Anti-coagulant pharmacology

Question 1

Unfractionated Heparin MOA

Answer 1

Increase Anti-thrombin capacity to inhibit clotting factors&raquo_space; inhibits II, VII, IX, X, XI

Inhibits Xa and IIa equally

Question 2

Unfractionated Heparin peak onset

Answer 2

IV&raquo_space; immediate

SQ&raquo_space; 1-2 hours

Question 3

Unfractionated Heparin adverse effects

Answer 3

Bleeding

Heparin induced thrombocytopenia

Question 4

Unfractionated Heparin monitoring

Answer 4

Therapeutic level monitoring via PTT

Routine daily monitoring of Hgb, Hct, platelets

Question 5

Low molecular weight heparin MOA

Answer 5

Increase Anti-thrombin capacity to inhibit clotting factors

Inhibits Xa preferentially

Question 6

LMWH drug name

Answer 6

Enoxaparin - Lovenox

Question 7

LMWH adverse effects

Answer 7

Bleeding

Heparin-induced thrombocytopenia

Question 8

LMWH monitoring

Answer 8

Does not require therapeutic level monitoring

Routine daily monitoring of Hgb, Hct, platelets

Question 9

LMWH peak onset

Answer 9

4-5 hours after injection

Question 10

Warfarin MOA

Answer 10

Antagonism of vitamin K&raquo_space; synthesis of Less-functional coagulation factors (VII, IX, X, II)&raquo_space; takes longer to clot

Question 11

Warfarin advantages

Answer 11

Long duration of activity&raquo_space;usually dosed weekly
Liver metabolism&raquo_space; no need to renal dose adjustments
Less expensive

Question 12

Warfarin disadvantages

Answer 12

Liver metabolism&raquo_space; LOTS of drug interactions
Weekly injections
High degree of variability&raquo_space; requires weekly INR monitoring
Patient education on consistent dietary vitamin k intake

Question 13

Dabigatran (Pradaxa) MOA

Answer 13

Direct IIa inhibitor

Inhibits both free and clot bound thrombin

Question 14

Rivaroxaban (Xarelto) MOA

Answer 14

Direct Xa inhibitor

Question 15

Apixaban (Eliquis) MOA

Answer 15

Direct Xa inhibitor

Question 16

DOAC disadvantages

Answer 16

Require renal does adjustments

Very expensive

Question 17

DOAC advantages

Answer 17

Oral administration
Do not require monitoring
Less drug interactions

Question 18

Rivaroxaban (Xarelto) dosing

Answer 18

DVT/PE prevention (ortho surgery)&raquo_space; 10 mg PO 1x/day

Treatment of acute DVT/PE&raquo_space; 15 mg PO BID x 21 days followed by 20mg PO 1x/day

Secondary prevention of recurrent DVT/PE&raquo_space; 10 mg PO 1x/day

Question 19

Apixaban (Eliquis) dosing

Answer 19

Prevention of DVT/PE (ortho surgery)&raquo_space; 2.5 mg PO BID

Treatment of acute DVT/PE&raquo_space; 10mg PO BID x 7 days, followed by 5 mg PO BID

Secondary prevention of recurrent DVT/PE&raquo_space; 2.5 mg PO BID