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Flashcards in Venous Thromboembolism Deck (80):
1

virchow's triad

venous stasis
venous endothelial injury
hyper-coagulability

2

gold standard for diagnosis VTE. Only test that can detect proximal and distal

venography

3

this test is only sensitive for proximal DVT. It is non-invasive and measures blood flow following occlusion

impedance plethysmography

4

this test is non-invasive and measures the rate of blood flow from the reflection of sound waves off RBCs

doppler U/S

5

combines doppler with real time B-mode U/S to give better sensitivity and specificity of detecting proximal DVTs

duplex U/S

6

this test has high sensitivity but low specificity. You can rule out DVT if normal, but cant rule-in if elevated

d-dimer

7

If non-invasive tests are negative and you suspect a PE, what should you do?

V/Q scan

8

objectives for DVT treatment

prevent development of PE
prevent postphlebitic syndrome
reduce mortality
minimize adverse events and costs

9

this drug blocks the synthesis of thromboxane A2 from arachidonic acid by inhibiting cyclooxygenase

aspirin

10

ADRs include bronchospasm and GI hemorrhage

aspirin

11

contraindications include children under 12, breast feeding, hemophilia, PUD, and known hypersensitivity rxn

aspirin

12

this drug is combined with aspirin to make aggrenox

dipyrdamole

13

this drug causes inhibition of phosphodiesterase that hydrolyzes cAMP. Increase in cAMP causes decreases tA2 synthesis and thus platelet aggregation

dipyrdamole

14

used to prevent thrombosis

aggrenox

15

used with prosthetic mechanical valves in combo with warfarin and is an alternative to exercise in thallium myocardial perfusion imaging

dipyrdamole

16

ADRs- HA, GI bleed, hypotension

dipyrdamole

17

caution in pts with hypotension and in pts with serious CAD

dipyrdamole

18

this drug block ADP-induced platelet-fibrinogen and platelet-platelet binding

ticlopidine

19

indicated for prevention of repeat stroke or TIA and in coronary artery stinting

ticlopidine

20

contraindicated in pts with severe liver dysfunction, thrombocytopenia, neutropenia, PUD, and internal bleeding

ticlopidine

21

interacts with cimetidine, digoxin, theophylline, and red clover

ticlopidine

22

ADRs include bleeding, N/V/D, thrombocytopenia, neutropenia, pancytopenia, nephrotic syndrome, and dark colored urine

ticlopidine

23

this drug inhibits activation of glycoprotein IIb/IIIa receptor on the surface of platelets, which is required for aggregation to occur

clopidogrel

24

indicated for secondary prevention of CV and cerebrovascular events and in patients allergic to aspirin

clopidogrel

25

ADRs include hemorrhage, abdominal discomfort, and N/V

clopidogrel

26

this drug is safer than ticlopidine and is often added to ASA to obtain better platelet inhibition

clopidogrel

27

an antibody fragment directed toward the GP IIb/IIIa receptor of platelets. Binding and blocking the receptor prevents platelet aggregation

abciximab

28

indicated to prevent ischemic cardiac complications in patients undergoing percutaneous coronary intervention. Short term prevention of MI in patients with unstable angina

abciximab

29

these two drugs work like abciximab but are peptide fragments. They are potentially antigenic and should only be used once

tirofiban and eptifbatide

30

work by inhibiting the action of coagulation factors or interfere with the synthesis of coagulation factors

anticoagulants

31

binds to antithrombin III and accelerates inactivation of coag factors. AT III is an anticoagulant (inhibits binding of fibrinogen to thrombin)

heparin

32

binds to thrombin, inactivating its activity

heparin

33

binds and inhibits factor Xa (which converts prothrombin to thrombin)

heparin

34

this drug complexes with antithrombin III and inactivates factor Xa but does not bind as well to thrombin

LMWH

35

indicated for DVT, PE. Coronary artery pr-thrombosis after thrombolytic therapy

heparin

36

can be used in pregnancy- does not cross placenta

heparin

37

indicated for DVT/PE, unstable angina, and MI

LMWH

38

in order to treat someone with this, make sure they have a stable proximal DVT or PE, normal vital signs, low bleeding risk, no renal insufficiency, and monitoring system

heparin and LMWH

39

contraindicated in hemophilia, thrombocytopenia, PUD

heparin/LMWH

40

ADRs: bleeding (esp in those >70, recent surgery or trauma, use of ASA or NSAIDs, and renal failure)

heparin/LMWH

41

antidote for heparin (and sort of for LMWH)

protamine

42

this can occur in 3% of UFH treated patients. It is associated with arterial or venous thrombosis and causes a drop in platelet count >50%

heparin induced thrombocytopenia (HIT)

43

complications of this include DVT, PE, MI, stroke, TIA, and end organ damage

HIT

44

treat HIT

D/C UFH
use DTIs (argotroban or lepirudin)
initiate warfarin once platelets are okay

45

ADR includes osteoporosis

heparin (less with LMWH)

46

monitor: baseline aPTT, PT/INR, and CBC along with signs and symptoms of bleeding

heparin

47

monitor: aPTT, PT/INR, CBC, and SrCr along with anti factor Xa activity

LMWH

48

this drug prevents DVT following orthopedic surgery. It requires cofactor of antithrombin III for activity

fondaparinux

49

this drug is indicated in prevention of DVT in patients undergoing knee or hip replacement. Also used in stroke and systemic embolism prophylaxis in patients with non-valvular afib

rivaroxaban

50

indicated for DVT prophylaxis in patients post hip and knee replacement- dont give if CrCl <15 or severe liver failure

apixaban

51

reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fib. Can inhibit both free and clot-bound thrombin

dabigatran

52

binds selectively and reversibly to the catalytic site of thrombin as a competitive inhibitor- can inhibit clot-bound thrombin

argatroban

53

short half life. Used in heparin induced thrombocytopenia with and without thrombosis, ischemic stroke, hemodialysis, PCI. NO antidote

argatroban

54

derived from the leech, these two drugs inactivate thrombin

desirudin and lepirudin

55

indicated in patients with heparin induced thrombocytopenia. Prophylaxis of DVT in patients undergoing hip and knee replacement

hirudins

56

contraindicated in active bleeding and renal or hepatic impairment

hirudins

57

ADRs hemorrhage and hypersensitivity

hirudins

58

vitamin K antagonist. Blocks the reduction of vitamin K epoxide (necessary for clotting factors II, VII, IX, X)

warfain

59

half life for clotting factors

II- 60 hours
VII- 6 hours
IX- 24 hours
X- 40 hours

60

used in acute MI, DVT, PE, afib, rheumatic disease, prosthetic heart valves, hip or knee replacement patients

warfarin

61

contraindicated in central thrombosis, peptic ulcer, pregnancy

warfarin

62

ADRs- bleeding and skin necrosis

warfarin

63

treat bleeding induced by warfarin

vitamin K

64

monitor PT/INR, aPTT, CBC, LFTs
UA and fecal occult
signs and symptoms of bleeding

warfarin

65

this class turns plasminogen into plasmin, which cleaves fibrin and lyses thrombi

thrombolytic agents

66

someone had an MI how do you administer throbolytic agent

intracoronary

67

used in acute MI, massive or submassive PE, heparin tx failures, extensive proximal DVT

thrombolytic agents

68

ADRs include hemorrhage and reperfusion arrhythmias

thrombolytic agents

69

contraindicated in recent surgery, CVA within 2 months, recent needle puncture, active bleeding, uncontrolled HTN, malignancy, pregnancy, CPR

thrombolytic

70

enzyme that catalyzes the conversion of tissue plasminogen to plasmin in the presence of fibrin. Fibrin specifically produces local fibrinolysis in the area of a recent clot with limited systemic proteolysis

alteplase

71

indicated for acute MI, PE, acute ischemic stroke

alteplase

72

ADRs include bleeding, arrhythmias, N/V, cardiac arrest, stroke, thromboembolism

alteplase

73

this drug forms a complex with plasminogen to convert the active enzyme plasmin, hydrolyzes fibrin plugs, and catalyzes the degradation of fibrinogen 7 clotting factors V and VII

streptokinase

74

indicated for life threatening DVT, PE, arterial thromboembolism, and acute MI

streptokinase

75

ADRs include N/V, bleeding, and antigenic reactions (allergic)

streptokinase

76

DVT/PE prevention: total hip replacement

LMWH, warfarin, factor Xa inh

77

DVT/PE prevention: total knee replacement

LMWH, warfarin, factor Xa inh, +/-IPC

78

DVT/PE prevention: hip fracture surgery

factor Xa inh, LMWH, warfarin, LDUH

79

DVT/PE prevention: trauma

LMWH, IPC or ES in LMWH C/I

80

DVT/PE prevention: general med (CHF, COPD) or bedrest and >1 RF

LDUH, LMWH, fondaparinux