pharmacology
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| primary hemostasis | platelet plug formation
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| secondary hemostasis | fibrin formation
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| drugs that infere with thrombus formation | antithrombotics
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| drugs that promote degradatio of existing thrombi | thrombolytics/fibrinolytics
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| thrombi that form in arteries | white thrombi
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| thrombi w/more platelets and less fibrin | white thrombi
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| thrombi that form in veins | red thrombi
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| thrombi w/more fibrin and less platelets | red thrombi
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| types of antithrombotic drugs | antiplatelets and anticoagulants
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| drugs that interfere w/platelet plug formation | antiplatelets
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| test(s) used to measure antiplatelet effectiveness | bleeding time
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| drugs that interfere w/fibrin formation | anticoagulants
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| test(s) used to measure anticoagulant effectiveness | PT, INR, and PTT
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| site of von Willebrand factor binding | glycoprotein Ib receptors
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| 1st step of platelet plug formation | platelet adhesion
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| 2nd step of platelet plug formation | platelet activation/secretion
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| 3rd step of platelet plug formation | platelet aggregation
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| needed to anchor platelets to BV wall | von Willebrand factor
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| 5HT, ADP, and PDGR are secreted via | platelet cytoplasmic granules
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| TXA2 is secreted via | de novo synthesis/secretion
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| undergoes conformation change during platelet activation | glycoprotein IIb/IIIa receptors
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| platelet activation allows this to bind | fibrinogen molecules
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| instrinc and extrinsic pathways converge here | factor X
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| measures integrity of extrinsic and common pathways | PT
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| measures integrity of intrinsic and common pathways | PTT
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| usually ordered w/PT | INR
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| test(s) ordered to check warfarin's efficacy | PT & INR
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| test(s) ordered to check unfractionated heparin's efficacy | PTT
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| test(s) ordered to check LMW heparin's efficacy | factor Xa inhibition assay
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| MOA = irreversibly acetylates COOX, inhibiting production of TXA2 | ASA
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| cardioprotective dose of ASA | 75-325 mg/day
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| avoid in pts w/asthma and nasal polyps | ASA
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| tinnitus may indicate | ASA toxicity
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| AE = GI sx, hemorrhagic strokes | ASA
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| MOA = inhibit ADP-mediated platelet activation by irreversibly binding to ADP receptors | thienopyridines
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| ticlopidine | thienopyridines
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| clopidogrel | thienopyridines
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| prasugrel | thienopyridines
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| AE = dyspepsia, diarrhea, neutropenia | thienopyridines
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| AE = thombotic thrombocytopenic purpura, severe neutropenia | ticlopidine
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| dosing = twice daily | ticlopidine, ticagrelor
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| used w/ASA following coronary stenting and for acute corony syndromes | clopidogrel
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| dosing = once daily | clopidogrel
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| metabolized by CYP-2C19 | clopidogrel
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| 30% are "poor responders" | clopidogrel
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| used w/ASA following PCI | prasugrel
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| CI= elderly, TIA/CVA hx, small frame | prasugrel
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| MOA = reversibly binds to platelet ADP receptors | ticagrelor
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| used w/ASA for acute coronary syndromes | ticagrelor
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| most effective antiplatelet drugs | GP IIb/IIIa inhibitors
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| MOA = prevent fibrinogen-mediated platelet aggregation | GP IIb/IIIa inhibitors
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| MOA = monoclonal AB against GPIIb/IIIa receptors | abciximab
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| MOA = peptide antagonist | eptifibatide
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| MOA = nonpeptide antagonist | tirofiban
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| MOA = inc cAMP in platelets, decreasing cystolic Ca++ and inhibiting platelet aggregation | dipyridamole
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| AE = thrombocytopenia | abciximab
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| not usually given alone, but may enhance effect of other antithrombotics | dipyridamole
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| needs at least 18 saccharide residues to produce effect | heparin
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| selectively inhibits factor Xa | LMW heparin
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| has equal inhibitory activity against factor Xa and thrombin | UF heparin
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| AE = bleeding, thrombocytopenia, osteoporosis, skin necrosis, alopecia, hypoaldosteronism | heparin
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| lower incidence of heparin-induced thrombocytopenia | LMW heparin
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| given when severe bleeding complications occur w/heparin | protamine sulfate
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| most common type of HIT | non-immune mediated
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| life-and-limb threatening thrombosis can occur with this | immune-mediated HIT
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| IgG + heparin + PF4 = | platelet activation/aggregation
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| given when immune-mediated HIT occurs | direct thrombin inhibitors
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| MOA= inhibit thrombin activity independent of antithrombin III | direct thrombin inhibitors
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| lepirudin | direct thrombin inhibitors
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| bivalirudin | direct thrombin inhibitors
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| argatroban | direct thrombin inhibitors
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| AE = BLEEDING | direct thrombin inhibitors
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| MOA = synthetic heparin analog, bind to antithrombin III | fondaparinux
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| inhibits factor Xa without causing HIT | fondaparinux
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| dosing = subQ injection once daily | fondaparinux
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| used for DVT prophylaxis in ortho surgery, and to treat DVT/PE | fondaparinux
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| MOA = inhibits formation of reduced Vit K | warfarin
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| necessary for activation of coagulation factors II, VII, IX, and X | Vit K
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| delayed onset of anticoagulation | warfarin
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| Vit K protein w/shortest half life | Protein C
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| avoid large loading doses | warfarin
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| given to avoid transient paradoxical hypercoagulable state | warfarin and heparin together
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| AE = bleeding, teratogenic, skin necrosis | warfarin
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| associated w/protein C or S deficiency & warfarin use | skin necrosis
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| given when bleeding complications occur with warfarin | vit K or fresh frozen plasma transfusion
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| used for DVT, atrial fib, mechanical heart valve, and STEMI | warfarin
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| used for unstable angina/NSTEMI, STEMI, DVT, and PCI | UF heparin
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| used for unstable angina/NSTEMI, STEMI, and DVT | LMW heparin
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| used for PIC and HIT | direct thrombin inhibitors
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| used for chronic angina, unstable angina/NSTEMI, STEMI, and PCI | ASA
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| used for unstable angina/NSTEMI and STEMI | thienopyridines
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| used for PCI and unstable angina/NSTEMI | GP IIb/IIIa inhibitors
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| given if pt is unable to take warfarin for mechanical heart valve or a fib | UF heparin
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