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IPCS 3 > Anticoagulant Drugs > Flashcards

Anticoagulant Drugs Flashcards

1
Q

Heparin MOA

A
  1. binds to antithrombin and inactivates factor IIa and Xa
  2. prevents fibrinogen–> fibrin
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2
Q

Unfractioned Heparin prophylaxis

A

SQ: 5000U q8 or q12

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3
Q

Unfractioned heparin VTE Tx

A

IV: 80u/kg IV bolus then 18u/kg/hr infusion

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4
Q

unfractioned heparin ACS/STEMI Tx

A

IV: 60u/kg bolus then 12u/kg/hr infusion

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5
Q

SE UFH

A

HIT, Hyperkalemia, osteoporosis

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6
Q

UFH antidote

A

protamine-completely reverses

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7
Q

UFH monitoring

A

caution with pork allergy
aPTT (goal 1.5-2x control) or heparin assay (goal 0.3-0.7) q6h til therapeutic then q24h
half life=1-2hr

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8
Q

low molecular weight heparin examples

A

Enoxaparin (Lovenox), Dalteparin (Fragmin)

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9
Q

lovenox prophylaxis

A

30mg SQ q12 or 40mg SQ qd
CrCl <30: 30mg qd

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10
Q

lovenox treatment

A

1mg/kg q12 (to nearest 10mg)
CrCl<30: 1mg/kg q24

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11
Q

LMWH SE

A

anemia, elevated LFTs, HIT, hyperkalemia, thrombocytopenia, osteoporosis, injection site bruising

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12
Q

LMWH antidote

A

protamine- incompletely reverses

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13
Q

preferred pregnancy agents

A

UFH and LMWH

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14
Q

LMWH monitoring

A

Anti-Xa level-obesity, pregnancy, renal failure

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15
Q

Warfarin (Coumadin, Jantoven) class

A

Vit K antagonist

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16
Q

Warfarin MOA

A

decreases Factors II, IV, IX, X and Protein C and S through competitive inhibition of subunit 1 of VKOR complex

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17
Q

Warfarin initial dosing

A

10mg qd x2d then 5mg qd
may start <5mg qd if old, malnourished, hepatic impairment, CHF, high risk of bleeding

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18
Q

Warfarin dose adjustments

A

based on INR
target INR 2-3 except mechanic heart valve (2.5-3.5)

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19
Q

Warfarin SE

A

purple-toe syndrome, skin necrosis
many drug interactions (CYP3A4), NTI

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20
Q

warfarin in pregnancy

A

AVOID

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21
Q

Warfarin antidote

A

Vitamin K +/- Kcentra or FFP

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22
Q

Factor Xa inhibitors

A

Rivaroxaban (Xarelto), Apixaban (Eliquis), Edoxaban (Savaysa), Fondaparinux (Arixtra)

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23
Q

FXa inhibitor MOA

A
  1. Xarelto and Eliquis directly inhibit factor Xa
  2. Fondaparinux indirectly inhibits factor Xa
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24
Q

Xarelto non-valvular AFib dosing

A

20mg qd

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25
Q

Xarelto DVT prophylaxis dosing

A

10mg qd
if hip/knee replacement, duration for 35 days for hip and 12 days for knee

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26
Q

Xarelto DVT/PE Tx

A

15mg BID for 21d then 20mg qd

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27
Q

Xarelto BBW

A

premature discontinuation increases risk of thrombotic events
TAKE WITH FOOD

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28
Q

Xarelto SE

A

anemia, more bleeding than warfarin

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29
Q

FXa inhibitor conversion

A

d/c warfarin and start:
Xarelto when INR <3
Edoxaban when INR <2.5
Apixaban when INR <2

30
Q

Eliquis, Xarelto, off-use Edoxaban antidote

A

Andexxa

31
Q

FXa inhibitor warnings

A

no use in pregnancy
avoid interacting agents (P-gp inhibitors/inducers for all DOACs and CYP3A4 inhib/inducers for apixiban/rivaroxaban)
Eliquis/Xarelto increase INR
concern w/ all DOACs in patients <50kg or >120kg

32
Q

Arixtra route

A

SQ

33
Q

Arixtra SE

A

anemia, thrombocytopenia, hypokalemia
CrCl <30: AVOID USE

34
Q

Direct Thrombin Inhbitors (DTIs)

A

Argatroban (IV), Dabigatran (Pradaxa) oral

35
Q

DTI MOA

A
  1. directly inhibit thrombin (Factor IIa)
  2. binds to and inhibits the active site of free and fibrin bound thrombin
36
Q

Argatroban HIT dosing

A

2mcg/kg/min
Max: 10mcg/kg/min

37
Q

HIT

A

heparin-induced thrombocytopenia

38
Q

Argatroban PCI dosing

A

350mg/kg (bolus) then 25mcg/kg/min

39
Q

PCI

A

percutaneous coronary intervention

40
Q

Argatroban SE

A

anemia, chest pain, GI hemorrhage

41
Q

Argatroban monitoring

A

aPTT
raises INR

42
Q

Pradaxa non-valvular AFib dosing

A

150mg bid

43
Q

Pradaxa DVT/PE Px and Tx dosing

A

150mg bid

44
Q

Pradaxa DVT Px knee/hip replacement dosing

A

110mg on day of surgery and 220mg qd for min of 10-14 days up to 35 days

45
Q

Pradaxa BBW

A

thrombotic events

46
Q

Pradaxa SE

A

dyspepsia, gastritis-like symptoms, bleeding, hemorrhage

47
Q

Pradaxa antidote

A

Idarucizumab (Praxbind)

48
Q

Pradaxa inititation

A

requires at least 5 days parenteral anticoag before initiation in Tx of DVT/PE
do not open/chew caps and keep in original container
D/C Warfarin and start Pradaxa when INR<2
use w/ EXTREME caution in patients >75yo

49
Q

Protamine reverses

A

completely: UFH
incompletely: LMWH, lovenox, fragmin

50
Q

Protamine MOA

A

Protamine (alkaline protein molecule, large + charge) and Heparin (acidic, - charge) when combined form a stable salt diminishing the anticoag activity

51
Q

Protamine considerations

A

IV only
rapidly reverses UFH
BBW: hypersensitivity (fish)

52
Q

Praxbind (Idarucizumab) reverses

A

Pradaxa (Dabigatran)

53
Q

Praxbind MOA

A

humanized MAb fragment that has an affinity for dabigatran that is ~350 times greater than that of thrombin

54
Q

Praxbind considerations

A

neutralized anticoag effect w/in minutes
lasts 24hrs, if pradaxa not cleared after 24hr, give another dose of Praxbind (ex. renal failure)
most common SE: headache
Monitor: re-elevation of coag parameters

55
Q

KCentra reverses

A

VitK Antag: Warfarin
off label: FXa drugs

56
Q

Kcentra MOA

A

Prothrombin Complex Concentrate (PCC): (II, VII, IX, X and Protein C and S)

57
Q

Kcentra considerations

A

BBW: arterial and venous thromboembolic complications
advantages to FFP (fresh frozen plasma): lower infusion volume, lower infection rate, less complications, rapid reversal

58
Q

NovoSeven reverses

A

warfarin-related intracerebral hemorrhage

59
Q

NovoSeven MOA

A

Factor VIIA (recombinant)
VKA-dependent glycoprotein that promotes hemostasis by activating the extrinsic pathway of the coag cascasde

60
Q

NovoSeven considerations

A

BBW: thrombosis
high cost

61
Q

Fresh frozen plasma reverses

A

Warfarin

62
Q

FFP considerations

A

high volumes of FFP may be problematic in all pts esp those sensitive to rapid fluid shifts (HF)

63
Q

Vitamin K reverses

A

Warfarin

64
Q

Vitamin K MOA

A

promotes liver synthesis of clotting factors II, IV, IX, X

65
Q

Vitamin K considerations

A

Formulations:
oral: 2.5-5mg when INR>10 (no bleeding) or minor bleeding w/ any INR
IV: 5-10mg infused slowly due to anaphylaxis indicated in emergency situations or major bleeding (in addition to PCC)

66
Q

Hemodialysis reverses

A

removes 57-68% of Pradaxa w/in 4hrs
removes 20% of Edoxaban

67
Q

Andexxa reverses

A

Eliquis and Xarelto

68
Q

Andexxa MOA

A

inactive recombinant modified Human Factor Xa Protein

69
Q

Andexxa considerations

A

BBW: thrombosis, ischemic events, cardiac arrest, sudden death
off-label reversal of Edoxaban

70
Q

Bleeding symptoms

A

tachycardia, SOB, blood-loss, blood in stool, urine, blowing nose, brushing teeth

71
Q

Bleeding signs

A

increased RR, increased HR, decreased BP

IPCS 3 (5 decks)

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