 16

measures the product of fibrin breakdown

Question 17

what is a DIC panel?

Answer 17

assortment of test in a coagulation profile

Question 18

what does aPPT monitor?

Answer 18

heparin therapy

Question 19

what is the average prothrombin time?

Answer 19

12-14 seconds

Question 20

what is the average aPPT?

Answer 20

26-33 seconds

Question 21

what is a normal INR?

Answer 21

0.8 to 1.2

Question 22

what is the therapeutic INR?

Answer 22

2 to 3
>3 risk of hemorrhage

Question 23

how is UFH administered?

Answer 23

via IV
effective immediately
adjust dosing according to coagulation test (aPPT)

Question 24

what is protamine sulfate?

Answer 24

polycationic protein that is the reversal agent of heparin binds tightly to heparin to neutralize the anticoagulant action

Question 25

what are some adverse effects of heparin?

Answer 25

thrombocytopenia (HIT/HAT) osteoporosis iatrogenic hemorrhage

Question 26

what is required for heparin to bind to antithrombin?

Answer 26

sulfate groups that have a negative charge

Question 27

what produces straight chain sulfated mucopolysaccharides?

Answer 27

mast cells and basophils

Question 28

where is heparin extracted from?

Answer 28

porcine small intestine or bovine lung

Question 29

what advantages of LMWH?

Answer 29

more predictable pharmacokinetic profile lower incidence of thrombocytopenia and osteoporosis

Question 30

how is LMWH administered?

Answer 30

SQ injection site longer half life than UFH

Question 31

what type of heparin requires monitoring?

Answer 31

UFH if monitoring is needed for LMWH, it requires an anti-factor Xa level

Question 32

what is fondaparinux sodium?

Answer 32

synthetic sulfated pentasaccharide that has a half life of 17-21 hours

Question 33

what is fondaparinux used for?

Answer 33

VTE prophylaxis in patients undergoing hip fracture surgery, hip replacement, knee replacement, or abdominal surgery

Question 34

is fondaparinux able to be reversed by protamine sulfate?

Answer 34

no it also has a low potential for thrombocytopenia

Question 35

what is the indication for rivaroxaban and apixaban?

Answer 35

treatment and prevention of VT and PE prevention of thrombosis in NV afib

Question 36

what is edoxaban indicated for?

Answer 36

treatment of VT and PE after 5 to 10 days with parenteral anticoag prevention of thrombosis in NV afib

Question 37

what is an important note about edoxaban?

Answer 37

it cannot be used in patients with a CrCl above 95 mL/min will easily be excreted then

Question 38

what is the indication for betrixaban (bevyxxa)?

Answer 38

prevention of VTE in hospitalized patients at risk for VTE

Question 39

what is andexanet?

Answer 39

the reversal agent for apixaban and rivaroxaban under investigational use with edoxaban and enoxaparin

Question 40

what is the blacked boxed warning for andexanet?

Answer 40

increased risk for thromboembolic events

Question 41

what is the mechanism of DTIs?

Answer 41

bind to the active site of thrombin, to exosites of thrombin, or both inhibit both soluble and fibrin-bound thrombin

Question 42

how non-heparinoid parenteral agents function?

Answer 42

do not act through antithrombin-III inhibit free thrombin and fibrin-bound thrombin instead

Question 43

what is lepirudin's MOA?

Answer 43

irreversible inhibition of thrombin

Question 44

what does lepirudin treat?

Answer 44

given via IV to treat HIT

Question 45

for bivalirudin, what amino acids bind to the catalytic site?

Answer 45

Phe-Pro-Arg-Pro

Question 46

what is argatroban derived from?

Answer 46

L-argine

Question 47

what is dabigatran indicated for?

Answer 47

prevention of stroke and systemic embolism in pts with nonvalvular afib

Question 48

what is the reversal agent for dabigatran?

Answer 48

idarucizumab (praxbind) --> humanized IgG1 FAB fragment