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Flashcards in Hematological agents II Deck (68):
1

What is type I heparin induced thrombocytopenia? What is the consequence of this?

Heparin can increase platelet aggregation which causes a decrease in circulation platelet numbers

Little clinical consequence

2

What is type II heparine induced thrombocytopenia?

Heparine can bind platelet factor 4, which some pts develop antibodies against. This causes thrombosis

3

Which type of heparin causes HIT: fractionated or unfractionated?

unfractionated

4

Which are more common in HIT: venous or arterial thromboses?

Venous

5

Who are more affected by HIT: men or women?

Women

6

How long does it take platelet counts to fall following heparin administration?

5-10 days

7

What is enoxaparin?

Lower molecular weight heparin

8

What is low molecular weight heparin called?

Enoxaparin

9

What is the major disadvantage to low molecular weight heparin? (2)

Cannot deactiveate thrombin

Protamine only partially reverses it

10

What are the advantages to low molecular weight heparin? (2)

Easier to dose
Lower risk for HIT

11

What disease contraindicates low molecular weight heparin?

Renal insufficiency

12

What is fondaparinux?

Synthetic analog of AT binding pentasaccharide sequence

13

What is the MOA of fondaparinux?

Binds to antithrombin and increases rate of factor X inhibition

14

True or false: protamine is only partially effectie against fondaparinux

False--not at all effective

15

What is the major contraidication with fondaparinux?

Renal disease

16

What is the monitoring assay for fondaparinux?

anti-factor Xa assay

17

True or false: monitoring of fondaparinux and LMWH is not as intensive as monitoring regular heparin

True

18

What is the MOA of hirudin?

Direct thrombin inhibitor at both active sites

19

Do direct thrombin inhibitors inhibit factor 10?

no

20

How do you administer hirudin?

parenterally

21

What is the MOA of lepirudin?

Direct thrombin inhibitor at both active sites

22

How do direct thrombin inhibitors work?

Directly binding to the active site in thrombin that cleaves fibrinogen into fibrin

23

What is the MOA of argatroban?

Direct thrombin inhibitor at the active site

24

What is the MOA of dabigitran?

Direct thrombin inhibitor at the active site

25

Which direct thrombin inhibitor is given orally?

Dabigitran

26

What is the major advantage of DTIs vs heparin?

can inhibit thrombin bound to fibrin

27

What type of drug should you use instead of heparin in cases of HIT?

Direct thrombin inhibitor

28

What is the MOA of bivalirudin?

Inhibits thrombin by binding directly to active site (direct thrombin inhibitor)

29

What is the drug used to reverse direct thrombin inhibitors

There is none

30

What is the MOA of warfarin?

Competes with Vit K for Vit K reductase

31

What are the factors that need vitamin K?

10 9 7 and 2 (and protein C and S)

32

What does vitamin K reductase do?

Reduces the oxidized form of Vit K, that is used in factor activation

33

How long does it take for warfarin to take full effect? Why?

3-5 days
Only affects new factors

34

What is the enzyme that degrades warfarin? What is the significance of this?

CYP2C9

pts with polymorphisms need lower dose

35

Why does warfarin have such a high Vd?

Plasma protein bound

36

What is the test to monitor warfarin?

PT

37

What are the general steps of performing a PT?

-blood collected in Ca free tube
-thromboplastin added
-Ca added
-time

38

Generally, what types of drugs are contraindicated with warfarin?

Any drug that interferes with Vit K absorption

39

Where does Vit K come from? What drugs, then, have to be carefully used when a pt is on warfarin?

Gut bacteria
Abx

40

Potentiate or reduce the anticoagulant effect of warfarin: NSAIDs. Why?

Potentiate
Interfere with primary hemostasis

41

Potentiate or reduce the anticoagulant effect of warfarin: SSRIs

Potentiate

42

Potentiate or reduce the anticoagulant effect of warfarin: anti-platelet drugs

Potentiate

43

Potentiate or reduce the anticoagulant effect of warfarin: drugs that decrease hepatic metabolism

potentiate

44

Potentiate or reduce the anticoagulant effect of warfarin: statins . Why?

Potentiate
Use same CYP enzyme, and saturate it

45

Potentiate or reduce the anticoagulant effect of warfarin: rifampin. Why?

Reduce

46

Potentiate or reduce the anticoagulant effect of warfarin: carbamazepine. Why?

reduce
Increase hepatic elimination of the drug

47

Potentiate or reduce the anticoagulant effect of warfarin: renal insufficiency. Why?

Potentiate since hypoalbuemia

48

Potentiate or reduce the anticoagulant effect of warfarin: decreased hepatic function

Reduce

49

What is the severe adverse side effect of warfarin use? What causes this?

Necrosis
Precipitous fall in vitamin C

50

What is the therapeutic INR range for warfarin?

2-3

51

What are the two things to administer a pt with too high of an INR d/t warfarin use?

Vit K
Administer fresh plasma

52

What is the MOA of rivaroxaban?

Direct inhibitor of factor X

53

What is the MOA of apixaban?

Directly inhibits factor X

54

What are the benefits of the newer oral anticoagulants like rivaroxaban, apixaban, and dabigatran?

-Faster onset
-Low food/drug interactions
-Predictable effect

55

IS warfarin or heparin safe to take during pregnancy?

Warfarin, no
Heparin, yes

56

What is the main protein involved in the fibrinolytic system? What activates it?

Plasmin
tPA

57

Why isn't there much activation of plasminogen in the plasma if there's tPA?

Both have higher affinity when bound to fibrin

58

What is the inhibitor in the plasma that will inhiit plasmi?

Alpha2 plasma inhibitor

59

How, generally, do the fibrinolytic drugs work?

Activate plasmin from plasminogen

60

What is the MOA of steptokinase?

forms a complex with plasminogen

61

What is the MOA of urokinase?

Natrual activator of plasmin, produced by the kidney

62

What are the two tPA agents used in clinic?

Alteplase
Reteplase

63

What are the adverse effects of streptokinase?

anaphylaxis

64

When are fibrinolytic drugs used?

STEMI or new LBBB

65

Should you use thrombolytics in NSTEMIs?

No

66

What is the MOA of aminocaproic acid?

Blocks interaction of plasmin with fibrin, thus preventing fibrin degradation

67

What is the MOA of tranexamic acid?

Blocks interaction of plasmin with fibrin, thus preventing fibrin degradation

68

What are aminocaproic acid and tranexamic acid used for?

Hemophila treatment