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Inhibitors of Fibrin Formation
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LMWH drugs
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Pharm- coag
Coagulation Drugs
| Question | Answer |
|---|---|
| Inhibitors of Fibrin Formation | Heparin LMWH- low molecular weight heparin |
| LMWH drugs | Enoxaparin (Lovenox) Dalteparin (Fragmin) Ardeparin (Normiflo) Warfarin (Coumadin) |
| Anti-platelet drugs | Aspirin (Bayer, Ecotrin) Dipyridamole (Persantine) Cilostazo (Pletal) Ticlopidine (Ticlid) Clopidogrel (Plavix) |
| Glycoprotein IIb-IIIa inhibitors | Abciximab (Repro)- monoclonal antibody Eptifibatide (Integrilin)- cyclicpeptide Tirofibam (Aggrastat)- nonpeptide |
| Fibrinolytics | Urokinase Tissue plasminogen activators (t-PA, rt-PA) Streptokinase |
| Heparin ind and MOA | Ind: tx and prevention of thromboembolic disorders MOA: binds to antithrombin III and exposes antithrombin II site; inactivates II, VII, IX, X and plasmin and prevents the conversion of fibrinogen to fibrin. Works in the blood |
| Heparin ADR | Bleeding, anaphylaxis, osteoporosis and spontaneous fx (chronic use), transient thrombocytopenia |
| Heparin Contraindications | Active bleeding, hemophilia, ulcers, thrombocytopenia, intercranial hemorrhage, visceral carcinoma, during or before lumbar puncture or regional anesthetic blocks, following brain, spinal cord, or eye surgery |
| When administering Heparin, what must be monitored? | aPTT (6-8 hrs after start and following any change in rate) platelet counts, H&H, person's own heparin levels |
| LMWH MOA | Enhace the inhibition of Factor Xa and thrombin by antithrombin III and potentiate preferentially the inhibition of coagulation factor Xa, while only slightly affecting thrombin and clotting cascade |
| LMWH ADR | thrombocytopenia, hemorrhage, local irritation, bruising |
| When administerin LMWH, what must be monitored? | platelets, occult blood, anti-Xa activity |
| LMWH precautions | Pts with epidural or spinal anesthesia. If administered to someone with an epidural catheter, the catheter should be removed prior to the next dose. May cause bleeding or hematomas to form on the spinal column and may lead to paralysis. |
| Lovenox | LMWH Enoxaparin Ind: prevention of DVT following hip or knee replacement or abdominal surgery in high-risk pts; tx of DVT with or without PE; Outpatient tx of DVT without PE; prevention of ischemic complications with ACS. Unlabeled use: prevention of D |
| High-Risk patients to be considered for Lovenox tx after abdominal surgery | >40 yo Obesity General anesthesia lasting >30 min Malignancy History of DVT or PE |
| Fragmin | LMWH Dalteparin Ind: Prevention of DVT following abdominal surgery, hip or knee replacement, prevention of ischemic complications with acute coronary syndromes. |
| Normiflo | LMWH Ardeparin Ind: Prevention of DVT following knee replacement surgery |
| Warfarin | LMWH Coumadin Ind: Prophylaxis and tx of thromboembolic disorders: a.fib w risk of embolism; prophylaxis of systemic embolism after MI; prevention of recurrent TIA/stroke. |
| Warfarin ADRs | hemorrhage, skin necrosis, alopecia, N/V, mouth ulcers |
| Warfarin MOAs | Interferes with the hepatic synthesis of Vitamin K dependent clotting factors. Does not acheive levels of maximum anticoagulation for 3-4 days. MUST BRIDGE THERAPY! |
| Drug interactions that increase Warfarin response | Drug which impairs platelet function. Drugs which displace warfarin from plasma protein. Drugs which interfere with the metabolism of warfarin. |
| Drug interactions that decrease Warfarin response | Drugs which increase metabolism. Drugs which decrease absorption. Drugs which promote the formation of prothrombin. |
| Therapeutic INR level with Warfarin | INR 2-3 (2.5-3.5 in valve replacement) |
| Antidote of Heparin | Protamine sulfate |
| Antidote of Warfarin | Vitamin K |
| Aspirin | Antiplatelet drug Ind: prophylaxis of MI, TIA/stroke |
| Aspirin MOA | Inhibits platelet aggregation by irreversibly inhibiting cyclooxygenase which is needed to form the prostaglandin thromboxane A2 (TXA2) which is necessary for platelet aggregation. |
| Aspirin dose for pts with low risk for embolism following AMI | 160-325 mg/day |
| Aspirin dose for pts with unstable angina | 160-325 mg/day |
| Aspirin dose for pts with clinical or laboratory evidence of CAD or stable angina | 160-325 mg/day |
| Aspirin dose for men or women 50 or older with at least one risk factor for CAD | 80-325 mg/day |
| Aspirin dose to be administered for general prevention of ischemic stroke | 50-325 mg/day |
| Persantine | Dipyridamole Antiplatelet |
| Cilostazol | Pletal Antiplatelet |
| Antiplatelet (persantine and pletal) MOA | Inhibits the activity of adenosine deaminase and phosphodiesterase, which causes an accumulation of adenosine, adenine nucleotides, and cyclic AMP. These mediators inhibit platelet aggregation and may cause vasodilation; may also stimulate the release of |
| Antiplatelet (ticlid and plavix) MOA | Reduces platelet aggregation by inhibiting the ADP pathway of platelets- blocks ADP receptors` |
| Ticlid | Ticlopidine Antiplatelet |
| Plavix | Clopidogrel Antiplatelet |
| Ticlid and Plavix Ind | Reduction of atherosclerosis events (MI, stroke) in patients with atherosclerosis documented by recent MI, stroke, or extablished peripheral arterial disease; Use after interventional cardiac catheterization to prevent platelet aggregation. |
| Ticlopidine ADR | Rash, thrombocytopenia, D/N/V, increased liver function tests |
| Clopidogrel ADR | N/V/D, rash, GI bleed, hepatotoxicity; Less incidence of thrombocytopenia and hepatotoxicity than with ticlopidine. |
| Glycoprotein IIb-IIIa inhibitors Ind | Inhibit platelet aggregation |
| Eptifibatide (Integrilin) MOA | Glycoprotein IIb-IIa inhibitor that inhibits platelet interaction with von Willebrand factor (which is responsible for initial adhesion and platelet activation) and fibrinogen, thus preventing the formation of stable platelet aggregates. |
| What is the anticoagulation DOC for pregnant women? | Heparin |
| Abciximab (Repro) MOA | Glycoprotein IIb-IIIc Inhibitor that selectively and irreversibly binds to platelet glycoprotein IIb/IIIa receptors to prevent adhesion of platelets to fibrinogen |
| Aggreatat | Tirofiban Glycoprotein IIb-IIIa inhibitor Nonpeptide |
| Repro | Abciximab Glycoprotein IIb-IIIa inhibitor monoclonal antibody |
| Integrilin | Eptifibatide Glycoprotein IIb-IIIa inhibitor Cyclicpeptide |
| Abboinase | Urokinase Fibrinolytic that enzymatically converts plasminogen to plasmin. Ind: used for catheter clearance and in the treatment of DVT of the iliofemoral vein and intra-arterially in pts with peripheral vascular ds |
| Activase | Tissue plasminogen activators, Ateplase, t-PA Fibrinolytics that activate fibrin bount plasminogen Ind: tx of coronary artery thrombosis (MI), PE, and stroke VERY EXPENSIVE |
| Kabikinase | Streptokinase Fibrinolytic that converts tissue proactivator to activator which converts plasminogen to plasmin. This drug is synthesized from streptococci. Used in tx of PE, post MI, massive DVT |
| Fibrinolytics | Urokinase (Abbokinase) Aletplase, t-PA (Activase) Streptokinase (Kabikinase) |
Created by:
Marywood
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