Term
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Definition
glycosaminoglycan found in the secretory granules of mast cells; enhances activity of antithrombin |
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Term
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Definition
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Term
Unfract heparin absorption |
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Definition
variable; SC 30-75% dose dependent |
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Term
unfract heparin distribution |
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Definition
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Term
metabolism of unfract heparin |
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Definition
hepatic and reticulo-endothelial |
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Term
elimination of unfract heparin |
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Definition
half-life 30-90 minutes, saturable enzymatic cleavage, renally excreted |
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Term
unfract heparin administration |
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Definition
intermittent IV, IV infusion, Deep SC injection |
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Term
unfract heparin monitoring |
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Definition
aPTT target range reflecting institutions reagents; NOT required for prophylactic dosing! |
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Term
unfract heparin adverse efeects |
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Definition
hemorrhage, osteoporosis, hyperkalemia (especially in renal failure), hypersensitivity reactions, thrombocytopenia |
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Term
management of bleeding due to heparin |
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Definition
discontinue, protamine 1% solution as a dose of 1 mg per 100 U of heparin |
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Term
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Definition
neutralizes heparin by forming an inactive complex with heparin |
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Term
max single dose of protamine |
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Definition
50 mg in 10 minutes but may be repeated; infuse SLOWLY over 3-5 minutes |
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Term
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Definition
discontinue all sources of Heparin, initiate alternative agents (argatroban, bivalrudin, lepirudin), VKA or other anticoagulant therapy will be necessary upon platelet recovery |
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Term
direct thrombin inhibitors |
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Definition
prevent an interaction between thrombin and substrates, does not require antithrombin as a cofactor; able to inactivate both free thrombin and thrombin bound to fibrin |
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Term
doesnot interact with plasma proteins or platelet factors; structurally unrelated to heparins |
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Definition
direct thrombin inhibitors |
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Term
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Definition
small synthetic molecule, binds only to active catalytic site of thrombin, ability to inhibit clot-bound thrombin |
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Term
elimination of argatroban |
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Definition
hydrocylated and aromatization in liver to inactivate metabolites |
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Term
|
Definition
39-51 minutes, longer with hepatic insufficiency |
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Term
|
Definition
LFT's, hypotention, aPTT and ACT tests |
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Term
|
Definition
first line for IV infusions in HIT patients, acute MI and fibrinolytics, percutaneous coronary intervention |
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Term
argatroban when starting oral anticoagulation |
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Definition
significantly influences INR |
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Term
when switching argatroban to oral anticoag; initiate warfarin therapy |
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Definition
using expected daily dose of warfarin while maintaining infusion of argaroban; do NOT use loading dose of warf |
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Term
measure INR daily when switching argatroban to oral VKA |
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Definition
INR= 4.0, continue concomitant therapy; if INR >/= 4.0, stop argatroban and repeat INR q4-6h...if INR is therapeutic continue VKA monotherapy, resume argatroban if not therapeutic |
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Term
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Definition
lepirudin and maybe bivalrudin |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
|
Definition
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Term
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Definition
does not have indication in HIT treatment; only for DVT prophylaxis in pts undergoing surgery for hip replacement |
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Term
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Definition
more predictable response compared to UFH due to reduced binding to proteins and cells |
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Term
|
Definition
90-100% subcutaneous; peak effect 3-5 hours |
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Term
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Definition
primarily renal; clearance independent of dose |
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Term
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Definition
SQ (abd area, upper outer part of thigh while patient is supine), IV |
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Term
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Definition
anti-Xa monitoring (4 hours after injection) especially in renal impairment, weight <50kg, morbidly obese, required prolonged therapy (ie. preggers), and high risk of bleeding or thrombotic recurrence (ie. cancer pts) |
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Term
|
Definition
every 12-24 hours depending on indication and product |
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|
Term
dose adjustments for LMWH |
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Definition
monitoring and adjustment for renal impairment |
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Term
|
Definition
119-234 minutes (2-4 hours) |
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Term
|
Definition
NO reversal agent, bleeding (major bleed, hemorrhage, hematoma), thrombocytopenia, injection site rxns (bruising, hemorrhage, skin necrosis) |
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Term
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Definition
synthetic active pentasaccharide binds specifically but reversibly to ATIII and selectively inactivates Xa |
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Term
no significant impact on thrombin, platelets or aPTT |
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Definition
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|
Term
adverse effects of fondaparinux |
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Definition
bleeding (weight-related), HIT--very rare |
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Term
weight-related contraindication of fondaparinux |
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Definition
<50 kg for VTE prophylaxis, high risk for bleed |
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Term
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Definition
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|
Term
fondaparinux distribution |
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Definition
does not bind RBC or other plasma proteins including albumin, glycoproteins, platelets or PF-4 |
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Term
peak plasma concentration fondaparinux |
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Definition
achieved after 2 hours after single dose, 3 hours with repeated doses |
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Term
elimination of fondaparinux |
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Definition
unchanged in urine; contraindicated in patients with severe renal dysfunction CrCl < 30 |
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Term
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Definition
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Term
glycoprotein IIb and IIIa inhibitors |
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Definition
surface receptor inhibitor for von willebrand factor and fibrinogen, preventing the anchorage of platelets to surfaces and to each other |
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Term
final pathway of platelet aggregation |
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Definition
glycoprotein IIb and IIIa inhibitors |
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Term
|
Definition
chimeric monoclonal antibody (Fab), irreversibly binds to GPIIb and IIIa receptor |
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Term
used in combo with ASA, clopidogel and UFH/LMWH |
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Definition
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|
Term
positive impact of Reopro |
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Definition
reduction of restenosis, recurrent MI and death, reduces ischemic events associated with high risk PTCA, and preventing restenosis in PCI patients |
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Term
Eptifibatide (Integrillin) |
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Definition
cyclic peptide inhibitor of fibrinogen binding sites of GPIIb/IIIa |
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Term
|
Definition
high risk NSTEMI patients as medical management without planned revascularization, NSTEMI with planned PCI, adjunctive for pts with recurrent ischemia despite use of ASA, clopidogrel and an anticoag |
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Term
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Definition
tyrosine derivative (non-peptide) inhibitor of GPIIb/IIIa |
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Term
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Definition
inferior to abciximab for use in PCI, failure to prove non-inferiority; main place in therapy NSTEMI and UA in hih risk patients or with those with recurrent symptoms |
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Term
advantage of aggrastat over peptide-based GP inhibitors |
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Definition
rapid onset f action and little/no immunogenicity |
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Term
risk of therombocytopenia |
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Definition
tirofiban and eptifibatide lower than abciximab |
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Term
renal adjusting in renal insufficiency for GPIIb/IIIa |
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Definition
eptifibatide and tirofiban |
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