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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?

A

Heparin

24
Q

Adverse effects of heparin?

A

hemorrhage, HIT, hypersensitivity rxns

25
Q

Heparin contraindications?

A

low platelets, surgeries, active bleeding

26
Q

Antidote for heparin?

A

Protamine sulfate

27
Q

Which labs should we monitor when administering heparin?

A

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
Q

What is the half life of heparin?

A

1.5hrs

29
Q

How is Dabigatran etexilate a prodrug?

A

When it is metabolized it undergoes rapid conversion to active dabigatran, a reversible, direct thrombin inhibitor

30
Q

Adverse effects of Lovenox?

A

bleeding but much less than heparin; ITP

31
Q

Which pathway of the coagulation cascade does heparin affect?

A

Intrinsic (blood vessel injury)

32
Q

What is the difference between PTT and aPTT?

A

Measure the same thing but aPTT has an activator added to speed up the clotting time

33
Q

Lovenox uses?

A

prevention and tx of DVTs

34
Q

Which anticoagulant works faster?

A

Heparin

35
Q

What is the therapeutic range for INR with warfarin?

A

2-3

36
Q

Do you need frequent blood tests when taking Lovenox?

A

No

37
Q

Route of administration for Lovenox?

A

SubQ, dosage based on body weight

38
Q

Which medications are direct thrombin inhibitors?

A

Dabigatran etexilate (Pradaxa, Pradax) and Argatroban

39
Q

Pradaxa MOA?

A

Oral prodrug that undergoes rapid conversion dabigatran, a reversible, direct thrombin inhibitor

40
Q

Pradaxa uses?

A

A fib, DVT/PE, knee or hip replacement

41
Q

Should Pradaxa be taken with our without food?

A

Either

42
Q

5 major advantages of Pradaxa?

A

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
Q

Disadvantages of Pradaxa?

A

No specific antidote, limited time on the market, more GI disturbances

44
Q

Uses of argatroban?

A

prophylaxis and tx of thrombosis in the patients with HIT

45
Q

Argatroban route?

A

IV

46
Q

What is the half life of Argatroban?

A

~45min

47
Q

What labs should be monitored with administration of Argatroban?

A

therapeutic levels of aPTT

48
Q

MOA of direct factor Xa inhibitors?

A

inhibit thrombin production by inhibiting factor Xa

49
Q

Prototypes for direct factor Xa inhibitors?

A

Rivaroxaban (Xarelto) and Apixaban (Eliquis)

50
Q

Pharmacokinetics of Direct factor Xa inhibitors?

A

highly protein bound, partial metabolism by the liver, excreted in urine and feces.

51
Q

Contraindications for direct factor Xa inhibitors?

A

pregnancy

52
Q

T/F. Xarelto has the same advantages and disadvantages of Pradaxa.

A

True

53
Q

Uses for Direct factor Xa inhibitors?

A

DVT prophylaxis including A fib and hip or knee replacement surgery.

54
Q

MOA of Lovenox?

A

low molecular weight (LMW) heparin that inhibits factor Xa

55
Q

Which anticoagulant has CRANKY drug interactions?

A

Warfarin

56
Q

Precautions for Direct Xa inhibitors?

A

patients with renal/liver impairment

PHARM (35 decks)

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