6. Anti-Hemostatic Agents

Question 1

Venous thrombosis is commonly triggered by blood stasis or inappropriate activation of the ______.

Answer 1

coagulation cascade

Question 2

Arterial thrombosis usuallu consists of a ______ clot.

Answer 2

platelet-rich

Question 3

What are the anti-hemostatic agent drug classes?

Answer 3

1. Anticoagulents

2. Platelet inhibitors

Question 4

The coagulation process culminates in the generation of _______ which stimulates conversion of ______ to the glycoprotein fibrin

Answer 4

thrombin, fibrinogen

Question 5

T/F The cascade of anticoagulent therapy consists of three interrelated pathways

Answer 5

False, two

Question 6

In anticoagulent therapy, drugs that are acting within the ________ pathway (which is most important in vivo) affect the synthesis of ________.

Answer 6

extrinsic, vitamin k-dependent coagulation factors

Question 7

in anticoagulent therapy, drugs that are acting within the ______ pathway inhibit the activity of _______.

Answer 7

intrinsic, coagulation factors

Question 8

What are the anticoagulent drug classes?

Answer 8

Vitamin K “Antagonists”

Coagulation Factor Antagonists

Question 9

An example of Vitamin K Antagonist?

Answer 9

Coumadin [Warfarin]

Question 10

What is the mechanism of Coumadin?

Answer 10

Inhibits vitamin K-dependent coagulation factor synthesis (II, VII, IX, X, proteins C and S)

Question 11

What are the drug interactions of Azole antifungals, Macrolides, Fluoroquinolones and Tetracyclines in the presence of Coumadin?

Answer 11

Impaired metabolism

Question 12

What are the drug interactions of NSAIDs, Omega-3 & Omega-6 fatty acids in the presence of Coumadin?

Answer 12

Additive

Question 13

T/F Coumadin is contraindicated in recent ocular surgery, HTN and DM.

Answer 13

True

Question 14

What is Coagulation Factor Antagonists?

Answer 14

It’s under the class of anticoagulent drugs of anti-hemostatic therapies.

Question 15

What are the Coagulation Factor Antagonists?

Answer 15

1. Enoxaparin [Lovenox®, Xaparin®, Clexane®] “MOST COMMON”

2. Rivaroxaban [Xarelto®]

Question 16

What is the indication for Enoxaparin (Coagulation Factor Antagonists)?

Answer 16

Post-op DVT prophylaxis, Unstable Angina.

Question 17

What is the mechanism of action of Enoxaparin?

Answer 17

Binds to Antithrombin-III and accelerates its activity, inhibiting thrombin and Factor-Xa

Question 18

What are the common adverse effects of Enoxaparin?

Answer 18

hemorrhage and fever

Question 19

What is the more serious adverse effects of Enoxaparin?

Answer 19

Anemia

Question 20

What is the drug interactions of NSAIDs, Omega-3 & Omega-6 fatty acids with Enoxaparin?

Answer 20

Additive

Question 21

What should you be cautious about when taking Enoxaparin?

Answer 21

1. Recent ocular surgery
2. Diabetic retinopathy
3. Hypertension
4. Diabetes

Question 22

What are the platelet inhibitor drug classes?

Answer 22

1. Adenosine Receptor Blockers

2. Glycoprotein 2b/3a Receptor antagonists

Question 23

What are the Adenosine Receptor Blockers?

Answer 23

1. Clopidogrel [Plavix®] “MOST COMMON”
2. Ticlopidine [Ticlid®]
3. Prasugrel [Effient®]
4. Dipyridamole [Persantine®]

Question 24

What is the indication for Clopidogrel (Adenosine Receptor Blockers)?

Answer 24

Acute Coronary Syndrome and Thrombotic Event Prophylaxis

Question 25

What is the mechanism of action of Clopidogrel?

Answer 25

- Prodrug: metabolized to active metabolite by the CYP450 enzyme CYP2C19* - Irreversible inhibition of platelet ADP receptors which normally trigger platelet activation and aggregation via downstream activation of the GPIIb/IIIa complex

Question 26

What are the common adverse effects of Clopidogrel?

Answer 26

Hemorrhage, pruritus cough, bronchitis, dizziness and headache

Question 27

What are the serious adverse effects of Clopidogrel?

Answer 27

1. Hypersensitivty: Angioedema, steven johnson syndrome and Toxic epidermal necrolysis (TEN) 2. Hematology: thrombotic thrombocytopenic purpura (TTP)

Question 28

What is the drug interactions of Evening Primrose Oil (omega 6), Flaxseed (omega 3), Omega-3 FA, NSAIDs with Clopidogrel?

Answer 28

Additive

Question 29

What is the drug interactions of Ketoconazole in the presence of Clopidogrel?

Answer 29

Reduced metabolism/activation

Question 30

What should you be cautious about when taking Clopidogrel?

Answer 30

Ocular disease

Question 31

What are the different Glycoprotein IIb/IIIa Receptor Antagonists drugs?

Answer 31

1. Abciximab [Reopro] "MOST COMMON" | 2. Eptifibatide [Integrilin]

Question 32

What is the indication for Abciximab?

Answer 32

- An adjunct to percutaneous coronary intervention (PCI) for the prevention of cardiac ischemic complications - Unstable angina

Question 33

What is the dosing for Abciximab?

Answer 33

IV bolus

Question 34

What is the mechanism of action of Abciximab?

Answer 34

Fab fragment: a chimeric human-murine mAB Binds to the GP IIb/IIIa receptor of human platelets and inhibits platelet aggregation Binds to the vitronectin (αvβ3) receptor on platelets and vessel wall endothelial and smooth muscle cells

Question 35

What are the common adverse effects of Abciximab?

Answer 35

hemorrhage, hypotention, dizziness and headache

Question 36

What are the drug interactions of Omega-3 & Omega-6 fatty acids, NSAIDs and opthalmic NSAIDs with Abciximab?

Answer 36

Additive

Question 37

What are the contraindications of Abciximab?

Answer 37

Recent surgery or trauma and uncontrolled hypertension