Anticoagulants

Question 1

MOA of unfractionated heparin (UFH)?

Answer 1

Binds ATIII causing inactivation of factor IIa and Xa

Question 2

MOA of low molecular weight heparin(LMWH)?

Answer 2

Binds ATIII causing inactivation of factor Xa

Question 3

MOA of warfarin?

Answer 3

Inhibit sliver synthesis of vitamin K dependent factors (II, VII, IX, X)

Question 4

MOA of dibigatran?

Answer 4

Direct thrombin (IIa) inhibitor

Question 5

MOA of rivaroxaban and apixaban?

Answer 5

Direct factor Xa inhibitor

Question 6

Onset of action of UFH?

Answer 6

rapid

Question 7

Onset of action of LMWH?

Answer 7

3-5 hours

Question 8

Onset of action of warfarin?

Answer 8

hours-days

Question 9

Onset of action of dabigatran?

Answer 9

peak 1-2 hours

2-3 days to steady state

Question 10

Onset of action of rivaroxaban and apixaban?

Answer 10

peak action 2.5-4 hours

Question 11

Elimination route of UFH?

Answer 11

Cleared by reticuloendothelial system

Question 12

Elimination route of LMWH?

Answer 12

Renal clearance (decrease dose in renal failure)

Question 13

Elimination route of warfarin?

Answer 13

Hepatic metabolism, CYP2C9

Question 14

Elimination route of dabigatran?

Answer 14

Primary renal (remember to renal dose)

Question 15

Elimination route for rivaroxaban and apixaban?

Answer 15

Hepatic CYP3A

Question 16

Monitoring lab test for UFH?

Answer 16

aPTT

anti-factor Xa prn

Question 17

Monitoring lab test for LMWH?

Answer 17

not needed

anti-factor Xa prn

Question 18

Monitoring lab test for warfarin?

Answer 18

PT (INR)

Question 19

Monitoring for dabigatran, rivaroxaban, and apixaban?

Answer 19

No routine monitoring

Question 20

Adverse effects of UFH?

Answer 20

Bleeding, thrombocytopenia

Question 21

Adverse effects of LMWH?

Answer 21

Bleeding, thrombocytopenia

Question 22

Adverse effects of warfarin?

Answer 22

Bleeding, skin necrosis

Question 23

Adverse effects of dabigatran?

Answer 23

Bleeding, gastritis symptoms

Question 24

Adverse effects of rivaroxaban and apixaban?

Answer 24

Bleeding

Question 25

What two anticoagulants are safe in pregnancy?

Answer 25

UFH and LMWH

Question 26

DDIs with all anticoagulants?

Answer 26

NSAIDs - they increase bleeding risk

Question 27

DDIs with UFH and LMWH?

Answer 27

Antiplatelet agents.

Question 28

DDIs with warfarin?

Answer 28

CYP450 inhibitors CYP450 inducers Dietary vit K

Question 29

DDIs with Dabigatran, rivaroxaban, and apixaban?

Answer 29

P glycoprotein inducers (rifampin, dronedarone) decrease effect P glycoprotein inhibitors increase effect CYP3A4 inhibitors effect rivaroxaban

Question 30

Overdose treatment for UFH?

Answer 30

Protamine

Question 31

Overdose treatment for LMWH?

Answer 31

Protamine

Question 32

Overdose treatment for warfarin?

Answer 32

Phytonadione (Vit K1) | FFP

Question 33

Overdose treatment for dabigatran?

Answer 33

Idarucizumab

Question 34

Overdose treatment for rivaroxaban, apixaban?

Answer 34

Andexanet alfa (rXa)

Question 35

Uses for UFH?

Answer 35

ACS, VTE

Question 36

Uses for LMWH?

Answer 36

ACS, VTE

Question 37

Uses for warfarin?

Answer 37

A-fib, VTE prophylaxis

Question 38

Uses for Dabigatran?

Answer 38

VTE

Question 39

Uses for rivaroxaban?

Answer 39

A fib, DVT-PE prevention after total hip or total knee

Question 40

Uses for Rivaroxaban?

Answer 40

A fib, DVT-PE prevention after total knee or total hip

Question 41

Uses for apixaban?

Answer 41

A fib