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Hemostasis/Thromobol
Dr. Jones; Hemostasis & Thrombolytics
| Question | Answer |
|---|---|
| What does activated partial thromboplastin time (aPTT) measure and what is it used to monitor> | The aPTT is a measure of the INTRINSIC coagulation pathway. -Used to monitor heparin |
| What does Prothrombin time (PT) measure and what does it monitor? | PT or INR is a measure of the EXTRINSIC coagulation pathway. -Used to monitor WARFARIN |
| What drugs inhibit thrombogenesis? | -Aspirin -Clopidogrel (Plavix) -Abcixmab (ReoPro) |
| What does aspirin do and why is it beneficial? | Aspirin inhibits Thromboxane A2 synthesis is platelets. Thromboxane A2 promotes platelet aggregation. |
| What does Thromboxane do? | Promotes platelet aggregation. Overcomes prostacyclin (preventor of platelet aggregation) |
| How long do platelets last? | 7-10 days |
| What is the FDA approved dose of Aspirin for the primary prevention of a MI? | 325 mg/d |
| What does clopidogrel (plavix) do? | Inhibits platelet aggregation by blocking ADP receptor. For patients allergic to aspirin. |
| What anticoagulant may be given during a MI? | Clopidogrel |
| What drug is given to patients undergoing angioplasty, atherectomy, and stent placement? | Abciximab (RePro) |
| What drug is used to treat unstable angina that is not responding to conventional therapy and AMIs. | Abciximab. |
| What mechanism of action does Abciximab have? | *Inhibits GP IIb/IIIa receptors: prevents binding of fibrinogen and von Willebrand factor. |
| Howis Abciximab given? | Anticagulant; Given intravenously |
| What are some toxicities that are associated with Abciximab? | Bleeding and thrombocytopenia.These drugs are very expensive. ($1500/dose) |
| What drug is a LMW heparin? | Enoxaprin (Lovenox) |
| What are the side effects of heparin? | Hemorrhage, Osteoporosis, Allergic Reactions, Decreased platelets. |
| What are the contraindications of heparin? | Do not use is patients who: Actively Bleeding, Hypersensitive, Hemophilia, Thrombocytopenia, Purpura, Severe Hypertension, Intercranial Hemorrhage (stroke), Infective endocarditis,active tuberculosis, ulcers,hepatic/renal disease. |
| What is LMW heparin used for? | Enoxaprin (Lovenox) Used in Catheters, bypass, and blood collection. |
| What is an antagonist to heparin? | Protamine Sulfate |
| What are some toxicities that are associated with protamine sulfate? | -Hypotension due to histamine release. -Pulmonary hypertension -Allergic Reaction |
| What target INR ratio should warfarin patients have? | 2 to 3 for most indications. |
| What is INR? | When the international reference thromboplastin preparation is used as the standardized control preparation, the ratio is expressed as the International Normalized Ratio. |
| What are some drug interactions for Warfarin? | Aspirin: increase bleeding. Drugs that affect liver enzymes: Cimetidine (Tagamet). Alcoholics (chronic) Oral contraceptives Barbituates |
| What are some tixcities that are associated with Warfarin? | -Hemorrhage -Vitamin K antidote -Hyperthyroidism: hpatic disease increases effect. -Pregnancy decreases effect: TERATOGENIC |
| What are some uses for Warfarin? | -Prevent development of emboli. -Deep vein Thrombosis. -Thromboembolism -Given chronically |
| What do thrombolytic agents do? | Converts plasminogen into plasmin. Unlike the antcoagulants and antiplatelet drugs, these drugs are administered intravenously to degrade an EXISTING THROMBUS |
| What are some uses of thrombolytic agents? | -Severe pulmonary embolism -Deep vein thrombosis -Arterial thrombosis -Stroke -AMI |
| What are some drugs that you can use thrombolytic agents with? | Aspirin, beta-blockers, and ACE inhibitors. (to prevent cardiac remodeling) |
| What is an antidote of t-PA? | Aminocaproic acid |
| What drug is made commercially by recombinant DNA technlogy? | t-PA (rt-PA, Alteplase, Activae) |
| What does t-PA do? | Converts plasminogen into plasmin. Active against fibrin-bound plasminogen. (more clot sensitive than others) |
| What is a benefit of t-PA? | More efective at establishing coronary re-perfusion, but higher risk of stroke. |
| What drug do you use for the reversal of fibrinolytic therapy? | Aminocaproic acid (Amicar) |
| What drug is used for bleeding disorders? | Fibrinolytic inhibitor: Aminocaproic acid (Amicar) |
| What drug would you use to prevent re-bleeding in an intercranial aneurysms? | Fibrinolytic inhibitor: Aminocaproic acid (Amicar) |
| What drug is not available in the US and is very useful in upper GI hemorrage? | Tranexamic Acid (Cyklokapron) |
| What are some toxicties that are related to Aminocaproic acid and Tranexamic acid? | -Intravascular Thrombis, hypotension, myopathy, GI discomfort, and nasal stuffiness. |
Created by:
allievisner2
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