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308 Clinical pharmacology > Anticoagulant drugs > Flashcards

Anticoagulant drugs Flashcards

1
Q

How does plasma differ from serum?

A

Plasma contains clotting factors, serum does not

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2
Q

What are the risk factors for a DVT?

A 
Virchow's triad 
Long-haul flight
COCP
Post-op
Hospitalisation
Pregnancy
Cancer
Obesity
IV drug use
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3
Q

What is Virchow’s triad?

A

Hypercoagulability
Haemodynamic changes
Endothelial injury

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4
Q

What types of anticoagulants are there?

A 
Warfarin
Heparin - unfractionated, LMW
DOAC
Anti-platelet drugs
Anti-fibrinolytics
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5
Q

What are the pharmacodynamics of warfarin?

A

Vitamin K antagonist
Prevents gamma carboxylation of factors II, VII, IX, X
Prolongs extrinsic pathway

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6
Q

What is the target INR on warfarin?

A
  1. 5 for DVT, PE, AF

3. 5 for recurrent VTE or metal heart valves

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7
Q

How long does warfarin take to achieve therapeutic levels?

A

At least 3 days

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8
Q

What anticoagulants does warfarin inhibit?

A

Natural anti-coagulants protein C and protein S

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9
Q

How do you prescribe warfarin?

A

Load with LMW heparin cover

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10
Q

What drugs can potentiate warfarin?

A

Enzyme cytochrome P450 inhibitors

Carbamazepine, azathioprine, allopurinol

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11
Q

What drugs can inhibit warfarin?

A 
Enzyme cytochrome P450 inducers
Rifampicin
Amiodarone
Citalopram
Phenytoin
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12
Q

What are the side effects of warfarin?

A 
Teratogenic
Significant haemorrhage risk
Minor bleeding
Skin necrosis
Alopecia
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13
Q

How can warfarin be reversed?

A

Octaplex - contains factors II, VII, IX, X
Vitamin K
Fresh frozen plasma

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14
Q

How does heparin work?

A

Mucopolysaccharide that potentiates anti-thrombin

Irreversibly inactivates factors II and Xa

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15
Q

Describe unfractionated heparin

A

Not often used due to inconvenience
Safe in renal failure
Safe in pregnancy

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16
Q

How is unfractionated heparin prescribed?

A

Initial bolus 5000 units

Constant infusion of 1000U/hour

17
Q

How is unfractionated heparin monitored?

A

APTT

Target range of 1.5-2.5 X normal

18
Q

How can unfractionated heparin be reversed?

A

Protamine sulphate

19
Q

Describe LMW heparin

A

Convenient due to OD S.C. injections
Prescribe according to weight
Need creatinine clearance of >30ml/min

20
Q

What are the 2 classes of DOACs?

A

Direct thrombin inhibitor e.g. dabigatran

Direct factor Xa inhibitor e.g. rivaroxaban

21
Q

When can’t DOACs be used?

A

Renal failure

Mitral heart valves

22
Q

When are DOACs indicated?

A

VTE prophylaxis
Treatment of DVTs and PEs
Stroke prevention in AF

23
Q

What is the dosing of rivaroxaban?

A

15mg BD for 3 weeks then 20mg OD

24
Q

What is an alternative drug if rivaroxaban can’t be used due to renal failure?

A

Apixaban

25
Q

What is the dosing of dabigatran?

A

150mg BD

Prophylaxis dose is 110mg BD

26
Q

How can dabigatran be reversed?

A

Praxbind (Idarucizumab)

27
Q

Give examples of anti platelets

A 
Aspirin
Clopidogrel
Dipyridamole
Prostacyclin
Glycoprotein IIb/IIIa inhibitors
28
Q

What type of drug is aspirin?

A

COX inhibitor

29
Q

What type of drug is clopidogrel?

A

ADP inhibitor

30
Q

How does dipyridamole work?

A

Inhibits phosphodiesterase

31
Q

How does prostacyclin work?

A

Stimulates adenylate cyclase

32
Q

Give examples of glycoprotein IIb/IIIa inhibitors?

A

Abciximab
Eptifibatide
Tirofiban

33
Q

What are fibrinolytic agents?

A

Thrombolytic agents used to lyse fresh thrombi by converting plasminogen to plasmin

34
Q

What genetic factors can predispose to clots?

A

Protein S deficiency
Protein C deficiency
Anti-thrombin deficiency
Factor V leiden thrombophilia

308 Clinical pharmacology (10 decks)

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