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Pharmacology 2: Section 1 > Anti-Coagulants & Anti-Platelets > Flashcards

Anti-Coagulants & Anti-Platelets Flashcards

1
Q

Drugs that inhibit platelet aggregation to prevent thrombus formation.

A

Anti-Platelets

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2
Q

What are Anti-Platelets primarily used for?

A

Prevention of Arterial Thrombosis

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3
Q

Medication that irreversibly inhibits Cyclooxygenase-1 (COX-1) and Thromboxane A2

A

Aspirin

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4
Q

Medications that inhibit the P2Y12 receptor and block ADP-induced platelet aggregation.

A

Clopidogrel (Plavix)
Ticagrelor

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5
Q

GPIIb/IIIa Inhibitors

A

Abciximab
Eptifibatide

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6
Q

Medications that inhibits phosphodiesterase and adenosine uptake.

A

Dipyridamole
Cilostazol

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7
Q

Aspirin is used for the primary prevention of what pathology?

A

Myocardial Infarction

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8
Q

Adverse effect of Aspirin that occurs in pediatric populations.

A

Reye’s Syndrome
(Liver + Brain Swelling)

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9
Q

What are the signs and symptoms of Aspirin overdose?

A

Tinnitus
Vertigo
Nausea, Vomiting, Diarrhea
Hyperventilation
Respiratory Alkalosis
Metabolic Acidosis
Hypokalemia
Hypoglycemia

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10
Q

A Salicylate level of what would indicate Aspirin overdose?

A

> 40mg/dL

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11
Q

How do you treat Aspirin overdose?

A

ABCs
Activated Charcoal
Sodium Bicarbonate
Dialysis

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12
Q

Irreversible inhibitors of P2Y12 or ADP receptor.

A

Clopidogrel
Prasgurel

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13
Q

What are the indications for Clopidogrel (Plavix)

A

Unstable Angina
NSTEMI
STEMI
Stroke
Peripheral Arterial Disease

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14
Q

What is an adverse event that can occur due to Clopidogrel?

A

Thrombotic Thrombocytopenic Purpura
(Blood clots in small blood vessels)

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15
Q

What medications can Clopidogrel interact with?

A

CYP-2C19 Inhibitors
Omeprazole

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16
Q

If a patient has an allergy to Aspirin, what medication can be used as an alternative?

A

Plavix

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17
Q

Medication that is more potent and than Plavix and is preferred in ACS when strong anti-platelet action is required.

A

Prasugrel (Effient)

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18
Q

How is Prasugrel metabolized?

A

Prodrug

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19
Q

What is Prasugrel a substrate of?

A

CYP-2C19

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20
Q

What medication should be avoided with Prasugrel (Effient)

A

Omeprazole

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21
Q

What is the indication for Prasugrel (Effient)

A

STEMI

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22
Q

When is Prasugrel (Effient) contraindicated?

A

History of TIA or Stroke

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23
Q

What patients should you be very cautious with when using Prasugrel (Effient)

A

Elderly (75+)
Only if Diabetic or prior MI

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24
Q

Patients below what weight need a reduced dose of Prasugrel?

A

< 60kg

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25
Q

Medication that is a reversible inhibitor of P2Y12 or ADP.

A

Ticagrelor (Brilinita)

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26
Q

When is Ticagrelor used?

A

Acute Coronary Syndrome + Aspirin
(Maximum Aspirin dose of 100mg)

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27
Q

What drugs does Ticagrelor interact with?

A

CYP3A4 Inhibitors
5x increase with Anti-Fungal!

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28
Q

When is Ticagrelor contraindicated?

A

History of Intracranial Hemorrhage

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29
Q

Medications that bind to and irreversibly Inhibits GPIIb/IIIa receptors and block platelet aggregation.

A

GPIIB/IIIA Antagonists
(Abciximab + Eptifibatide & Tirofiban)

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30
Q

When are GPIIB/IIIA antagonists used?

A

Percutaneous Coronary Intervention
Acute Coronary Syndromes

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31
Q

What patients should you be cautious with when prescribing GPIIb/IIIa antagonists?

A

Renal Dysfunction (reduce dose)

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32
Q

What are some adverse drug reactions of Abciximab?

A

Anaphylaxis
Thrombocytopenia

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33
Q

What are some adverse drug reactions of Eptifibatide & Tirofiban?

A

Anaphylaxis
Thrombocytopenia
Renal Dysfunction

34
Q

Medication that inhibits platelet function by inhibition adenosine uptake and cGMP phosphodiesterase activity (PDE3 Inhibitor)

A

Dipyridamole

35
Q

When is Dipyridamole used?

A

With another Agent
(Aspirin or Warfarin)

36
Q

What are the adverse effects of Dipyridamole (PDE3 Inhibitor)

A

Headaches
GI Distress
Dizziness

37
Q

PDE3 Inhibitor that is used for Intermittent Claudication.

A

Cilostazol (Pletal)

38
Q

What can cause interactions with Cilostazol (Pletal)

A

High Fat Diet = ↑ Level
Grapefruit = ↑ Level via CYP3A4

39
Q

Medications used for prevention of Venous Thromboembolism and stroke prevention in A-Fib.

A

Anti-Coagulants

40
Q

What are the three factors that contribute to the formation of blood clots in Virchow’s Triad?

A

Endothelial Injury
Hypercoagulability
Stasis

41
Q

Vitamin K Antagonist that inhibits Vitamin K epoxide reductase.

A

Warfarin

42
Q

Direct Factor Xa Inhibitors (Oral)

A

Apixaban (Eliquis)
Rivaroxaban (Xarelto)

43
Q

Direct Thrombin Inhibitors (Oral)

A

Dabigatran (Pradaxa)

44
Q

Medication that binds to Antithrombin III and allows for the inhibition of Thrombin and Factor Xa

A

Heparin

45
Q

Type of Heparin that is preferred for outpatient use.

A

Low Molecular Weight Heparins

46
Q

What clotting factors are inhibited by Warfarin? (S.N.T.T = Snot)

A

VII (7)
IX (9)
X (10)
II (2)

47
Q

What proteins are inhibited by Warfarin?

A

Protein C and S

48
Q

When is Warfarin indicated?

A

DVT + PE from Valvular and Non-Valvular A-Fib

Stroke Prophylaxis during:
- Cardioversion
- Rate Control Therapy

Reduce risk of embolism after MI

49
Q

What must you bride with Warfarin until you reach a therapeutic INR?

A

Indirect Thrombin Inhibitor

50
Q

What are some adverse effects of Warfarin?

A

Bleeding
Teratogenic
Skin Necrosis
CYP2C9
VKORC1

51
Q

When using Warfarin, what is the goal INR?

A

2 - 3

52
Q

What is the reversal agent for Warfarin and when is it given?

A

Vitamin K (orally)
INR of 4.5 - 10 or Pre-Surgery
Fresh Frozen Plasma for active bleeding

53
Q

What medication can increase INR due to interacting with Warfarin?

A

Amiodarone

54
Q

What medication can decrease INR due to interaction with Warfarin?

A

Rifampin

55
Q

What Direct Factor Xa Inhibitor should be taken with food for doses above 10mg?

A

Rivaroxaban (Xarelto)

56
Q

Medications that are metabolized by CYP3A4 and P-Glycoprotein. Should be avoided in patients with severe renal and hepatic impairment.

A

Direct Factor Xa Inhibitors
(Apixaban + Rivaroxaban)

57
Q

What are the ABCs of prescribing Apixaban?

A

A = Age 80+
B = Body Mass ≤ 60kg
C = Creatinine 1.5+

DO NOT GIVE IF AT LEAST 2 of THESE

58
Q

Direct Thrombin Inhibitors that are given Parenteral.

A

Bivalirudin
Argatroban

59
Q

Direct Thrombin Inhibitor that is given parenterally for Percutaneous Coronary Intervention (PCI)

A

Bivalirudin

60
Q

Direct Thrombin Inhibitor that is given parenterally for Heparin-Induced Thrombocytopenia (HIT) and PCI

A

Argatroban (Acova)

61
Q

Direct Thrombin Inhbitor that is given orally. It does not require routine monitoring, doesn’t interact with CYP450, and has a rapid onset and offset.

A

Dabigatran (Pradaxa)

62
Q

What are the Black Box Warnings on Dabigatran (Pradaxa)

A

Spinal + Epidural Hematomas
Abrupt Discontinuation

63
Q

What is the reversal agent for Direct Oral Anti-Coagulants (Factor Xa) such as Eliquis and Xarelto

A

Andexxa

64
Q

What is the reversal agent for Dabigatran?

A

Idarucizumab

65
Q

Binds to enzyme inhibitor antithrombin III and inactivates clotting factors IIa (Fibrin) and Xa

A

Unfractionated Heparin

66
Q

Binds to Antithrombin III but not Fibrin.

A

Low Molecular Weight Heparin
Synthetic Heparin

67
Q

Heparin that is used primarily in the prevention of clotting in arterial and cardiac surgery and to maintain patency of IV devices and for Dialysis patients.

A

Unfractionated Heparin

68
Q

Name three Low-Molecular Weight Heparins.

A

Enoxaparin
Dalteparin
Tinzaparin

69
Q

When is Low-Molecular Weight Heparin preferred?
(TOP)

A

Trauma
Oncology
Pregnancy

70
Q

Patients taking Direct Oral Anticoagulants (Eliquis + Xarelto) can have weight false reading?

A

Falsely Elevated PTT Levels

71
Q

What is an advantage of Unfractionated Heparin?

A

NO RENAL DOSING

72
Q

Adverse drug reactions caused by Heparin.

A

HIT
Platelet Factor 4-Heparin
(5-14 days after starting Heparin)

73
Q

How do you treat HIT?

A

Stop Heparin
NO PLATELET TRANSPLANT
Replace with Fondiparinux

74
Q

What is the reversal agent for Heparin?

A

Protamine

75
Q

Medications that cause fibrinolysis by binding to fibrin in a clot and converting entrapped plasminogen to active plasmin.

A

Fibrinolytics
(Clot Busters)

76
Q

Name three Fibrinolytics.

A

Alteplase
Reteplase
Tenecteplase

77
Q

When do you use Fibrinolytics?

A

Stroke
PE
STEMI

78
Q

How soon must a Fibrinolytic be given after symptom onset?

A

Within 3 hours

79
Q

Contraindications for Fibrinolytics.

A

Bleeds
Stroke in last 3 months
Brain or Spine surgery in last 3 months
Serious head trauma in last 3 months
Uncontrolled Severe Hypertension
Brain lesions or aneurysm or malformation

80
Q

What are some advantages of Tenecteplase over Alteplase

A

Better Outcomes at 90 days
Cheaper
Less bleeding
Less Adverse Drug Reactions

Pharmacology 2: Section 1 (4 decks)

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