Quiz 4 Flashcards
(31 cards)
Which direct thrombin inhibitor promotes nitric oxide release?
argatroban
Pulmonary is to bleomycin, as cardias is to?
doxorubicin (adriamycin)
How does ASA work as an antiplatelet medication?
inhibits thromboxane synthesis- interferes with COX 1 and 2 enzymes (irreversible- lasts for life of platelet)
Heparin is present endogenously on?
basophils and mast cells (as well as liver)
Which antimicrotubule chemo agent causes vascular permeability, peripheral edema, pleural effusion, and ascites?
Docetaxel
Heparin characteristics
- binds to antithrombin
- poorly lipid soluble, high molecular weight
- given IV or deep SQ
- prevents clot formation
What lab values evaluate heparin?
APTT and ACT
Contraindications for heparin
known bleeding tendencies, intracranial or intraocular surgery
Side effects of heparin
- bleeding
- HIT
- CV changes (decreased MAP from decreased SVR)
- altered protein binding (displaces alkaline drugs, increased concentrations of unbound drugs like propofol)
- decreased antithrombin
- altered cell morphology (leukocytes and RBCs)
Protamine characteristics
- specific antagonist to heparin
- strongly alkaline, positively charged
- cleared by reticuloendothelial system
- 1.3 mg for every 100 units heparin
Side effects of protamine
- hypotension (rapid injection)
- pulmonary hypertension (release of thromboxane and serotonin)
- allergic reactions (fish allergy)
Warfarin characteristics
- prevention of embolic events
- rapidly and completely absorbed
- high protein binding
- does NOT cross into placenta
What lab test evaluates warfarin?
PT and INR
Warfarin and surgery
- minor surgery ok
- d/c 1-3 pre op before majory surgery (bridge with hep)
- need Vit K and FFP to reverse warfarin for emergent surgery
Alteplase
- thrombolytic
- major risk of spontaneous bleeding (trauma)
What do you treat spontaneous bleeding with from alteplase?
FFP, cryo, platelets
Very rapid acting insulins and timing
lispro, aspart, glulisine
5-15 onset
45-75 peak
2-4 hour duration
Rapid acting insulin
regular
20 min onset
2-4 h peak
6-8 h duration
Intermediate acting insulin
NPH
2h onset
4-12 h peak
18-28 hour duration
Long acting insulins
detemir (2 h onset, 3-9h peak, 6-24h duration)
glargine (1.5 h onset, no peak, 20-24h duration)
ultra long acting insulin
degludec
2 hour onset
no peak
>40 hour duration
Insulin is metabolized by:
proteolytic enzymes in the liver and kidneys
Pharmacokinetics of heparin
- poorly lipid soluble, high molecular weight
- poorly absorbed from GI
- does not cross placenta
- circulates bound to plasma proteins (may neutralize anticoag effects)
- non linear dose response relationship
- elimination 1/2 time increased by low body temp and hepatic and renal dysfunction
Regular crystalline zinc insulin
onset 0.5-1 hours
peak 2-3 hours
duration 6-8 hours
