Term
| Which step of the formation of the platelet plug is described as von Wilebrand factor binds to the subendothelial matrix, when the endothelium is damaged glycoprotein Ib/IX on the platelet surface binds to the vWF thereby causing platelets to adhere to the damaged endothelium? |
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Definition
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Term
| What factor and platelet protein are essential during the Adhesion phase of the formation of the platelet plug? |
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Definition
| vWF and glycoprotein Ib/IX on platelet |
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Term
| Which step of the formation of the platelet plug is described as after platelet stimulation the GPIIb/IIIa complex on the platelet surface binds one end of the molecule of fibrinogen, while the other end of the molecule of the fibrinogen binds a GPIIb/IIIa complex on another platelet resulting in a cross-linking of platelets? |
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Definition
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Term
| What factor and platelet protein are essential during the Adhesion phase of the formation of the platelet plug? |
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Definition
| Fibrinogen and GBIIb/IIIa |
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Term
| Which step of the formation of the platelet plug is described as stimulated platelets release multiple factors (eg ADP, serotonin, thromboxane) that promote platelet aggregation and stimulation? |
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Definition
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Term
| Which factors are involved in the Secretion phase of the formation of the platelet plug? |
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Definition
| ADP, Serotonin, Thromboxane |
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Term
| Which step of the formation of the platelet plug is described as when activated, platelets produce factor V on their surface, thereby assuring that the coagulation cascade will take place at the site of the platelet plug? |
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Definition
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Term
| What factor is essential during the Procoagulation phase of the formation of the platelet plug? |
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Definition
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Term
| What endogenous antithrombic is released from damaged endothelial cells and converts plasminogen to plasmin which degrades fibrin? |
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Definition
| Tissue Plasminogen Activator |
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Term
| Which endogenous circulating factor acts to inhibit platelet activity? |
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Definition
|
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Term
| What endogenous circulating factors inhibits platelet adhesion and aggregation? |
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Definition
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Term
| What factors are inhibited by endogenous tissue factor pathway inhibitor? |
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Definition
|
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Term
| What is the endogenous protein C activated by? What does activated protein C bind to? What factors are inhibited by this combo? |
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Definition
| Thrombomodulin; protein S; factor Va and VIIIa |
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Term
| What factors does endogenous Antithrombin III inhibit? |
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Definition
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Term
| Which anticoagulant agent acts by accelerating the action of antithrombin III? |
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Definition
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Term
| What is Heparin used to treat? |
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Definition
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Term
| What can the SE of bleeding with the use of Heparin be treated with? |
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Definition
|
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Term
| How is the efficacy of heparin treatment monitored? What is the goal? |
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Definition
| Monitoring PTT; PTT about 2x the normal control |
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Term
| Which drugs are low molecular weight forms of heparin? |
|
Definition
| Enoxaparin and dalteparin |
|
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Term
| Which form of heparin has a greater activity in degrading factor X, and has a longer duration of action? |
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Definition
| LMW Heparin Forms - Enoxaparin and Dalteparin |
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Term
| Which anticoagulant inhibits the vitamin K-dependent Y-carboxylation of factors II, VII, IX and X and protein C and S in the liver, thereby resulting in defective molecules? |
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Definition
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Term
| What is Warfarin used for? |
|
Definition
| Chronic anticoagulation in pts at high risk for thromboembolic events |
|
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Term
| What is the half-life and onset of action of Warfarin? |
|
Definition
LONG half-life
SLOW onset of action |
|
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Term
| What is the half-life and onset of action of Heparin? |
|
Definition
SHORT half-life
RAPID onset of action |
|
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Term
| What can the SE of bleeding with Warfarin be treated with? |
|
Definition
| Administer Vitamin K (or fresh frozen plasma) |
|
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Term
| Can Warfarin be used in pregnant women? |
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Definition
|
|
Term
| How is the efficacy of Warfarin monitored? |
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Definition
|
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Term
| Which drugs inhibit the metabolism of Warfarin? |
|
Definition
Cimetidine
Metronidazole
TMP-SMX |
|
|
Term
| Which drug accelerates the metabolism of Warfarin? |
|
Definition
Barbituates
Rifampin
Cholestyramine |
|
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Term
| What happens to PT and PTT with use of Heparin? ... Warfarin?...Direct Thrombin Inhibitors? |
|
Definition
Heparin - PTT increases
Warfarin - PT increases
Direct Thrombin Inhibitors - BOTH PT and PTT are increased |
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Term
| What class of drugs acts on the intrinsic and extrinsic coag pathways because of its effects on thrombin? |
|
Definition
| Direct Thrombin Inhibitors |
|
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Term
| Which med is used as an anticoagulation agent in pts who must use one for chronic anticoagulation therapy and are unable to take Heparin? |
|
Definition
| Direct Thrombin Inhibitors - hirudin, bivalirudin, lepirudin, argatroban, melagatran, dabigatran |
|
|
Term
| What med can be used to treat heparin-induced thrombocytopenia? |
|
Definition
| Argatroban (Direct Thrombin Inhibitor) |
|
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Term
| Which med irreversibly inhibits cyclooxygenase 1 and 2? What effect does this have? |
|
Definition
| ASA; Causes decreased Prostaglandin synthesis leading to an anti-inflammatory effect, analgesia, decrease in temp |
|
|
Term
| What is the MC SE of aspirin? |
|
Definition
| GI Bleed, GI Ulcers, Reye Syndrome |
|
|
Term
| When ASA is taken in toxic amounts, what Acid/Base d/o can result? |
|
Definition
| Metabolic Acidosis and Respiratory Acidosis |
|
|
Term
| What is generally given to treat ASA overdose? |
|
Definition
| Sodium Bicarb (alkalinize the urine) |
|
|
Term
| What is the mechanism behind ASA causing GI Ulcers? |
|
Definition
Without PGE2 = Decreased synthesis of gastric mucus,
Without PGI2 = increased gastric acid secretion |
|
|
Term
| What drug decreases platelet aggregation by inhibiting the ADP pathway? |
|
Definition
|
|
Term
| What med is used in patients undergoing placement of a coronary artery stent to prevent thrombosis? |
|
Definition
|
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Term
| What med can be used as an alternative agent in those pts who cannot tolerate ASA? |
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Definition
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|
Term
| What med is used to treat acute coronary syndrome along with ASA as well as to prevent cerebrovascular ischemic events? |
|
Definition
|
|
Term
| What SE are associated with Ticlopidine? |
|
Definition
| neutropenia and thrombotic thrombocytopenic purpura |
|
|
Term
| What med is used to perform pharmacologic cardiac stress tests and as a secondary prevention of stroke when used in conjunction with ASA? |
|
Definition
|
|
Term
| What med is used to treat acute coronary syndromes and is as the adjunctive treatment for the prevention of thrombosis during percutaneous coronary intervention? |
|
Definition
| Abciximab, Eptifibatide, Tirofiban |
|
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Term
| Which drug acts by binding to the GP IIb/IIIa receptor complex which is present on the platelet surface and inhibits the binding of fibrin and vWF to the receptor, thus inhibiting cross-linking of fibrinogen and impeding platelet aggregation? |
|
Definition
| Abtiximab, Eptifibatide, Tirofiban |
|
|
Term
| What are the Fibrinolytic agents? |
|
Definition
Steptokinase
Urokinase
Anistreplase
Alteplase
Reteplase |
|
|
Term
| Which med works by promoting the conversion of plasminogen to plasmin which then acts to degrade fibrin and degrade the thrombus? |
|
Definition
| Fibrinolytic Agents: Steptokinase, Urokinase, Anistreplase, Alteplase, Reteplase |
|
|
Term
| What med is used to aid in the treatment of massive PE, stroke, acute MI and other thrombolytic events? |
|
Definition
| Fibrinolytic Agents: Steptokinase, Urokinase, Anistreplase, Alteplase, Reteplase |
|
|
Term
| When are fibrinolytics in general most effective? |
|
Definition
| Given early after symptom onset (within a few hours) |
|
|
Term
| What drugs inhibit plasminogen activation thereby resulting in the inhibition of fibrinolysis? |
|
Definition
| Aminocaproic Acid, Tranexamic Acid |
|
|
Term
| What drug is used in the treatment of bleeding associated with post-operative bleeding and is used in the treatment of hemophilia? |
|
Definition
| Aminocaproic Acid, Tranexamic Acid |
|
|
Term
| What is the SE of Aminocaproic Acid? |
|
Definition
| Thrombosis, GI upset, hypotension |
|
|
Term
| What med stimulates the bone marrow to enhance erythroid proliferation and differentiation thereby increasing hematocrit? |
|
Definition
|
|
Term
| What mean is used in the tx of anemia associated with chronic renal insufficiency, chemo or critical illness? |
|
Definition
|
|
Term
| What med has SE including Cardiovascular events and thrombotic complications in pts with renal failure? at what levels does this occur? |
|
Definition
| EPO; if hemoglobin levels over 13 |
|
|
Term
| Any new thrombus while a pt is on heparin, should raise concern of what condition? |
|
Definition
| HIT - Heparin-Induced Thrombocytopenia |
|
|
Term
| What should you do to treat a pt who is on Heparin and develops HIT? |
|
Definition
| discontinue heparin and switch to a direct thrombin inhibitor or fondaparinux |
|
|
Term
| What was Warfarin initially used as? |
|
Definition
|
|
Term
| Which foods should pts on Warfarin avoid? |
|
Definition
| green leafy vegetables, broccoli, salads, spinach, etc. |
|
|
Term
| What is the target INR for the majority of pts on Warfarin? |
|
Definition
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