Anti-Platelets, Anti-coagulants, & Thrombolytics

Question 1

What are the two anti-platelet drugs?

Answer 1

Clopidogrel (Plavix)

Abiciximab

Question 2

Which drug is used as an alternative to low dose aspirin?

Answer 2

Clopidogrel (plavix)

Question 3

Which drug binds irreversibly to platelet PY12 ADP receptor?

Answer 3

Clopidogrel

Question 4

What is the black box warning of Clopidogrel?

Answer 4

CYP2C19*2 allele - loss of function and cannot convert the prodrug to the active drug = plavix ineffective

Question 5

MOA of Abiciximab

Answer 5

Monoclonal ab against the GPIIb/IIIa receptors and prevents fibrinogen binding

Question 6

Which anti-platelet drug is the most effective, but only used in inpatient settings due its high cost?

Answer 6

Abiciximab

Question 7

Heparin MOA

Answer 7

Unfractionated heterogenous mucopolysaccharide (40), highly negative that activates AT and factor Xa equally

Question 8

Which drug inactivates thrombin and Factor Xa equally?

Answer 8

Heparin

Question 9

What is the antidote for Heparin induced bleeding?

Answer 9

Protamine sulfate

Question 10

What is the major side effect of Heparin?

Answer 10

HIT (heparin induced thrombocytopenia)

Question 11

Which drug is effective against Xa but only partially effective for thrombin?

Answer 11

Enoxaparin (LMWH)

Question 12

Which drug does protamine sulfate only partially works for?

Answer 12

Enoxaparin (LMWH)

Question 13

Which drug is only effective for inactivating Xa and has no effect on thrombin?

Answer 13

Fondaparinux

Question 14

Which drug does protamine sulfate have no effect on and thus has no antidote in bleeding situations?

Answer 14

Fondaparinux

Question 15

Which two drugs are beginning to replace heparin in outpatient settings?

Answer 15

Fondaparinux and Enoxaparin

Question 16

What is the MOA of Protamine sulfate?

Answer 16

cationic protein antidote that forms a complex with negatively charged heparin, the complex is inactive and rapidly reverses the effects of heparin

Question 17

Which drug suppresses the synthesis of Vitamin K factors?

Answer 17

Warfarin

Question 18

MOA of Warfarin

Answer 18

Inhibit Vitamin K epoxide reductase

Question 19

Why does Warfarin have a delayed onset of action?

Answer 19

Takes a long time to get through all the factors to prevent the formation of thrombin (the final coagulation enzyme)

Question 20

Can warfarin be used for emergencies?

Answer 20

No

Question 21

Which drug has interactions with abx that increase its effects?

Answer 21

Warfarin

Question 22

Which drug must be closely monitored by PT-INR?

Answer 22

Warfarin

Question 23

What is the antidote for warfarin?

Answer 23

Vitamin K

Question 24

What are the indications for using phytonadione?

Answer 24

When INR>10, prophylaxis for bleeding with warfarin use

Can only be used prophylactically do not use in hemorrhage (need PCC concentrate)

Question 25

Vitamin K MOA

Answer 25

restores hepatic synthesis of clotting factors

Question 26

Which direct thrombin inhibitor is a derivative of leech?

Answer 26

Bivalrudin

Question 27

What are the two direct thrombin inhibitors?

Answer 27

Bivalruidin and Dabigatran

Question 28

which direct thrombin inhibitor needs to be given parenterally?

Answer 28

Bivalrudin

Question 29

Which direct thrombin inhibitor needs to be given orally?

Answer 29

Dabigatran

Question 30

Which thrombin inhibitor is now termed a warfarin replacement?

Answer 30

Dabigatrain (dagnabit that warfarin replacer)

Question 31

What is the MOA of Bivalrudin?

Answer 31

Reversibly bind to thrombin substrate site, preven thrombin from activating fibrinogen

Question 32

Dabigatran MOA

Answer 32

Prodrug – > Competitive inhibitor

Question 33

TPA MOA

Answer 33

digests fibrin converts plasminogen to plasmin

Question 34

When must TPA be adminsteredd?

Answer 34

3-6hr after ischemic event