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Pharm Unit 5 > Anticoags > Flashcards

Anticoags Flashcards

1
Q

coag factors are ___

A

enzymes

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2
Q

each step of the cascade amplifies the ___

A

initial signal

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3
Q

coag factors are made in the ___

A

liver

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4
Q

“Final pathway” results in:

A

conversion of prothrombin (II) to thrombin

which catalyzes the conversion of fibrinogen to fibrin

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5
Q

fibrin activates the ____

A

fibrinolytic system (plasmin, tissue plasminogen activator (tPA))

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6
Q

Homeostasis of the cascade is maintained by balance of

A 
procoagulants (coag factors) 
endogenous anticoagulants (proteins C & S, antithrombin III)
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7
Q

proteins C and S are important for ___

A

warfarin dosing

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8
Q

antithrombin III is important for ___

A

heparin dosing

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9
Q

purpose of fibrinolytic system

A

degrades fibrin

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10
Q

fibrinolytic system results in:

A 
fibrin split products (FSP) AKA fibrin degredation products (FDPs) 
Fibrin dimers (d-dimers)
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11
Q

increased fibrin degradation product or d dimer levels suggest presence of ___

A

thrombi

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12
Q

consequence of inappropriate thrombosis:

A

venous thrombi

arterial thrombi

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13
Q

venous thrombi:

A

DVT
Red thrombus AKA venous stasis thrombi
VTE (venous thromboembolism)

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14
Q

arterial thrombi are __ driven

A

platelet driven

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15
Q

complication of venous thrombi

A

pulmonary embolism

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16
Q

arterial thrombi

A

white thrombus

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17
Q

complication of arterial thrombi

A

strokes, myocardial infarction

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18
Q

thrombosis risk factors

A 
surgery
cancer
immobility
varicose veins
pregnancy
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19
Q

potential complication of anticoagulant agents

A

BLEEDING

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20
Q

complications of anticoagulation agents are NOT an ___. it is an extension of their ___

A

allergy; MOA

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21
Q

heparin binds to ___

A

antithrombin III

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22
Q

heparin binding requires specific _____

A

pentasaccharide sequence

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23
Q

Heparin’s limitations

A

heparin activates platelets directly
Heparin can dinduce immune response in the form of HIT/HITTs
Heparin exhibits nonlinear dose response
Heparin increases affinity of thrombin for fibrin

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24
Q

unfractionated heparin is a :

A

heterogenous mix of sulfated glycosaminoglycans

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25
Q

only ___ of UFH molecules have the pentasaccharide

A

~1/3

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26
Q

UFH antithrombin complex is approx ______ x > anticoagulant than antithrombin alone

A

100-1000x

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27
Q

UFH is only effective on ____ fibrin

A

soluble (non clot-bound fibrin)

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28
Q

UFH prevents the ____ of the thrombus

A

growth/propagation

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29
Q

UFH allows the patient’s fibrinolytic system to ___

A

degrade the clot

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30
Q

UFH is measured by the ______

A

activated partial thromboplastin time aPTT)

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31
Q

DVT prophylaxis – subQ heparin

A

UFH

5,000 units SubQ q12h or q8h

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32
Q

Risk of HIT is that of ___ UFH

A

IV (increased risk)

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33
Q

Advantages of UFH

A 
immediate anticoag
measured by aptt
effects reversed by protamine
prevents propagation of a clot
may be given subQ for prophylaxis
usually done by Pharmacy Dosing Service
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34
Q

disadvantages of UFH

A 
non-linear kinetics
frequent lab tests required
increased risk of bleeding
potential for life-threatening immune-mediated thrombocytopenia "HIT)
minimal effect on interior of the clot
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35
Q

___ is used to reverse UFH heparins

A

protamine sulfate

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36
Q

MOA of protamine sulfate

A

combines with strongly acidic heparin

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37
Q

2 types of HIT

A 
HIT 1 (non-immune) 10% 
HIT II (immune) VERY BAD <3% of patients
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38
Q

HIT I is transient due to ___

A

clumping of platelets (actually an artifact)

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39
Q

HIT-I happens ___

A

immediately

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40
Q

HIT II is seen after ___ of heparin

A

5-10 days

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41
Q

in HIT II, platelet count falls by ____ from baseline

A

> 50%

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42
Q

HIT II is immune mediated by ____

A

anti-platelet factor 4

test for PF4

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43
Q

LMWH have a more favorable ___

A

benefit/risk ration

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44
Q

LMWH have predictable ____

A

dose response ratio

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45
Q

LMWH ahs ___ dosing

A

weight base

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46
Q

LMWH has less risk fo ___

A

HIT (if started initially)

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47
Q

LMWH (fractionated) has ___ administration

A

subQ

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48
Q

Available LMWH agent

A

enoxaprin (lovenox)

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49
Q

indications for LMWH

A

ACS treatment
DVT
PE
VTE prophylaxis in high risk populations

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50
Q

Dose of lovenox for acute DVT w/ or w/o PE (inpatient)

A

1mg/kg/dose (roundedO subQ q12h
OR
1.5mg/kg (rounded) subQ once daily

51
Q

lovenox dose for acute DVT w/ or w/o PE (outpatient)

A

1mg/kg/dose (rounded) subQ q12h

52
Q

vitamin k antagonists inhibit ___

A

post-translational carboxylation of coag factors II (prothrombin), VII, IX, X

53
Q

vitamin K antagonists inhibit two vitamin k sensitive ___

A

synthetic enzymes

54
Q

warfarin is reversed with ____

A

pharmacological doses of vitamin K (phytonadione; mephyton)

55
Q

doses of vitamin K to reverse warfarin

A

2.5-10mg PO (5mg tablet)

1-10 mg IVPB (rare risk of anaphylaxis w/ rapid infusion)

56
Q

vitamin K antagonists are often started with heparin for

A

Afib, DVT, PE

57
Q

D/C IV heparin when ____

A

warfarin is therapeutic

58
Q

warfarin takes ____ for full anticoagulation

A

5-7 days

59
Q

when using warfarin, measure effects wiht ___ and ___

A

prothrombin time (PT) and international normalized ratio (INR)

60
Q

Therapeutic INR ranges for Afib, DVT< PE

A

2-3

61
Q

therapeutic INR ranges for mechanical heart values (NOT porcine)

A

2.5-3.5

62
Q

each dose of warfarin takes ____ to take effect

A

~48h

63
Q

complication of starting 10mg warfarin daily

A

possibility of warfarin induced skin necrosis

64
Q

INR 3-5, no sig bleeding

A

lower or hold next dose

resume when INR nears 2-3

65
Q

INR 5-9; no sig bleeding

A

omit next 1-2 doses. Monitor INR, resume when INR nears 2-3

66
Q

INR >9; no sig bleeding

A

hold warfarin.
give vit k 5-10 mg PO
Monitor INR next 2-3 days, give addl vit k if needed

67
Q

any increased INR; serious bleeding

A

hold warfarin
give vit k 10 mg via SLOW IVPB AND FFB
may repeat vit K IV q12h

68
Q

any increased INR; life threatening bleeding

A

hold warfarin.

give PT complex & vit K 10mg IVPB (slow); repeat if necessary

69
Q

drugs that inhibit CYP2C9 increase ___ an d___

A

INR and risk of bleeding

70
Q

drugs that inhibit CYP2C9:

A

bactrim

flagyl

71
Q

drugs that INDUCE CYP2C9 decrease ___ and INCREASE ___

A

INR and the increase the risk of thrombosis

72
Q

drugs that induce CYP2C9

A

contraceptives

73
Q

sources of high dietary folate

A

beef, pork liver
green teas
leafy green vegetables
spinich

74
Q

___ is in prefilled syringes

A

Fondaparinux (Arixtra)

75
Q

Anti-Factor Xa inhibitors is a ___

A

synthetic pentasaccharide

76
Q

Anti Factor Xa inhibitors are mainly ___ eliminated

A

renally

77
Q

Anti factor Xa inhibitors are contraindicated in ___

A

CrCl <30

78
Q

unlabeled use of anti factor Xa inhibitors:

A

DVT px in patients w/ h/o HIT

79
Q

oral direct Xa inhibitor

A

xarelto (rivaroxaban) Bayer

80
Q

oral direct xa inhibitor w/ no lab monitoring

A

xarelto

81
Q

recent reversal agent of xarelto

A

aadexant alfa

82
Q

MC adverse affect of xarelto

A

bleeding

>5%

83
Q

bivalent direct thrombin inhibitors

A

lepirudin
bivalrudin
desirudin

84
Q

univalent DTIs

A

argatroban

dabigatran

85
Q

DTIs may be used in pts w/ ____

A

h/o HIT II

86
Q

used to treat HIT

A

argatroban

87
Q

argatroban is given ___ and monitored w/ ___

A

IV; monitored w/ PTT

88
Q

Argatroban is NOT ___

A

really eliminated. (used inpatients w/ HIT and poor renal function)

89
Q

AZ withdrew application of Ximelagatran in ____

A

2006

90
Q

Dabigatran requires no ____

A

lab testing

91
Q

new reversal agent for dabigatran was released in ___

A

2015

92
Q

dabigatran (pradaxa) reversal agent

A

idarucizumab (prdxbind)

93
Q

idarucizumab is humanized ___

A

monoclonal antibody

94
Q

MOA of Idarucizumab

A

binds to pradaxa

95
Q

dosage of praxbind

A

two consecutive 2.5 g doses given IV

96
Q

cost of PRaxbind

A

3,500$

97
Q

decoy protein

A

factor Xa

98
Q

Andexanet alfa corrects

A 
apixaban
rivaroxaban
edoxaban
enoxaprin
fondaparinux
99
Q

anti platelet drugs

A

glyprotein IIB/IIIa inhibitors
ADP receptor antagonists
others

100
Q

eptifibatide is administered __

A

IV

101
Q

purpose of eptifibatide

A

ACS

PCI and/or stent

102
Q

abciximab (RepPro)

A

chimeric monoclonal antibody (human/murine)

103
Q

abciximab has numerous ___

A

adverse effects

104
Q

___ is rarely used

A

abciximab

105
Q

___ has a black box warning

A

ticlopidine

106
Q

ticlopidine is reserved for patients:

A

intolerant to aspirin

those who failed aspirin therapy

107
Q

clopidogrel is a prodrug converted to ___

A

unidentified active metabolite

108
Q

clopidogrel ultimately prevents ___

A

platelet aggregation

109
Q

clopidogrel drug interactions:

A

decreased activity w/ PPIs via CYP2C19 inhibition

increased his of restenosis while on PPIs

110
Q

prasugrel is more effective w/ ___

A

clopidogrel or ticlopidine

111
Q

prasugrel has less inhibition by ___

A

PPIs

112
Q

platelet antagonists:

A

aspirin

113
Q

aspirin inhibits platelet aggregation by ___

A

acetylation of ADP receptor

114
Q

(aspirin) acetylation of ADP receptor lasts ___

A

life of the platelet

115
Q

benefits of aspirin are waited against adverse effects:

A 
GI bleed (minimal at low doses) 
Tinitis (minimal at low doses)
116
Q

don’t chew ___ aspirin

A

baby

117
Q

mechanisms of dipyridamole

A

platelet aggregation inhibitor

vasodilator

118
Q

dipyridamole is used w/ ___ in patients w/ ___

A

warfarin; mechanical heart valves (rarely)

119
Q

dipyridamole is used as a ___ in CAD

A

diagnostic agent (persantine stress test) frequently

120
Q

Available tissue plasminogen activators

A

alteplase (activase, cathflo)

121
Q

tPA (alteplase) is used for

A

lysis of coronary artery thrombi in AMI
management of ischemic stroke (more common0
lysis of occluded ports of catheters

122
Q

stroke dose of tPA (alteplase)

A

0.9mg/kg

load 0.09 mg/kg (10% of total dose) over one min; followed by 0.81 mg/kg (90% of dose) CIV over 1 hr

123
Q

max dose of tPA

A

90mg

Pharm Unit 5 (4 decks)

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