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61 Cards in this Set
- Front
- Back
what does damage to blood vessels cause release of?
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this releases von Willebrand factor
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What do damage to endothelium reduce the production of?
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reduces PGI2 (prostacyclin) production
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What is Antithrombin III?
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this is a plasma protease inhibitor, that inactivates clotting factors
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What things get overwhelmed in DIC?
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the protease inhibitors AT3, Alpha1-antiprotease, and alpha2-macroglobulin
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what causes fibrinolysis?
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plasmin
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what converts plasminogen (inactive) into plasmin?
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tissue-plasminogen activator (t-PA)
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what is a white thrombus?
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this is the initial plug formed by platelets in high pressure arteries.
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what is a red thrombus?
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this is an insoluble fibrin and mesh like thrombus that includes RBCs and platelets
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What does aPTT measure?
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this measures the clotting time of the intrinsic pathway
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What does PT measure?
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this is a measure of extrinsic pathway clotting (tissue factor mediated)
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How is heparin administered?
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IV ONLY
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how is heparin cleared?
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mainly in the liver by heparinase
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What is heparin made of?
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a heterogenous mix of sulfated mucopolysacharides
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How does heparin work?
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heparin binds AT-3, and speeds up its inactivating effects by 1000X (a catalyst)
Knocks out IXa, Xa, and IIa |
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What pathway dose heparin affect?
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this increases aPTT, so it must affect the intrinsic pathway.
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How long does heparin take to work?
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immediate action
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What is the trade name of heparin sodium?
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Liquaemin
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What conditions prolong the action of heparin sodium?
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Renal or hepatic dysfunction pts.
also people with low body temperature |
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What is the name of LMW heparin?
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Enoxaparin
(kind close to heparin, right?) |
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How is Enoxaparin BEST given?
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injected subcutaneously is the best method, requires less frequent dosing.
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What are the two main toxic effects of Enoxaprin (a LMW heparin)
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Hemorrhage (duh)
and Heparin induced thrombocytopenia |
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What is the antagonist of heparin?
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Protamine sulfate
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Other than obvious pts like folks with bleeding disorders...who should NOT get heparin?
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people who have brain, spinal cord, or eye surgery
lumbar puncture pts, or regional anesthetic therapy |
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What is heparin used for?
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anticoagulation during surgery
DVT prophylaxis Maintaining catheters open **in pregnant pts to replace warfarin, because it does not cross the palcenta** |
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What does protamine sulfate do in the absence of heparin?
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this causes anticoagulation effects (ironically)
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what are the adverse effect sof protamine sulfate?
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hypotension due to histamine release
pulmonary hypertension allergic reactions |
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What is Lepirudin?
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this is recombination of hirudin, a leech anticoagulant
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What does Lepirudin do?
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this is a *direct* inhibitor of thrombin
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How does Warfarin work?
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this prevents reduction of vitamin K, and interferes with processing of clotting factors II, VII, IX, and X
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How long does Warfain take to work?
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this takes 12-16 hours to work, because it prevents the development of NEW clotting factors II,VII,IX, X
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What is the therapeutic range for Warfarin, and how is it defined?
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you use the international normalized ratio, which is a function of Prothrombin time.
You want an INR of 2-3. (INR 3= PT of 1.6) |
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Please READ Katzung about warfain interactions!
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DO it! its page 596!
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What is the main toxicity with warfain?
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hemorrhage! duh
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when is warfarin contraindicated?
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in pregnancy, it causes birth defects
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What do you give to reverse the action of warfarin
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Vitamin K1**
fresh frozen plasma, Factor IX concentrates |
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What does Dabigatran inhibit?
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this directly inhibits thrombin (like lepirudin)
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What does Rivaroxaban do?
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this is an inhibitor of Factor Xa
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What does protein C do?
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this stimulates thrombin, and increases fibrinolysis
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What do thrombolyic agents do?
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these cause the lysis of formed clots, and re-establish tissue perfusion
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What are thrombolytics useful in treating?
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heart attacks
severe pulomnary embolism DVT Arterial thrombosis |
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What are the drug names for commercial t-PA?
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rt-PA, Alteplase, Activase
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How does Streptokinase work?
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this complexes with plasminogen, increase fibrinolytic activity
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How is Streptokinase given?
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IV
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What are the problems with streptokinase?
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allergic reactions
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Is streptokinase fibrin specific?
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No it is not, causes general fibrinolysis
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What is rt-PT selective for?
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this acts on fibrin bound plasminogen (rather than plasma plasminogen)-
called clot selective |
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What is Anistreplase (eminase)
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this is a mix of plasminogen and streptokinase that has been acylated
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How clot selective is Anistreplase?
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this is more selective than streptokinase (which isnt selective at all)
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What does Aminocaproic acid do?
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this inhibits plasminogen activation
inhibiting streptokinase and urokinase activity - no plasmin formed |
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What does Aminocaproic acid treat?
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hemophilia
reversal of fibrinolytic therapy (any bleeding disorder, this helps) |
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What is Tranexamic acid like?
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Aminocaproic acid- prevents bleeding by preventing fibrinolysis
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How does Aspirin work?
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this inhibits TXA2 synthesis, and decreases platelet aggregation
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What is the primary prevention for MI dose of aspirin?
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325mg/day
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How does Clopidogrel (plavix) work?
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this inhibits the ADP pathway, and affects platelet aggregation
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What does Plavix NOT affect?
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the prostaglandin pathway, unlike aspirin
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Who should take Plavix (Clopidogrel)
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people who are allergic to aspirin
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What drug is Ticlopidine like?
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this is like plavix
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what side effect does Ticlopidine have that clopidogrel does not?
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ticlopidine can cause severe bone marrow toxicity
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How does Abciximab (ReoPro) work/
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this inhibits platelet aggregation by inhibiting GP IIb/IIIa receptors.
this stops fibrinogen and vWF from binding the integrin receptor |
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How is Abciximab (ReoPro) given?
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IV (it is an antibody )
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What is Argatroban (Novastan) used for?
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this directly inhibits thrombin, and is used for pts with heparin induced thrombocytopenia
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