Term
|
Definition
| glycosaminoglycan found in the secretory granules of mast cells; enhances activity of antithrombin |
|
|
Term
|
Definition
|
|
Term
| Unfract heparin absorption |
|
Definition
| variable; SC 30-75% dose dependent |
|
|
Term
| unfract heparin distribution |
|
Definition
|
|
Term
| metabolism of unfract heparin |
|
Definition
| hepatic and reticulo-endothelial |
|
|
Term
| elimination of unfract heparin |
|
Definition
| half-life 30-90 minutes, saturable enzymatic cleavage, renally excreted |
|
|
Term
| unfract heparin administration |
|
Definition
| intermittent IV, IV infusion, Deep SC injection |
|
|
Term
| unfract heparin monitoring |
|
Definition
| aPTT target range reflecting institutions reagents; NOT required for prophylactic dosing! |
|
|
Term
| unfract heparin adverse efeects |
|
Definition
| hemorrhage, osteoporosis, hyperkalemia (especially in renal failure), hypersensitivity reactions, thrombocytopenia |
|
|
Term
| management of bleeding due to heparin |
|
Definition
| discontinue, protamine 1% solution as a dose of 1 mg per 100 U of heparin |
|
|
Term
|
Definition
| neutralizes heparin by forming an inactive complex with heparin |
|
|
Term
| max single dose of protamine |
|
Definition
| 50 mg in 10 minutes but may be repeated; infuse SLOWLY over 3-5 minutes |
|
|
Term
|
Definition
| discontinue all sources of Heparin, initiate alternative agents (argatroban, bivalrudin, lepirudin), VKA or other anticoagulant therapy will be necessary upon platelet recovery |
|
|
Term
| direct thrombin inhibitors |
|
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 |
|
|
Term
| doesnot interact with plasma proteins or platelet factors; structurally unrelated to heparins |
|
Definition
| direct thrombin inhibitors |
|
|
Term
|
Definition
| small synthetic molecule, binds only to active catalytic site of thrombin, ability to inhibit clot-bound thrombin |
|
|
Term
| elimination of argatroban |
|
Definition
| hydrocylated and aromatization in liver to inactivate metabolites |
|
|
Term
|
Definition
| 39-51 minutes, longer with hepatic insufficiency |
|
|
Term
|
Definition
| LFT's, hypotention, aPTT and ACT tests |
|
|
Term
|
Definition
| first line for IV infusions in HIT patients, acute MI and fibrinolytics, percutaneous coronary intervention |
|
|
Term
| argatroban when starting oral anticoagulation |
|
Definition
| significantly influences INR |
|
|
Term
| when switching argatroban to oral anticoag; initiate warfarin therapy |
|
Definition
| using expected daily dose of warfarin while maintaining infusion of argaroban; do NOT use loading dose of warf |
|
|
Term
| measure INR daily when switching argatroban to oral VKA |
|
Definition
| INR/= 4.0, stop argatroban and repeat INR q4-6h...if INR is therapeutic continue VKA monotherapy, resume argatroban if not therapeutic |
|
|
Term
|
Definition
| lepirudin and maybe bivalrudin |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| does not have indication in HIT treatment; only for DVT prophylaxis in pts undergoing surgery for hip replacement |
|
|
Term
|
Definition
| more predictable response compared to UFH due to reduced binding to proteins and cells |
|
|
Term
|
Definition
| 90-100% subcutaneous; peak effect 3-5 hours |
|
|
Term
|
Definition
| primarily renal; clearance independent of dose |
|
|
Term
|
Definition
| SQ (abd area, upper outer part of thigh while patient is supine), IV |
|
|
Term
|
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) |
|
|
Term
|
Definition
| every 12-24 hours depending on indication and product |
|
|
Term
| dose adjustments for LMWH |
|
Definition
| monitoring and adjustment for renal impairment |
|
|
Term
|
Definition
| 119-234 minutes (2-4 hours) |
|
|
Term
|
Definition
| NO reversal agent, bleeding (major bleed, hemorrhage, hematoma), thrombocytopenia, injection site rxns (bruising, hemorrhage, skin necrosis) |
|
|
Term
|
Definition
| synthetic active pentasaccharide binds specifically but reversibly to ATIII and selectively inactivates Xa |
|
|
Term
| no significant impact on thrombin, platelets or aPTT |
|
Definition
|
|
Term
| adverse effects of fondaparinux |
|
Definition
| bleeding (weight-related), HIT--very rare |
|
|
Term
| weight-related contraindication of fondaparinux |
|
Definition
| <50 kg for VTE prophylaxis, high risk for bleed |
|
|
Term
|
Definition
|
|
Term
| fondaparinux distribution |
|
Definition
| does not bind RBC or other plasma proteins including albumin, glycoproteins, platelets or PF-4 |
|
|
Term
| peak plasma concentration fondaparinux |
|
Definition
| achieved after 2 hours after single dose, 3 hours with repeated doses |
|
|
Term
| elimination of fondaparinux |
|
Definition
| unchanged in urine; contraindicated in patients with severe renal dysfunction CrCl < 30 |
|
|
Term
|
Definition
|
|
Term
| glycoprotein IIb and IIIa inhibitors |
|
Definition
| surface receptor inhibitor for von willebrand factor and fibrinogen, preventing the anchorage of platelets to surfaces and to each other |
|
|
Term
| final pathway of platelet aggregation |
|
Definition
| glycoprotein IIb and IIIa inhibitors |
|
|
Term
|
Definition
| chimeric monoclonal antibody (Fab), irreversibly binds to GPIIb and IIIa receptor |
|
|
Term
| used in combo with ASA, clopidogel and UFH/LMWH |
|
Definition
|
|
Term
| positive impact of Reopro |
|
Definition
| reduction of restenosis, recurrent MI and death, reduces ischemic events associated with high risk PTCA, and preventing restenosis in PCI patients |
|
|
Term
| Eptifibatide (Integrillin) |
|
Definition
| cyclic peptide inhibitor of fibrinogen binding sites of GPIIb/IIIa |
|
|
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 |
|
|
Term
|
Definition
| tyrosine derivative (non-peptide) inhibitor of GPIIb/IIIa |
|
|
Term
|
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 |
|
|
Term
| advantage of aggrastat over peptide-based GP inhibitors |
|
Definition
| rapid onset f action and little/no immunogenicity |
|
|
Term
| risk of therombocytopenia |
|
Definition
| tirofiban and eptifibatide lower than abciximab |
|
|
Term
| renal adjusting in renal insufficiency for GPIIb/IIIa |
|
Definition
| eptifibatide and tirofiban |
|
|
