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Hematology > Coagulopathy Pharmacology > Flashcards

Coagulopathy Pharmacology Flashcards

1
Q

Warfarin (Coumadin)

A

Oral anticoagulant that inhibits the vitamin K factors: II, VII, IX and X. Also inhibits protein C and S.

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2
Q

How long does it take to achieve full effect of warfarin?

A

36 - 72 hours. Normal clotting factors need to be cleared from circulation.

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3
Q

Which factors does coumadin inhibit?

A

II, VII, IX and X. Also protein C and S.

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4
Q

Warfarin indications

A 
Venous and arterial thromboembolism.
PE
Stroke prevention of Afib
Thrombus prevention in valve replacement
Stroke
TIA
PREVENTION OF CLOTS
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5
Q

Can warfarin break up a clot that is already there?

A

No, it can only prevent them.

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6
Q

What is the preferrable INR range?

A

2.0 - 3.0

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7
Q

How soon should INR be checked after each warfarin dose change?

A

2nd or 3rd day

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8
Q

Warfarin Dosing

A

5mg nightly is a safe dose.

Adjust dose as needed for therapeutic INR

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9
Q

Assume that _____ drug interacts with warfarin.

A

EVERY.

Major interactions with statins, abx, NSAIDS, and DRUGS CLEARED THRU LIVER

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10
Q

Which foods will decrease INR?

A

Vitamin K containing foods. dark leafy greens, green tea.
Tobacco decreases INR.
Alcohol INCREASES INR.

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11
Q

Warfarin adverse effects

A

Bleeding, skin necrosis, purple toe syndrome, BLEEDING.

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12
Q

No bleeding and INR < 5

A

Hold warfarin

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13
Q

Bleeding or INR > 5

A

Hold warfarin AND administer oral, IV or subQ vitamin K.

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14
Q

What to do in life-threatening bleeding?

A

Vitamin K, Factor VII, FFP or PCC (prothrombin complex concentrates)

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15
Q

How long does oral and IV vitamin K take for therapeutic effects?

A

IV: 1-2 hrs
Oral: 24 - 48 hrs
Can affect warfarin for up to a week

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16
Q

How long should warfarin be held before a surgery/invasive procedure?

A

5 days

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17
Q

Name 2 reasons it might be best to take warfarin at night.

A
  1. Fewer food reactions

2. If it is high in the morning, you can adjust their dose that evening more easily (tell them not to take it)

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18
Q

Why is bridging with heparin important for initiation of therapy and for patients that may need procedures?

A

Warfarin has a pro-coagulation state that heparin can overcome.
Heparin is also faster-acting, and can cover them through the procedure.

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19
Q

What does Dabigatran (pradaxa) target?

A

IIa

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20
Q

What does Apixaban (Eliquis) target?

A

Xa

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21
Q

What does Rivaroxaban (Xarelto) target?

A

Xa

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22
Q

Types of LMW Heparin?

A

Enoxaparin (Lovenox)
Dalteparin (Fragmin)
Fondaparinux (Arixtra)

23
Q

Heparin MOA

A

Potentiates the action of antithrombin III.
Inactivates thrombin, IX, X, XI and XII (9 - 12)
Prevents conversion of fibrinogen to fibrin

24
Q

What must be monitored in a patient taking heparin?

A

Frequent monitoring of PTT, because of the narrow therapeutic window.

25
Q

Which disorders in unfractionated heparin used for?

A 
DVT
PE
Dialysis machines
Afib
MI
Thrombosis
26
Q

Heparin CI and SE

A

CI: anaphylaxis and recent major surgery
SE: bleeding, allergic rxns, transaminitis, heparin induced thrombocytopenia.

27
Q

What is used to reverse heparin?

A

Protamine Sulfate rapidle reverses heparin.
SLOW IV push to prevent anaphylaxis.
Can be used for LMWH and UFH

28
Q

Heparin induced thrombocytopenia (HIT)

A

Can occur with LMWH and UFH (most likely to happen).
Noted when platelets drop 50% after therapy
Platelet factor 4 (sensitive)
Serotonin release factor (specific AND sensitive)

29
Q

HIT Tx

A

Stop the heparin
Give alt. anticoagulant
NO platelet transfusions
do not give warfarin until platelet count increases.

30
Q

LMWH advantages

A

Can be given subQ without need for labs.
Lower risk of HIT
Home administration
Safer than UFH for extended admin.

31
Q

LMWH mechanism

A

Inhibits antithrombin III and Xa
Indirect thrombin inhibitor
More strongly inhibits Xa than UHF

32
Q

What is the time to effect for LMWH?

A

SQ - 2 hrs, with peak at 4 hrs

33
Q

Aspirin

A

Irreversible platelet inhibitor
Prevents formation of clots by inhibiting platelet plug.
Rapid absorption w/ peak effects in 1 hr.

34
Q

Aspirin Dosing

A

81 mg/day for CVA/MI prevenion
325 mg/day acutely for MI/CVA
325 daily chewed for acute coronary syndrome

35
Q

Aspirin SE

A 
GI bleeding
Administer w/ food.
PPI's and H2 blockers may decrease this risk.
TInnitus
Resistance
Allergy
36
Q

Stop aspirin ___ days before surgery.

A

4

37
Q

Clipidoogrel (Plavix) Mechanism

A

P2Y12 antagonist.

Irreversible inhibition of activation and aggregation of platelets.

38
Q

Plavix indications

A

Prevention of thrombotic events and acute coronary syndrome.

39
Q

Plavix SE

A

Bleeding
Multiple drug interactions
Stop 7 days prior to surgery

40
Q

Dipyridamole

A

Secondary prevention in patients following stroke or TIA.

Used with ASA is single pill (Aggrenox)

41
Q

Dipyridamole Mechanism

A

inhibits ADP and phosphodiesterase

Causes vasodilation and prevents aggregation

42
Q

GPIIb/IIIa antagonists

A

Reopro, Integrilin
IV, used for ACS
During percutaneous coronary intervetion

43
Q

GPIIb/IIIa SE

A

Bleeding
Thrombocytopenia
Allergy

44
Q

Fibrinolytics

A

tPA, Streptokinase, Urokinase

Convert plasminogen to plasmin to break down fibrin strands

45
Q

Fibrinolytic indications

A

MI
Stroke
Massive PE
Limb-threatening ischemia

46
Q

Fibrinolytic CI

A

Long check-list

Major bleeding or risk of major bleeding

47
Q

Uses for factor VIIa

A

Hemophilia A and B
Tx of warfarin related intercerebral hemorrhage
Factor VII deficiency

48
Q

Autoplex T contains

A

inanactivated II, IX, X and VIIa.

Can be used to reverse bleeding on pradaxa

49
Q

Aminocaproid acid (ECA)

A

AKA amicar
Antifibrinolytic agent
Used for acute bleeding

50
Q

ECA uses

A

Bleeding post-dental in hemophilia/vWD
Epistaxis
Menorrhagia

51
Q

Aprotinin

A

Derived from bovine lung tissue.

Hemostatic agent during CABG surgery

52
Q

Desmopressin acetate (DDAVP)

A

Synthetic analogue of vasopressin (ADH)

Increased VIII and vWF release from endothelial storage sites

53
Q

DDAVP uses

A

Tx of mild to moderate bleeding in hemophilia.
vWD bleeding tx or prophylaxis
IV, SQ or nasal

54
Q

DDAVP SE

A

water retention
hyponatremia (seizures)
limit dose to once daily to avoid tachyphylaxis (development of resistance to medication)

Hematology (14 decks)

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