Pharm 13-Direct/Indirect Thrombin Inhibitors Flashcards Preview

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Flashcards in Pharm 13-Direct/Indirect Thrombin Inhibitors Deck (96)
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1

How are anticoagulants classified?

Direct or indirect thrombin inhibitors

2

What drugs are indirect thrombin inhibitors? (Anticoagulants)

Warfarin (Coumadin)
Unfractionated Heparin/LMWH (Lovenox)
Fondaparinux (Arixtra)

3

What drugs are direct thrombin inhibitors? (Anticoagulants)

Lepirudin (Refludon)
Argatroban (No brand name)
Bivalirudin (Angiomax)

4

How do anticoagulants work?

Inhibit one or more steps in the clotting cascade that lead to fibrin formation; they do not dissolve clots

5

What is the single most important drug you will use as a perfusionist?

Heparin

6

What is heparin made out of?

Mix of straight-chain polymers consisting of extremely anionic repeating dissacharide units

7

Why is heparin so acidic?

So many carboxyl and sulfate groups attached

8

Which critters produce heparin?

virtually all critters, even ones lacking traditional blood so its an ancient molecule on the evolutionary tree

9

What are circulating mast cells?

basophils

10

Where does heparin "live"?

Mast cells

11

What do mast cells produce?

Histamine

12

What is the kind of heparin that is used the most?

Unfractionated heparin

13

How big is unfractionated heparin?

5000-30,000 Daltons

14

How many daltons is water?

Daltons

15

What is a Dalton?

a unit used in expressing the molecular weight of proteins, equivalent to atomic mass unit.

16

What is heparin measured in?

Units

17

What is 1 unit of heparin?

The quantity of heparin required to keep 1 mL of cat's blood fluid for 24 hours at 0 degrees C

0.002 mg of heparin/ unit

18

What are the two main sources of heparin?

1. Porcine intestinal-derived heparin
2. Bovine lung

19

Which source of heparin may be better in preventing some complications (such as HIT)?

Porcine intestinal-derived heparin

20

How is heparin administered?

Parenterally

21

Unfractionated heparin

High molecular weight heparin (HMWH)
5,000- 30,000 Daltons

22

Fractionated heparin

Low molecular weight heparin (LMWH)
5500 Daltons

23

Which type of heparin is much more uniform, contains less contaminants and inactive forms of heparin?

Fractionated heparin

24

What does heparin do?

Isn't an anticoagulant by itself
Acts on AT-III

25

Heparin + ATIII is how many more x active than ATIII by itself?

>1000x

26

IV Half Life: Heparin vs. LMWH

Heparin: 2 hours
LMWH: 4 hours

27

Anticoagulant Response: Heparin vs LMWH

Heparin: Variable
LMWH: Predictable

28

Bioavailability: Heparin vs LMWH

Heparin 20 %
LMWH: 90%

29

Major adverse effect: Heparin vs. LMWH

Heparin: Frequent bleeding
LMWH: Less frequent bleeding

30

Setting for therapy: Heparin vs LMWH

Heparin: Hospital
LMWH: Hospital and outpatient