Term
|
Definition
Activates antithrombin (which inhibits Factors 9, 10, 11, 12, and thrombin)
End result being inhibition of prothrombin to thrombin and fibrinogen to fibrin |
|
|
Term
| Heparin (pharmacokinetics) |
|
Definition
|
|
Term
|
Definition
Bleeding
HIT
osteoporosis
drug-drug interactions
Reverse with: protamine sulfate |
|
|
Term
|
Definition
| Monitor by partial thromboplastin time (PTT, or aPTT) |
|
|
Term
|
Definition
Pulmonary embolism, evolving stroke, DVT, MI, DIC (I guess...)
Can be used during pregnancy |
|
|
Term
|
Definition
| enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep) |
|
|
Term
|
Definition
| Works with antithrombin to inhibit Factor X, but not thrombin |
|
|
Term
| LMWH (pharmacokinetics compared to heparin) |
|
Definition
Longer half-life
Higher bioavailability
Can be self-administered subcutaneously w/o lab monitoring |
|
|
Term
|
Definition
| Not easily reversible like heparin |
|
|
Term
|
Definition
| Approved for DVT prevention following hip/knee replacement, but also used to treat established DVT, ischemic stroke, PE, and thromboembolism in cancer patients |
|
|
Term
| Fondaparinux (type of drug) |
|
Definition
| Synthetic LMWH derivative |
|
|
Term
|
Definition
| Works with antithrombin to inhibit Factor X, but not thrombin |
|
|
Term
| Fondaparinux (side effects) |
|
Definition
| Bleeding, and can lower platelets, but will not cause HIT |
|
|
Term
|
Definition
| Inhibits thrombin, Factor X, and some other coag factors |
|
|
Term
| Antithrombin (indication) |
|
Definition
| Patients with antithrombin deficiencies during child birth or surgery to prevent thrombosis |
|
|
Term
| Rivaroxaban (type of drug and route) |
|
Definition
| Direct Xa Factor inhibitor administered orally |
|
|
Term
|
Definition
| Interacts with CYP3A4 and a substrate for P-glycoprotein |
|
|
Term
| Rivaroxaban (clinical use) |
|
Definition
| DVT prophylaxis for hip and knee replacement surgery, and strokes in a-fib patients |
|
|
Term
|
Definition
| Reversible direct thrombin inhibitor |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Given in combination with aspirin to prevent clots with unstable angina undergoing coronary angioplasty |
|
|
Term
| All heparins, Xa, and thrombin inhibitors (contraindications) |
|
Definition
Hemophilia
Peptic ulcer
Aneurysm
Severe liver/kidney diseae
Thrombocytopenia
Hemorrhaging
Lumbar Puncture
Surgery on eye, brain, or spinal cord |
|
|
Term
|
Definition
| Competitive inhibitor of Vitami-K epoxide reductase, interfering with normal synthesis and gamma-carboxylation of Factors II, VII, IX, X, Proteins C and S. |
|
|
Term
| Warfarin (most sensitive factor) |
|
Definition
|
|
Term
| Warfarin (time to peak onset) |
|
Definition
| 3 days before peak anticoagulant effect |
|
|
Term
|
Definition
High bioavailability
99% bound to plasma proteins
35 hour half-life |
|
|
Term
|
Definition
Hemorrhage
Skin necrosis
terratogenic |
|
|
Term
|
Definition
| Monitor by prothombin time (PT) or INR |
|
|
Term
|
Definition
Aspirin - reduced platelet aggregation and displaces warfarin from albumin
Gemfibrozil (fibric acid derivatives)
Broad spec antibiotics - gut flora make vit. K, killing them, warfarin more potent
Thyriod - increases metabolism of clotting factors
Acetaminophen and Miconazole - inhibits warfarin degradation |
|
|
Term
|
Definition
Barbiturates - increases warfarin metabolism
Rifampin - increases warfarin metabolism
Vitamin K - direct competition
Estrogens - Increases Factor VII and X, but decreases antithrombin
Cholestyramine - eliminates warfarin if given concurrently |
|
|
Term
|
Definition
Vitamin K (oral, IV, or SC)
Fresh frozen plasma (depending on who you ask...) |
|
|
Term
|
Definition
Chronic anticoagulation (after STEMI and to prevent VTE, and stroke in a-fib)
Rheumatic heart valves
Prosthetic heart valves |
|
|
Term
| Warfarin (contraindications) |
|
Definition
Hemorrhage
Thrombocytopenia
LP
Surgery of eye, brain or spineal cord
LIVER DISEASE
ALCOHOLISM
PREGNANCY OR LACTATION |
|
|
Term
|
Definition
Forms non-enzymatic complex with plasminogen and converts it to plasmin which digests circulating fibrinogen and fibrin thrombin.
Lacks fibrin or clot specificity |
|
|
Term
|
Definition
|
|
Term
| Streptokinase (adverse reactions) |
|
Definition
Allergic reactions -> yes
Bleeding -> yes
Hypotension |
|
|
Term
|
Definition
Forms complex with fibrin bound plasminogen and catalyzes the conversion of plasminogen to plasmin directly on the clot
Fibrin and clot specific |
|
|
Term
|
Definition
| From human tissue-type plasminogen activator via recombinant DNA technology |
|
|
Term
| Alteplase (tPA) (adverse reactions) |
|
Definition
Allergic reactions -> no
Bleeding -> yes
No hypotension, but higher intracranial bleeding risk |
|
|
Term
|
Definition
| From human kidney cells, and only indicated for pulmonary embolism |
|
|
Term
|
Definition
| Reteplase and Tenecteplase |
|
|
Term
| Reteplase and tenecteplase (advantages over tPA) |
|
Definition
| Long half-life thus shorter infusion times for acute MI (only approved indication) |
|
|
Term
| General indications for thrombolytics |
|
Definition
| Cardiac arrhythmias, ischemic stroke, MI, central deep venous thrombosis, massive pulmonary embolism |
|
|
Term
| General contraindications for thrombolytics |
|
Definition
Active bleeding, hemorrhagic stroke, neoplasms, aneurysms
SEVERE HYPERTENSION
recent surgery
intracranial arterial/venous malformations
ANTICIPATED ANGIOPLASTY |
|
|
Term
|
Definition
| Aminocaproic acid (an inhibitor of fibrinolysis) |
|
|
Term
| Fibrin specificity levels |
|
Definition
| tenecteplase > alteplase > reteplase |
|
|
Term
|
Definition
Irreversible inhibition of cyclooxygenase in platelets thus inhibiting TXA2 synthesis in platelets.
Platelets cannot make new enzyme, so effect lasts until new platelets are produced |
|
|
Term
| Aspirin (general lab effects) |
|
Definition
Bleeding time: increased
TXA2 and prostaglandins: decreased
PT: no effect
PTT: no effect |
|
|
Term
|
Definition
Low dose increases uric acid levels
80-90% bound to plasma albumin -> synergistic with warfarin
Crosses placenta |
|
|
Term
|
Definition
Salicylism
Metabolic respiratory acidosis
Reye's syndrome |
|
|
Term
|
Definition
| Prophylaxis for heart attacks and ischemic strokes |
|
|
Term
|
Definition
| Clopidogrel, ticlopidine, ticagrelor |
|
|
Term
| ADP Receptor inhibitor (moa) |
|
Definition
| Blocks ADP receptor on platelet surface preventing expression of the GpIIb-IIIa receptor and binding by fibrinogen |
|
|
Term
| Clopidogrel (clinical use) |
|
Definition
Acute coronary syndrome
Coronary stenting
Pts allergic to aspirin |
|
|
Term
| Ticagrelor (side effects) |
|
Definition
|
|
Term
| Ticagrelor (co-administration) |
|
Definition
| Administer aspirin (<100mg) with ticagrelor |
|
|
Term
|
Definition
Abciximab (irreversible)
Eptifibatide, Tirofiban (both reversible antagonists) |
|
|
Term
| GpIIb-IIIa inhibitors (moa) |
|
Definition
| Bind GpIIb/IIIa receptors on activated platelets and prevent aggregation |
|
|
Term
| GpIIb-IIIa inhibitors (clinical use) |
|
Definition
Acute coronary syndrome
Preceeding coronary artery revascularization (angioplasty) |
|
|
Term
| GpIIb-IIIa inhibitors (side effects) |
|
Definition
| Bleeding, thrombocytopenia |
|
|
Term
| Cilostazol, Dipyridamole (moa) |
|
Definition
| Inhibit phosphodiesterase III -> increase in cAMP -> vasodilation and decreases platelet aggregation |
|
|
Term
| Cilostazol, Dipyridamole (clinical use) |
|
Definition
Intermitten claudication
Prevention of stroke or TIAs |
|
|
