10.18.18 Anticoagulant Drugs

Question 1

How does aspirin work?

Answer 1

By irreversibly acetylating COX-1 thus inhibiting platelet generation of thromboxane A2

Question 2

What is aspirin used for?

Answer 2

Primary and secondary prevention of arterial blockages (MI, stroke, PVD)

Question 3

What are adverse effects with aspirin?

Answer 3

• GI bleeding- inflammation and peptic ulcer disease
• Provoke asthma
• Don’t use in children and teenagers with chickenpox or flu symptoms (Reye’s Syndrome)
• Kidney damage

Question 4

What do you need to use with Warfarin because its anticoagulant effect is not immediate?

Answer 4

Bridging anticoagulant therapies

Question 5

What are the side effects of warfarin?

Answer 5

Warfarin Skin NEcrosis

Question 6

When does warfarin skin necrosis happen?

Answer 6

When warfarin is started in someone who is Vit K deficient or Protein C deficiency w/o bridging

Question 7

How do you reverse warfarin?

Answer 7

Vit K

Prothrombin Complex Concentrates (PCC)

Question 8

All of heparin’s effects require binding to what?

Answer 8

Antithrombin (AT)

Question 9

How long does the thrombin and AT complex need to be to inactivate thrombin?

Answer 9

18 sugars

Question 10

How must unfractionated heparin be given?

Answer 10

IV/SQ monitored and administered in the hospital

Question 11

What lab values should you monitor with heparin?

Answer 11

1. Follow aPTT
2. Follow anti-Xa level
3. TCT will be prolonged (bc we’re inhibiting thrombin)

Question 12

What is an example of low molecular weight heparin

Answer 12

Enoxaparin = Lovenox

Question 13

LMWH-AT inactivates what and cannot inactivate what?

Answer 13

Only inactivates Xa

Cannont inactivate thrombin

Question 14

What do you need to follow with LMWH?

Answer 14

Anti-Xa levels

Question 15

What is the antidote to LMWH?

Answer 15

None

Question 16

When should you use LMWH?

Answer 16

VTE (Treatment/Prophylaxis)

VTE associated with cancer (Don’t use warfarin)

Question 17

How does dabigatran effect thrombin time?

Answer 17

Binds and inactivates IIa (Thrombin) so it prolongs TT

Question 18

This drug is an intravenous direct thrombin inhibitor that is hepatically metabolized

Answer 18

Argatroban

Question 19

How does argatroban affect aPTT, PT/INR and TT?

Answer 19

Prolongs all

Question 20

What is used in hospital for patients with HIT?

Answer 20

Argatroban

Question 21

How do you monitor argatroban?

Answer 21

aPTT

Question 22

What are the advantages to using DOACs?

Answer 22

• Convenient

- Fever intracranial bleeds

Question 23

What are the disadvantages to using DOACs?

Answer 23

NOT effective in preventing stroke in patients with mechanical heart valves