Lecture 29 - Anticoagulants + Hemostatic Flashcards Preview

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Flashcards in Lecture 29 - Anticoagulants + Hemostatic Deck (92):
1

What are examples of hypercoaguable states?

Hypertrophic cardiomyopathy
IMHA
Cushing's disease
Acute phase inflammation
Protein-losing nephropathy

2

What are examples of a hypocoaguable state?

post-surgery
Genetic bleeding disorders
Liver failure

3

What are the three necessary components of a functional clotting system?

Production of clotting factors
Functional platelets
Break down of clots

4

What is the breaking down of blood clots called

Firbinolysis

5

What interacts with blotting factors to induce the coagulation cascade?

Platelets

6

What are the factors within the intrinsic pathway?

12 - 11 - 9 - 8

7

What are the factors within the extrinsic pathway?

Tissue factor - 7

8

Where are the extrinsic molecules located?

Wall of the blood vessel

9

What tests the extrinsic pathway?

PT

10

What tests the intrinstic pathway?

aPTT

11

What is part of the common pathway?

Factor 10
2 - 1

12

What is factor 2 known as?

Thrombin

13

What is factor I known as?

Fibrinogen

14

What does fibrinogen do?

Polymerizes into a clot

15

What are the factors that depend on Vitamin K?

2 - 7 - 9 - 10

16

How does vitamin K activate certain Factors in the coag pathway?

Reduced --> Oxidized state
with y-glutamyl carboxylase

17

What recycles y-glutamyl carboxylase back to reduced form?

Vitamin K epoxide reductase

18

What is warfarin used in, in an extra-label use manner?

Food animals + Horses

19

how is warfarin distributed throughout the body?

Via plasma protein

20

What are the differences that you see in 1/2 life of warfarin?

extremely long in cats

21

How is warfarin metabolized?

Hepatic

22

How is warfarin excreted?

Urine + Feces

23

Why is the use of warfarin complicated?

Very small theraputic index

24

What is seen with warfarin toxicity?

Fatal hemorrhade w/ anemia
Hematomas all over
Congenital malformation in dogs + cats

25

What are therapeutic complications seen with warfarin use?

Dogs tolerant within a month
Need frequent testing of PT
Drug interactions

26

When do you see warfarin toxicity?

Antirodenticides
Moldy sweet clover + Sweet vernal hay

27

What is the biggest problem when it comes to warfarin toxicity in AZ?

Sweet clover

28

Where does warfarin affect the coag pathway?

Vit. K epoxide reductase

29

Why does giving Vitamin K in Warfarin toxicity help the animal?

Concentration of Vitamin K now high enough it can bypass the reductase and use DL-diaphorase instead

30

When, besides warfarin toxicity, is Vitamin K used for treatment?

Chronic sulfonamide treatment of birds for coccidiosis
Congenital, vit. K dependent coagulopathy
Porcine hemorrhagic syndrome

31

Why wont Vitamin K adminstration help animals in chronic liver failure?

The enzyme used to bypass the system is no longer being made in high enough quantities to help

32

How should Vitamin K be given?

Dogs - with fatty meal PO
Food animals/Horses - IM/SC

33

Why is Vd of vitamin K low?

Bind to chylomicrons + concentrating in the liver

34

How long does it take for a therapeutic effect of Vitamin K to occur?

6 ot 12 hours

35

What adverse reactions are seen with vitamin K adminstration?

Anaphylaxis

36

What are the three types of blood products?

Fresh/Fresh frozen plasma
Whole blood
Packed RBC's

37

Which of the blood products does not help with hemostasis?

Packed RBC's

38

What is contained within whole blood?

Coagulation factors, platelets, + RBC's

39

What is contained within FFP?

All Coagulation factors

40

What is the ranking of shelf life within the blood products?

FFP > WB ~ Fresh plasma

41

What is the risk, comparatively, of transfusion reactions wtih blood products?

FFP ~ FP

42

What are the two types of heparin?

Sulfate + LMW heparin

43

What is the structure of Heparin Sulfate?

Large glycosaminoglycan

44

What is the route of administration for heparin?

IV

45

What is the distribution of heparin?

Confined to the ciruclation

46

What is heparin metabolized by?

Liver + Reticuloendothelial cells

47

What is the length of therapeutic efficacy after a single dose in a dog?

5 to 6 hours

48

What happens with IM or deep admin of heparin?

Hematomas

49

What can cause thrombocytopenia with heparin administration?

Nonspecific binding of heparin to platelets

50

What happens as an adverse reaction in horses due to heparin admin?

RBC agglutination

51

What is the reversal agent for heparin?

Prothamine sulfate

52

What are the adverse effects of prothamine?

Pulmonary hypertension + Hypersensitivity rxn + Vascular hypotension + Bradycardia

53

What are the four steps to clot activation?

Injury + Initiation + Extension + Stabilization

54

At what step in clot activation does thrombin come in?

Extension

55

What is released by endothelial cells when injury occurs?

PGI + NO
CD39 on surface

56

With aspirin administration what do you have to keep in mind when giving it to a wind range of animals?

Only works in monogastrics

57

What is the distribution of acetylsalicylic acid within the body?

Plasma protein binding

58

What is acetylsalicylic acid converted to once in the body?

Salicylate

59

What time of metabolism does acetylsalicylic acid go through?

Modified by 2nd pass mechanisms

60

What occurs in cats given acetylsalicylic acid ?

Prolonged half life due them lacking the glucoronylation pathway

61

How is acetylsalicylic acid eliminated?

Renal

62

Acetylsalicylic acid 1/2 life: Dogs

8 hours

63

Acetylsalicylic acid 1/2 life: Cats

38 hours

64

Acetylsalicylic acid 1/2 life: Horses

30 min

65

What happens with Acetylsalicylic acid overdose?

Metabolic acidosis
Depression + Vomiting + Hyperventilation + Hyperthermia

66

What adverse reaction can be seen in horses with colic when given Acetylsalicylic acid ?

Nephrotoxicity
Even more so when horse is on aminoglycoside AB's

67

What drugs does Acetylsalicylic acid interaction?

Furosemide + Spironolactone
Increase clearance of corticosteroids
Increase or decrease secretion if urine pH is changed

68

What is Clopidogrel being found to be great to treat?

Cardiogenic embolism in cats - survival rate DOUBLEd

69

Where does Clopidogrel work in the pathway?

Blocks receptor for platelet activation = no plug formation
NO ADP, can't bind to R on platelet anymore

70

What does Clopidogrel require to work?

Low pH

71

What are the characteristics of the metabolism of Clopidogrel?

Inactive until 1st pass metabolism

72

Clopidogrel 1/2: Cats

3 days

73

Clopidogrel 1/2 life: dogs

3 hours

74

Clopidogrel 1/2 life: horses

75

What drug interactions are seen with Clopidogrel?

Proton pump inhibitors
-- and --
Histamine inhibitors

76

What are the two types of topicals used for the coag pathway?

Type 1: Activate patients platelets
Type 2: Fibrinogen + Activating agent = Quick clot/gel formation

77

Describe: Collasate

Type I collagen foam
Activates platelets by binding to collagen receptor

78

What protein is responsible for fibrinolysis?

Plasmin

79

What activates plasmin?

Tissue plasminogen activators

80

What are the indications for using TPa?

Pulmonary thormboembolism
-- and --
Arterila thromboembolism

81

What does the drug E-aminocaproic acid affect?

stops tPA from activating plasminogen

82

How is E-aminocaproic acid used in horses?

Guttural pouch bleeding

83

How is E-aminocaproic acid used in dogs?

Post-sx bleeding in sighthounds

84

How is E-aminocaproic acid admin?

IV

85

What are the hemostatic drug groups?

Topical
Systemic
Anti-fibrinolytic

86

Drugs within: Topical

Collasate

87

Drugs within: Hemostatic Systemic

Vitamin K
-- and --
Blood + Blood components

88

Drugs within: Anti-fibrinolytic

E-aminocaproic acid

89

What are the anticoagulant drug groups?

Fibrinolytics
Antiplatelet drugs
Systemic

90

Drugs within: Fibrinolytics

tPA

91

Drugs within: Anti-platelet

Clopidogrel
-- and--
Asprin

92

Drugs within: Anti-coagulant Systemic

Heparin
-- and --
Warfarin