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PHARM > Anticoagulant > Flashcards

Anticoagulant Flashcards

1
Q

What is required for successful clotting?

A

Platelets and coagulation factors

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2
Q

What are the 3 major groups of drugs to tx thromboembolic disorders?

A

anticoagulants, antiplatelet, and thrombolytics

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3
Q

What is the primary use of anticoagulants?

A

prevention of thrombosis in veins and the atria of the heart

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4
Q

What is the primary use of antiplatelets?

A

prevent thrombosis in the arteries

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5
Q

Which class is the only one that breaks up clots?

A

Thrombolytics

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6
Q

Which anticoagulant affects the extrinsic pathway (Tissue injury) of the coagulation cascade?

A

Warfarin

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7
Q

MOA of Warfarin (Coumadin)?

A
  • inhibits the synthesis of clotting factors (VII, IX, X, and prothrombin)
  • Vitamin K antagonist
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8
Q

Warfarin uses?

A
  • long-term prophylaxis of thrombosis

- heart valve replacement

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9
Q

What labs should we monitor with warfarin?

A

INR and PT

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10
Q

Adverse effects of warfarin (coumadin)?

A

hemorrhage

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11
Q

What is the reversal agent for hemorrhage when taking coumadin?

A

Vitamin K

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12
Q

Warfarin is contraindicated in?

A

-pregnancy d/t fetal hemorrhage and teratogenesis

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13
Q

D/t Warfarin’s delayed onset which drug is used as a bridge?

A

Lovenox

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14
Q

Who should we be cautious about when taking Warfarin?

A

pt’s w/ GI ulcers, hemophilia, and any bleeding disorder

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15
Q

Patient education for Warfarin?

A

keep a log, f/u with testing, avoid venous stasis, dosage, take at the same time everyday, multiple drug interactions, diet restrictions, reversal agent, use soft bristle toothbrush, electric razor, apply extra pressure to wounds, minimize use of concurrent anticoagulants or antiplatelet.

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16
Q

What does INR measure?

A

The time it takes for the blood to clot

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17
Q

What does it mean if a patient’s INR is high?

A

They are at risk for bleeding

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18
Q

What does it mean if a patient’s INR is low?

A

They are at risk for clots

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19
Q

What are signs of bleeding?

A

epistaxis, easy bruising, sudden severe HA, bleeding gums, melena, vomiting blood, ↑ HR and ↓ BP, hematuria

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20
Q

Warfarin or heparin is not for patient’s with?

A

active bleeding (ulcers, wounds), surgery (eye, spinal, brain), renal or liver failure

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21
Q

What class of anticoagulant is heparin?

A

Indirect thrombin inhibitor; Inactivates factor Xa and thrombin

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22
Q

Routes of heparin administration?

A

IV or subQ. Avoid the IM route.

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23
Q

What is the preferred anticoagulant during pregnancy?

24
Q

Adverse effects of heparin?

A

hemorrhage, HIT, hypersensitivity rxns

25
Heparin contraindications?
low platelets, surgeries, active bleeding
26
Antidote for heparin?
Protamine sulfate
27
Which labs should we monitor when administering heparin?
aPTT (only drawn if someone is on a heparin drip) and Anti-factor Xa heparin assay Pre-administration: BP, HR, RBC count, platelets, HCT
28
What is the half life of heparin?
1.5hrs
29
How is Dabigatran etexilate a prodrug?
When it is metabolized it undergoes rapid conversion to active dabigatran, a reversible, direct thrombin inhibitor
30
Adverse effects of Lovenox?
bleeding but much less than heparin; ITP
31
Which pathway of the coagulation cascade does heparin affect?
Intrinsic (blood vessel injury)
32
What is the difference between PTT and aPTT?
Measure the same thing but aPTT has an activator added to speed up the clotting time
33
Lovenox uses?
prevention and tx of DVTs
34
Which anticoagulant works faster?
Heparin
35
What is the therapeutic range for INR with warfarin?
2-3
36
Do you need frequent blood tests when taking Lovenox?
No
37
Route of administration for Lovenox?
SubQ, dosage based on body weight
38
Which medications are direct thrombin inhibitors?
Dabigatran etexilate (Pradaxa, Pradax) and Argatroban
39
Pradaxa MOA?
Oral prodrug that undergoes rapid conversion dabigatran, a reversible, direct thrombin inhibitor
40
Pradaxa uses?
A fib, DVT/PE, knee or hip replacement
41
Should Pradaxa be taken with our without food?
Either
42
5 major advantages of Pradaxa?
rapid onset, no need to monitor anticoagulation, few drug food interactions, lower risk of major bleeding, and same dose can be used for all patients, regardless of age or weight.
43
Disadvantages of Pradaxa?
No specific antidote, limited time on the market, more GI disturbances
44
Uses of argatroban?
prophylaxis and tx of thrombosis in the patients with HIT
45
Argatroban route?
IV
46
What is the half life of Argatroban?
~45min
47
What labs should be monitored with administration of Argatroban?
therapeutic levels of aPTT
48
MOA of direct factor Xa inhibitors?
inhibit thrombin production by inhibiting factor Xa
49
Prototypes for direct factor Xa inhibitors?
Rivaroxaban (Xarelto) and Apixaban (Eliquis)
50
Pharmacokinetics of Direct factor Xa inhibitors?
highly protein bound, partial metabolism by the liver, excreted in urine and feces.
51
Contraindications for direct factor Xa inhibitors?
pregnancy
52
T/F. Xarelto has the same advantages and disadvantages of Pradaxa.
True
53
Uses for Direct factor Xa inhibitors?
DVT prophylaxis including A fib and hip or knee replacement surgery.
54
MOA of Lovenox?
low molecular weight (LMW) heparin that inhibits factor Xa
55
Which anticoagulant has CRANKY drug interactions?
Warfarin
56
Precautions for Direct Xa inhibitors?
patients with renal/liver impairment

PHARM (35 decks)

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