Anticoagulant

Question 1

What are the two types of clots?

Answer 1

White and Red

Question 2

What is the main component of white clots, patho of the clot, what types of vessels do we find them in, what pathological condition is most associated with white clots?

Answer 2

Platelets. Platelets adhere to damaged endothelium. High pressure arteries. Local ischemia.

Question 3

Main component of red clots, what types of vessels do we most commonly find red clots, and what pathological condition do we get from red clots?

Answer 3

Fibrin trapping RBCs, low pressure veins and heart, embolism.

Question 4

What are the three families of drugs to treat clots?

Answer 4

Anticoagulants, anti-platelets, and thrombolytics

Question 5

Big picture, when do we use anticoagulants?

Answer 5

To prevent clot formation in the veins and heart, so red clots.

Question 6

Big picture, when do we use antiplatelet drugs?

Answer 6

To prevent clots in the arteries, so white clots.

Question 7

Big picture, when do we use thrombolytics?

Answer 7

Restore blood flow after a clot has formed. Bust up the clot.

Question 8

Big picture what is the MOA for anticoagulants?

Answer 8

Regulate function and synthesis of clotting factors

Question 9

Two groups of anticoagulants?

Answer 9

Parenteral (indirect and direct thrombin blockers) and oral

Question 10

What drug are we talking about with indirect thrombin inhibitors and what is its MOA?

Answer 10

Heparin. Increases AT3 activity by 1000 fold.

Question 11

What are the three types of indirect thrombin and 10 inhibitors and what are their differences in their effects?

Answer 11

HMW: inhibits both thrombin and factor 10
LMW: inhibits factor ten mostly, a little of thrombin
Fonda: only factor 10

Question 12

What are the two ways we can monitor patients on heparin?

Answer 12

aPTT (intrinsic pathway) and anti 10 assay

Question 13

2 adverse effects of heparin?

Answer 13

Bleeding and HIT

Question 14

What is the big picture patho of HIT?

Answer 14

Antibodies attack the heparin-platelet factor 4 complex and activates the platelets, and lead to a pro thrombotic state.

Question 15

Two big indications for these indirect thrombin inhibitors?

Answer 15

DVT and PE

Question 16

How does Lepirudin and Bivalirudin bind to thrombin?

Answer 16

Bind at both the active site and the substrate site.

Question 17

How does Argatroban bind to thrombin?

Answer 17

Only at the active site.

Question 18

What is the route of administration for indirect thrombin inhibitors and direct thrombin inhibitors?

Answer 18

Parenterally

Question 19

2 clinical indications for direct?

Answer 19

HIT and angioplasty

Question 20

What is the most commonly prescribed anticoagulant in US?

Answer 20

Warfarin

Question 21

What is the MOA for warfarin, 2 things?

Answer 21

1. Inhibits vitamin K epoxide reductase

2. Inhibits GGCX from carboxylating clotting factors

Question 22

What clotting factors are affected by not being able to carboxylate?

Answer 22

2,7,9,10

Question 23

Which Warfarin isomer is more potent?

Answer 23

S

Question 24

3 indications for Warfarin?

Answer 24

Treat clots, A fib, and patients with prosthetic heart valves.

Question 25

What is the adverse effect of warfarin that is specific to a specific patient population?

Answer 25

Teratogenic effect in fetus. Bleeding disorder.

Question 26

What is the bioavailability of warfarin and what is its state in the blood?

Answer 26

100% bio and mostly bound to albumin.

Question 27

High chance of thrombosis INR, Normal, chance of bleeding, and warfarin patients INR?

Answer 27

.5, .9-1.3, 4-5, and 2-3

Question 28

What is responsible for the most variation of Wafarin? What ethnicity is more resistant to warfarin? What ethnicity is less resistant to Warfarin?

Answer 28

The individuals unique reductase. AA. Asians.

Question 29

4 advantages of using warfarin?

Answer 29

Oral, long action, don’t need kidneys for drug clearance, and reversed by giving vitamin K.

Question 30

2 main drawbacks to using Warfarin?

Answer 30

Doing incredibly variable which leads to problems and required INR monitoring.

Question 31

What are the direct oral anticoagulants blocking and what are their 3 clinical uses?

Answer 31

Factor 10 And thrombin

Prevent embolism, treat embolism, and prevent stroke in Afib.

Question 32

3 advantages of DOAC?

Answer 32

Fixed doses so don’t need monitoring
Equal in efficacy of warfarin
Rapid onset of action

Question 33

1 drawback of DOAC?

Answer 33

Excreted by kidney so you have to adjust dose for patients with kidney disease

Question 34

What is the only oral direct thrombin blocker?

Answer 34

Dabigatran

Question 35

2 clinical indications for dabigatran?

Answer 35

Reduce the risk of embolism in a fib patients and treat venous clots.

Question 36

What is the disadvantage of dabigatran?

Answer 36

Mostly excreted by the kidneys

Question 37

What is the antidote for DOAC for factor ten?

Answer 37

A Alfa

Question 38

What is the antidote for DOAC for thrombin?

Answer 38

Idarucizumab

Question 39

What blood coag test do we do to monitor heparin?

Answer 39

APTT and anti10

Question 40

What test do we do to monitor warfarin?

Answer 40

PT based INR

Question 41

What test do we do to monitor DOAC ten blockers?

Answer 41

Anti 10

Question 42

What blood test do we do to monitor DOAC thrombin blockers?

Answer 42

Diluted TT