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Kol- Pharm 323 Spring > AntiCoag > Flashcards

AntiCoag Flashcards

1
Q

3 types of drugs effecting coagulation

A

Anticoagulants
Antiplatelet
Thrombolytic Therapy

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2
Q

prevents the formation of clots- VENOUS (DVT)

A

Anticoagulants

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3
Q

inhibits platelet aggregation (arterial - MI/Stroke)

A

Antiplatelet Agents

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4
Q

dissolves life threatening clots

A

Thrombolytic

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5
Q

5 types of anticoag drugs

A
  1. Heparin
  2. Low Molecular Weight Heparin
  3. Vitamin K antagonist
  4. Direct Thrombin Inhibitors
  5. Direct Factor Xa Inhibitors
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6
Q

heparin is the prototype for …

A

heparin unfractionated!

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7
Q

How do anticoagulants work? What do they do?

A

=PREVENT clot formation
—>Increase time it takes the body to form clots

FXN:
-Inhibit synthesis clotting factors (factor X and thrombin)
OR
-Inhibit the activity of clotting factors (Xa, thrombin)

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8
Q

Uses for anticoagulant?

A
  • Prevention of venous thrombosis

- –> DVT, pulmonary embolism, atrial fibrillation can throw clots

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9
Q

Routes for anticoagulants? When would you use which route?

A
  • IV/SubQ = if life threatening = Heparin, LMWH

- Oral= long term use

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10
Q

Heparin is not a ____ ______

A

blood thinner

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11
Q

3 ways heparin fxns?

A
  • Inactivates several clotting factors (factor Xa)
  • inhibits thrombin activity
  • suppresses formation of fibrin.
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12
Q

how is heparin measured?

A

in units

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13
Q

Route and reason for heparin?

A
  • IV immediate action: PE/Stroke/Renal Dialysis – intermittent or continuous
  • SQ-up to 1 hour for effect, abdomen, no aspirate/massage
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14
Q

half life for heparin? hours to reach therapeutic level of heparin?

A

1/2 life = 90 minutes

therapeutic = 6 hours

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15
Q

Antidote for heparin overdose? how often do we use it and why?

A

protamine sulfate (onset 5 min)

-hardly ever used…. -short half life of heparin = can just stop the IV drip and will resolve on its own

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16
Q

2 lab tests when on heparin?

A
  1. aptt

2. Anti-factor Xa level

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17
Q

aPTT measure _____ factor pathway

A

intrinsic

INpatient = IV heparin = INtrinsic =bigger # b/c more sick

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18
Q

Normal vss therapeutic levels of aPTT

A
  • Normal = 40 sec

- Therapeutic levels = 1.5-2X baseline : 60-80 sec

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19
Q

How often do we measure aPTT on IV heparin?

A

every 6 hours

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20
Q

therapeutic levels fo Anti- factor XA levels?

A

0.3-0.7 IU/mL

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21
Q

Side effects of heparin?

A
  1. bleeding

2. HIT

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22
Q

What is HIT? what we monitoring for?

A

(Heparin Induced Thrombocytopenia) - monitor platelets.
->4 days use, body creates antibodies again heparin platelet protein complexes resulting in platelet drop

-If <100,000 or platelets reduce by 50% then stop heparin.

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23
Q

-If______ or platelets reduce by _____ then stop heparin.

A

-If <100,000 or platelets reduce by 50% then stop heparin.

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24
Q

how do you know if your patient is bleeding?

A

-petechiae, blood from orifices, bruises, discolored urine, lumbar pain

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25
Q

who is NOT getting heparin and why?

A

do not give with epidural or spinal anesthesia

—-> risk of hematoma

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26
Q

prototype for

Low Molecular Weight Heparin

A

enoxaparin(Lovenox)

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27
Q

how does enoxaparin(Lovenox) fxn?

A

same mechanism of action as heparin, but SAFER, better bioavailability

  • Inactivates several clotting factors (factor Xa)
  • inhibits thrombin activity
  • suppresses formation of fibrin.
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28
Q

Benefits of enoxaparin(Lovenox)

A
  • No frequent blood tests
  • Dosage based on weight
  • Can be administered at home
  • longer half life - 6x longer
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29
Q

What is drug of choice for DVT prevention?

A

enoxaparin(Lovenox)

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30
Q

Side effects of enoxaparin(Lovenox)?

A

same as heparin!

bleeding, HIT

31
Q

Check ______ before admining enoxaparin(Lovenox)

A

platelets

32
Q

antidote to enoxaparin(Lovenox)

A

protamine sulfate, same as heparin

33
Q

enoxaparin(Lovenox)- do or don’t expel the bubble?

Admin in the ____ only

A

Don’t expel the bubble!

Abdomen only!

34
Q

prototype for Vitamin K antagonist

A

Warfarin (Coumadin)

35
Q

how does Warfarin (Coumadin) fxn?

A

Vitamin K antagonist

inhibiting hepatic synthesis of vitamin K dependent clotting factors VII, IX, IX, X, and prothrombin

36
Q

antidote for Warfarin (Coumadin)?

Will see effects in ___ hours

A

Antidote: Vitamin K (↓ effects in 6 hours)

37
Q

enoxaparin(Lovenox) is only administered

A

SubQ

i think this is true? lemme know if its not

38
Q

route for Warfarin (Coumadin)? which one has a risk?

A

Vitamin K antagonist

oral, IV (risk of anaphylaxis), SubQ

39
Q

uses for Warfarin (Coumadin)

A

Vitamin K antagonist

-Prevent DVT, PE, prevent clots in patients with Afib, prosthetic heart valves or who had TIA or recurrent MI

40
Q

Warfarin (Coumadin) is highly ____ bound

A

protein

41
Q

drug/food interactions with Warfarin ?

A

Vitamin K antagonist

  • Inactive by CYP2CP pathway
  • Foods high in vitamin K , green leafy veg
  • –> eat consistent amount of high vitamin K foods
42
Q

VKORC1 & CYP2C9 variants =Increased risk of bleeding with which drug?

A

Warfarin (Coumadin)

43
Q

Can you take Warfarin (Coumadin) while pregnant?

A

nope

44
Q

Side effects of Warfarin (Coumadin)?

A

Hemorrhage

45
Q

2 labs tests for Warfarin (Coumadin)?

A
  1. PT

2. INR

46
Q

What do PT and INR measure : _____________pathway

A

EXtrinsic pathway

warfarin = outpatient =exit hospital

47
Q

Normal range and therapeutic range for PT? test for which drug?

A
  • PT normal 12 sec, Therapeutic = 1-2X baseline (12-24)

- warfarin

48
Q

therapeutic level for INR? Test for which drug?

A
  • INR (Internationalized Ratio) 2.0-3.0 = therapeutic level

- warfarin

49
Q

which is more consistent to test platelets for Warfarin- INR or PT?

A

INR

50
Q

half life of Warfarin (Coumadin)

A

Half life: 1.5-2 days

51
Q

Teachings for Warfarin (Coumadin)

A

-Take same time every day
-Balance Vit K foods
-Watch s/s bleeding
—>labs
Soft toothbrush
-No straight edge razor
-Pain control drugs? Route?- best choice is tylenol! not aspirin/ibuprofen
-Venipuncture/ procedures- hold pressure longer, stop coumadin 1 week prior to surgery
-Medical Alert Bracelet
-Garlic? Gingko? - increase risk of bleeding

52
Q

stop Warfarin (Coumadin) __ ___ prior to surgery

A

1 week

53
Q

Don’t take the 2 supplements ___ or ____ with warfarin

A

garlic and gingko bilboa

–> increase risk of bleeding

54
Q

Best choice for OTC pain control on Warfarin (Coumadin) is _____

A

tylenol!

-don’t take ASA or Ibuprofen

55
Q

Prototype for Direct Thrombin Inhibitors

A

Prototype: dabigatran (Pradaxa)

56
Q

How does Prototype: dabigatran (Pradaxa) fxn?

What locations of thrombin does it act on?

A

direct, REVERSIBLE inhibitor of thrombin that is free in blood and bound to clots

57
Q

Route for dabigatran (Pradaxa)

A

Direct Thrombin Inhibitors

IV, SQ, oral

58
Q

uses for dabigatran (Pradaxa)

A

Afib; hip/knee replacement (Canada)

59
Q

side effects of dabigatran (Pradaxa)

A

bleeding, GI

60
Q

Benefits of dabigatran (Pradaxa)

A

Direct Thrombin Inhibitors

  • no lab monitoring
  • lower risk of bleeding
  • few drug-drug/ drug-food interactions
  • rapid onset
  • Set dose
61
Q

stop taking dabigatran (Pradaxa) before ______

A

surgery

62
Q

antidote for dabigatran (Pradaxa) ?

A

idarucizumab (Praxbind)

63
Q

prototype for Direct Factor Xa Inhibitors?

A

Rivaroxaban (Xarelto)

apixaban (Eliquis)

64
Q

how do Rivaroxaban (Xarelto) and apixaban (Eliquis) fxn?

A

binds with factor Xa and inhibits thrombin

65
Q

route for Rivaroxaban (Xarelto) and apixaban (Eliquis)

A

oral only!

Direct Factor Xa Inhibitors

66
Q

benefits of Rivaroxaban (Xarelto)and apixaban (Eliquis)

A

Direct Factor Xa Inhibitors

  • Does not require anticoagulant monitoring
  • Rapid onset
  • Fixed dose
  • Lower bleeding risk
  • Few drug interactions (CYP3A4)
67
Q

drug interaction with Rivaroxaban (Xarelto) and apixaban (Eliquis)

A

(CYP3A4)

68
Q

Uses for Rivaroxaban (Xarelto) and apixaban (Eliquis) ?

A

Post hip/knee replacement, Afib, tx of DVT/PE

69
Q

Side effects of Rivaroxaban (Xarelto) and apixaban (Eliquis)

A

Bleeding; spinal/epidural hematoma

70
Q

Rivaroxaban (Xarelto) and apixaban (Eliquis) contraindicated in

A

liver disease and pregnancy

71
Q

antidote forr Rivaroxaban (Xarelto) and apixaban (Eliquis)

A

andexanet alfa (AndexXa)

72
Q

If on IV heparin and then need to switch to oral agent Rivaroxaban or apixaban (Direct Factor Xa Inhibitors)

A
  • Stop heparin and immediately start oral does.

- May see doubled up doses for a couple of days, then once a day dosing.

73
Q

If on IV heparin and need to switch to oral agent Warfarin…..

A
  • Typically, 2-3 days simultaneous administration
  • Takes a couple of days for warfarin to take effect
  • No effect on clotting factors already in circulation
  • Increased risk of bleeding
  • Monitor both PTT and PT/INR

Kol- Pharm 323 Spring (41 decks)

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