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1. Theme 2 > T2 L7: Thrombosis > Flashcards

T2 L7: Thrombosis Flashcards

1
Q

Order from abdomen to foot: Femoral vein, Tibial vein, Popliteal vein and Iliac vein

A

Iliac vein, femoral vein, popliteal vein and Tibial vein

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2
Q

What is Virchows triad?

A

3 factors that are critically important in the development of venous thrombosis: venous stasis, activation of blood coagulation, and vein damage.

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3
Q

Why is pregnancy a thrombotic risk factors?

A

It causes a hypercoagulative state

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4
Q

What is a baker’s cyst (popliteal cyst)?

A

A fluid-filled swelling that develops at the back of the knee.

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5
Q

What are the 5 clinical presentations of a deep vein thrombisis?

A

Unilateral calf swelling, heat, pain, redness, hardness

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6
Q

How is an ultrasound used as a diagnosis for deep vein thrombosis?

A

The veins will be non-compressible and this is visible with an ultrasound

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7
Q

What is a venogram?

A

A dye is injected into the vein and then x-rays are taken

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8
Q

What is the Wells score?

A

It measures the risk of developing an acute pulmonary embolism. Can be used for deep vein thrombosis too

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9
Q

What is a D-dimer test?

A

Looks for D-dimer in the blood (a protein fragment that’s made when a blood clot dissolves in your body)

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10
Q

What does a high Wells score and positive D-dimer test indicate?

A

Likelihood of deep vein thrombosis so ultrasound is needed to confirm

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11
Q

What type of drug is Tinzaparin?

A

A LMW Heparin

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12
Q

What type of drug is Enoxaparin?

A

A LMW Heparin

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13
Q

When is IV unfractionated heparin given?

A

When other heparin can’t be given because the patient has insufficient kidney function

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14
Q

What is the adequate EGFR for kidney function?

A

> 30ml/min

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15
Q

What is EGFR?

A

Estimated glomerular filtration rate

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16
Q

Why is someone given Heparin when being switched to Warfarin first as treatment for deep vein thrombosis?

A

When the INR is >2.0 for 2 days. Heparin is only used to start the patient of anticoagulants

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17
Q

What is INR?

A

International normalised ratio (INR) is the prothrombin time. It’s used to see how long blood takes to clot

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18
Q

What is the treatment when someone is having their first DVT?

A

Anticoagulants for 6 months

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19
Q

What is the treatment when someone is having their second DVT?

A

Lifelong coagulants

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20
Q

What should the INR normally be?

A

2-3

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21
Q

What are the classic symptoms of a medium PE?

A

Pleuritic pain, dyspnoea, and haemoptysis

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22
Q

What is dyspnoea?

A

Uneasy breathing which can cause shortness of breath

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23
Q

What are the classic symptoms of a massive PE?

A

Syncope and death

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24
Q

What is haemoptosis?

A

Coughing up blood

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25
Q

What are the presentations of a PE on examination?

A

Tachycardia, tachypnoea, and hypotension

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26
Q

What is Tachycardia?

A

Fast heart rate

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27
Q

What is Tachypnoea?

A

Rapid breathing

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28
Q

What is a V/Q mismatch?

A

A ventilation/ perfusion mismatch. The lung receives O2 without the blood or the other way around. It means that perfusion is not efficient

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29
Q

What is a V/Q scan?

A

A ventilation/perfusion radio-isotope scan. Not done anymore

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30
Q

What are the classic indication of a PE on and ECG?

A

Sinus tachycardia, atrial fibrillation and/or right heart strain (RBBB (Right bundle branch block)). Most common pattern is S1Q3T3 pattern

31
Q

What would a CXR look like when someone has a PE?

A

Usually normal. There might be linear atelectasis and small effusions

32
Q

Why won’t a blood clot show up on an R-ray?

A

Because the clot is radiolucent. A CT will show blood clots

33
Q

What is a atelectasis?

A

A complete or partial collapse of the entire lung or

a lobe of the lung

34
Q

What is the mortality rate for PE despite treament?

A

5%

35
Q

What is tPA?

A

Alteplase (A thrombolytic drug)

36
Q

How does Alteplase work?

A

It’s a tissue plasminogen activator. A fibrinolytic drug

37
Q

What is an inferior Vena Cava filter and what is it used for?

A

A small device put into the vein to catch blood clots

38
Q

What type of drug has been shown to give better outcomes to cancer patients?

A

LMW Heparin

39
Q

What is a DOAC?

A

Direct oral anticoagulant

40
Q

What type of drug is Dabigatran and how does it work?

A

An anticoagulant that directly inhibits thrombin

41
Q

What type of drug is Rivaroaxaban and how does it work?

A

An anticoagulant that directly inhibits Xa

42
Q

What do anti-thrombin, protein s and protein c have in common?

A

They help regulate coagulation

43
Q

What is lupus?

A

An autoimmune disease that causes inflammation throughout the body. It’s partly genetic and environmental

44
Q

What disease is DRVVT used to diagnose?

A

Dilute Russell viper venom time is used to diagnose lupus

45
Q

What type of drug is apixaban and how does it work?

A

An anticoagulant that directly inhibits factor Xa

46
Q

How does Warfarin work?

A

It’s a Vitamin K antagonist that prevents the gamma-carboxylation of factors II, VII, IX, and X which is required for those factors to mature. This all prolongs the prothrombin time

47
Q

How long does it take for Warfarin to achieve therapeutic effects?

A

> 3 days

48
Q

What is the half life of prothrombin (Factor 2)?

A

60 hours

49
Q

Which anticoagulant inhibits Protein C and S?

A

Warfarin so the patient becomes prothrombotic

50
Q

What is meant by prothrombotic?

A

Promote blood clotting

51
Q

What is the interaction of Warfarin with cytochrome P450?

A

Enzyme inhibitors will potentiate Warfarin and enzyme inhibitors will inhibit Warfarin

52
Q

What is meant by potentiate?

A

Increase power of effect

53
Q

What is the interaction between Warfarin and alcohol?

A

Binge drinking tends to potentiate Warfarin. Chronic alcoholism inhibits Warfarin (alcohol upregulates inhibitors)

54
Q

What is meant by teratogenic?

A

Affect embryo and causes developmental issues

55
Q

Why can’t Warfarin be used during pregnancy?

A

Its teratogenic. LMW Heparin is used instead

56
Q

What are the 5 main side effect of Warfarin?

A

It’s teratogenic, Increases risk of haemorrhage, causes minor bleeding, skin necrosis, and Alopecia

57
Q

What is Alopecia?

A

Hairloss

58
Q

What is the drug Octaplex used for?

A

It’s an activated prothrombin complex that reverses Warfarin effects

59
Q

What is the drug Beriples used for?

A

It’s an activated prothrombin complex that reverses Warfarin effects

60
Q

What are the steps to reversing the effect of Warfarin?

A

Give an activated prothrobmin complex and Vitamin K

61
Q

What is the dose of activated prothrombin complex?

A

25-50 units pew kg depending on the INR level

62
Q

What dose of vitamin K is given to reverse Warfarin effects?

A

2-10 mg depending on INR level

63
Q

Why may a patient become refractory when they are being reloaded with Warfarin after the effects were previously reversed?

A

Because clotting factors sometimes have long half lives

64
Q

When is FFP (Fresh frozen plasma) given to reverse Warfarin effects?

A

In an emergency

65
Q

What is Heparin and how does it work?

A

A Mucopolysaccharide that potentiates anti-thrombin by irreversibly inactivating factor IIa and factor Xa

66
Q

What’s another name for factor IIa?

A

Thrombin

67
Q

Why is unfractionated Heparin not used much?

A

It’s usually given by IV which is inconvenient

68
Q

What is a bolus infusion?

A

Not gradual, all the drug is given at once

69
Q

What dosage is unfractionated heparin at and how?

A

Given IV with 5000u bolus and then about 10000/hour infusion

70
Q

Where is unfractionated heparin metabolised?

A

In the liver

71
Q

What does the APTT test for?

A

Intrinsic pathway

72
Q

What does PT test for?

A

Extrinsic pathway

73
Q

What does TT test for?

A

Common pathway

1. Theme 2 (12 decks)

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