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Hematology > Coagulopathy Pharmacology > Flashcards

Coagulopathy Pharmacology Flashcards

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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?

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A

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

23
Q

Heparin MOA

Study These Flashcards
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?

Study These Flashcards
A

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

25
Which disorders in unfractionated heparin used for?
``` DVT PE Dialysis machines Afib MI Thrombosis ```
26
Heparin CI and SE
CI: anaphylaxis and recent major surgery SE: bleeding, allergic rxns, transaminitis, heparin induced thrombocytopenia.
27
What is used to reverse heparin?
Protamine Sulfate rapidle reverses heparin. SLOW IV push to prevent anaphylaxis. Can be used for LMWH and UFH
28
Heparin induced thrombocytopenia (HIT)
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
HIT Tx
Stop the heparin Give alt. anticoagulant NO platelet transfusions do not give warfarin until platelet count increases.
30
LMWH advantages
Can be given subQ without need for labs. Lower risk of HIT Home administration Safer than UFH for extended admin.
31
LMWH mechanism
Inhibits antithrombin III and Xa Indirect thrombin inhibitor More strongly inhibits Xa than UHF
32
What is the time to effect for LMWH?
SQ - 2 hrs, with peak at 4 hrs
33
Aspirin
Irreversible platelet inhibitor Prevents formation of clots by inhibiting platelet plug. Rapid absorption w/ peak effects in 1 hr.
34
Aspirin Dosing
81 mg/day for CVA/MI prevenion 325 mg/day acutely for MI/CVA 325 daily chewed for acute coronary syndrome
35
Aspirin SE
``` GI bleeding Administer w/ food. PPI's and H2 blockers may decrease this risk. TInnitus Resistance Allergy ```
36
Stop aspirin ___ days before surgery.
4
37
Clipidoogrel (Plavix) Mechanism
P2Y12 antagonist. | Irreversible inhibition of activation and aggregation of platelets.
38
Plavix indications
Prevention of thrombotic events and acute coronary syndrome.
39
Plavix SE
Bleeding Multiple drug interactions Stop 7 days prior to surgery
40
Dipyridamole
Secondary prevention in patients following stroke or TIA. | Used with ASA is single pill (Aggrenox)
41
Dipyridamole Mechanism
inhibits ADP and phosphodiesterase | Causes vasodilation and prevents aggregation
42
GPIIb/IIIa antagonists
Reopro, Integrilin IV, used for ACS During percutaneous coronary intervetion
43
GPIIb/IIIa SE
Bleeding Thrombocytopenia Allergy
44
Fibrinolytics
tPA, Streptokinase, Urokinase | Convert plasminogen to plasmin to break down fibrin strands
45
Fibrinolytic indications
MI Stroke Massive PE Limb-threatening ischemia
46
Fibrinolytic CI
Long check-list | Major bleeding or risk of major bleeding
47
Uses for factor VIIa
Hemophilia A and B Tx of warfarin related intercerebral hemorrhage Factor VII deficiency
48
Autoplex T contains
inanactivated II, IX, X and VIIa. | Can be used to reverse bleeding on pradaxa
49
Aminocaproid acid (ECA)
AKA amicar Antifibrinolytic agent Used for acute bleeding
50
ECA uses
Bleeding post-dental in hemophilia/vWD Epistaxis Menorrhagia
51
Aprotinin
Derived from bovine lung tissue. | Hemostatic agent during CABG surgery
52
Desmopressin acetate (DDAVP)
Synthetic analogue of vasopressin (ADH) | Increased VIII and vWF release from endothelial storage sites
53
DDAVP uses
Tx of mild to moderate bleeding in hemophilia. vWD bleeding tx or prophylaxis IV, SQ or nasal
54
DDAVP SE
water retention hyponatremia (seizures) limit dose to once daily to avoid tachyphylaxis (development of resistance to medication)

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