anti thrombotics

Question 1

unfractionated heparin moa

Answer 1

binds to and inactivates Xa and IIa via antithrombin

reversible w/ protamine

Question 2

LMWH moa

Answer 2

Xa and IIa via antithrombin, smaller than heparin and less risk

inhibit Xa and IIa to different degrees

Question 3

fondaparinux moa

Answer 3

inactivates Xa via anti thrombin

Question 4

indirect thrombin inhibitor delivery

Answer 4

heparins given IV and sub Q (LMWH and fonda)- large molecules and not orally absorbed

Question 5

heparin toxicities

Answer 5

HIT- low platelets and thrombosis risk

Question 6

parenteral direct thrombin inhibitors

Answer 6

argatroban and bivalirudin

Question 7

use for parenteral direct thrombin inhibs

Answer 7

argatroban and bival are alternatives to heparins for ppl w/ HIT

Question 8

what are the oral direct acting anti coags?

Answer 8

thrombin: dabigatran
Xa: apixaban, riveroxaban, edoxaban

Question 9

warfarin moa

Answer 9

oral vit K inhib (vit K reductase enzyme inhib)- blocks carboxylation of II, VII, IX, X, C and S

Question 10

PK issues w/ warfarin

Answer 10

slow onset, must have current coag factors degrade first- dealt with thru heparin bridging

Question 11

warfarin drug interaction in blood

Answer 11

NSAIDs and drugs (like FADs) compete for albumin binding increasing the free warfarin in blood

Question 12

genetic issues w/ warfarin PK

Answer 12

VKORC1 and CYP2C9 polymorphisms affect dosing: CYP2C9 metabolizes warfarin and VKORC1 is the target

Question 13

diet issues w/ warfarin

Answer 13

variability in vit K intake from diet affects warfarin

Question 14

pregnancy issues w/ warfarin

Answer 14

fetal warfarin syndrome: bone defects, facial defects, shortened fingers, etc

Question 15

warfarin drug interaction in liver

Answer 15

amiodarone and cimetidine inhibit cyp2c9 which metabolizes warfarin

Question 16

CV aspirin uses

Answer 16

unstable angina, MI, stroke

Question 17

P2Y12 inhib CV uses

Answer 17

MI and stroke

Question 18

GPIIb/IIIa CV uses

Answer 18

angioplasty and stent placement

Question 19

cox 1/2 inhib toxicities

Answer 19

gastric damage

Question 20

P2Y12 inhib examples and moa

Answer 20

clopidogrel, prasugrel, ticagralor

irreversibly block ADP receptor and platelet activation

Question 21

PK issues for clopidogrel

Answer 21

it is a prodrug, must be activated by cyp2c19

some ppl are slow metabolizers w/ cyp2c19

Question 22

gpIIb/IIIa inhib examples and moa

Answer 22

block receptor for fibrin on platelets

abciximab, eptifibitide, tirofiban

Question 23

fibrinolytics general moa

Answer 23

stimulate activity of plasmin to break down clots

Question 24

fibrinolytics examples

Answer 24

t-PA, alteplase, streptokinase

Question 25

moa of atleplase and streptokinase

Answer 25

convert inactive plasminogen to plasmin

Question 26

uses for fibrinolytics

Answer 26

immediate therapy for STEMIs, if no cath lab available

Question 27

other uses for streptokinase and alteplase

Answer 27

both for immediate PE if pt is in shock,

alteplase also for immediate stroke tx

Question 28

drugs for initial ACS

Answer 28

anti platelet and anti coag

Question 29

drugs for secondary ACS prevention

Answer 29

dual anti platelet- ASA and P2Y12

Question 30

drugs for acute VTE

Answer 30

anti coag w/ NOAC if low risk, fibrinolytics if in shock

Question 31

drugs for chronic VTE

Answer 31

anti coag (NOAC unless has active cancer)

Question 32

VTE prophylaxis for ill pts

Answer 32

anti coag like NOACs or VKA, enoxaparin is preferred over both but VKA good for renal disease

Question 33

anti thrombotics for ppl w/ mechanical valve

Answer 33

VKA

heparin if procedure is needed