26 anticoag

Question 1

Factor Xa inhibitors

Answer 1

Rivaroxaban

Apixaban

Heparin

LMWH

Question 2

what should be monitored while giving heparin?

Answer 2

PTT!

Question 3

adverse effects of heparin

Answer 3

bleeding

HIT - Ab against platelets can form

chronic use:

osteoporosis

hypoaldosteronism

SAFE FOR PREGOS!

Question 4

what can be given instead of heparin if the patient has had HIT before

Answer 4

argatroban - Xa inhibitor!

Question 5

heparin mechanism

Answer 5

blocks Xa AND thrombin action through interaction w/antithrombin

Question 6

low molecular weight heparin compared to unfractionated heparin

Answer 6

LMWH has no 13 pentasaccharide seq.
LMWH acts more on Xa than thrombin
LMWH has a more predictable anticoagulant response

• binds to less shit

Question 7

“clinical indications for heparin”

Answer 7

acute coronary syndrome(LMWH may be better than unfractionated)

DVT/PE

CVA/TIA; cerebrovascular disease

Question 8

enoxaparin

Answer 8

LMWH

Question 9

rivaroxaban
administration, indications

Answer 9

PO, QID

Afib

DVT prophylaxis during surgery

DVT/PE

Question 10

apixaban

administration, indications

Answer 10

PO, BID

Afib

DVT prophylaxis after surgery

DVT/PE treatment

Question 11

advantages/disadvantages of non-heparin Xa inhibitors

Answer 11

rivaroxaban, apixaban

advantages:

no monitoring required

dont need antithrombin to work

can take orally!

disadvantages:

no antidote

Question 12

vitamin K antagonist

Answer 12

warfarin

Question 13

clotting factors affected by vitamin K deficiency

Answer 13

2, 7, 9, 10

Question 14

indications for warfarin

Answer 14

DVT/PE

prosthetic heart valves

Afib/stroke prevention

peripheral artery disease

Question 15

adverse effects of warfarin

Answer 15

bleeding!
prolonged PT can be a problem

INR of 2-3 is target

Question 16

pharmacokinetics of warfarin

Answer 16

99% of the drug is bound to plasma proteins(albumin)

need to wait for existing clotting factors to leave body before anticoagulation effects kick in

• earlierst INR change is 24-36 hrs

Question 17

direct thrombin inhibitors

Answer 17

bivalirudin

dabigatran

Question 18

bivalirudin, dabagitran mechanism

administration?

Answer 18

blocks thrombin active site

does free AND clot bound

does some platelet aggregation too

bivalirudin is IV

dabagitran is PO

Question 19

indications for bivalirudin

Answer 19

ACS pts undergoing PCI

patients at high risk of HIT undergoing PI

Question 20

pharmacokinetics of dabigatran

Answer 20

cant detect with INR

35% protein bound

negative interactions w/rifampin

Question 21

fibrinolytic agents

Answer 21

tPA

rPA

SK

Question 22

mechanism of fibrinolytics

Answer 22

analogs of tissue plasminogen activator are infused to activate plasminogen

plasminogen disassembles clots by clearing the crosslinked fibrin mesh

Question 23

clinical indications for fibrinolytics

Answer 23

• venous thromboembolism
• STEMI if no cath lab available
• stroke(t-PA is drug of choice)
• IV-radiology

Question 24

adverse effects of fibrinolytics

Answer 24

intracranial hemorrhage

oozing from puncture sites

BLEEDING