Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

C/R > Anticoagulants > Flashcards

Anticoagulants Flashcards

1
Q

Heparin (Unfractioned Heparin UFH)

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Route of administration:

Adverse Effects:

Absolute Contraindications:

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI-

Body Weight Considerations:

Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Heparin (Unfractioned Heparin UFH)

Class: Parental anticoagulant

Indication: Anticoagulation- Prophylaxis and treatment of thromboembolic disorders (e.g, venous thromboembolism, pulmonary embolism) and thromboembolic complications associated with atrial fibrillation; prevention of clotting in arterial and cardiac surgery; as an anticoagulant for blood transfusions, extracorpeal circulation, and dialysis procedures

Mechanism of Action: Heparin potentiates antithrombin. Antithrmbin is a natural anticoagulant in the body. Antithrombin decreases transformation from Prothrombin to thrombin.

Effects of mechanism of Action: Increase bleeding time

Route of administration: SubQ (Prophylaxis) IV (treatment)

Adverse Effects: thrombocytopenia, Heparin Induced thrombocytopenia

Absolute Contraindications: hypersensitivity, severe thrombocytopenia, History of Heparin induced thrombocytopenia with thrombosis.

Half life: 1-2 hours (IV)

Pregnancy: –

Warning/ Precautions:–

DDI-

Body Weight Considerations: Higher body weight may require higher dosing

Renal Adjustments: None

Monitoring Parameters:

  1. Monitor Anti-Xa levels q 4-6 hours or aPTT that corresponds to Anti-Xa levels
  2. Monitor in obese patients, patients with renal dysfunctions, and pregnant patients

Pearls: Workehorse in the hospital, rarey used outpatient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Low Molecular Weight Heparin

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Route of administration:

Adverse Effects: –

Absolute Contraindications:–

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations:

Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Low Molecular Weight Heparin

Class: Parental anticoagulant

Indication: Anticoagulation

Mechanism of Action: potentiates antithrombin. Antithrmbin is a natural anticoagulant in the body. Antithrombin decreases transformation from Prothrombin to thrombin. ALSO inactivates Factor Xa. Factor Xa cleaves Prothrombin to generate thrombin.

Effects of mechanism of Action: Increase bleeding time

Route of administration: SubQ (can rarelly be given IV)

Adverse Effects: –

Absolute Contraindications:–

Half life: approx.12 hours

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations: BMI >/= 40 kg/m^2

Renal Adjustments: CrCl < 30 mL/min

Monitoring Parameters:
1. Monitor Anti-Xa levels q 4-6 hours or aPTT that corresponds to Anti-Xa levels
2. GOAL: Anti Xa: ).0.3-0.7 units/ mL (aPTT will be dependent on lab)
Monitor Hemoglobin, hematocrit, platelets

Pearls: Commonly used in the hospital, can be given outpatient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Fondaparinux (Arixtra)

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Route of administration:

Adverse Effects: –

Absolute Contraindications:–

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations:

Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Fondaparinux (Arixtra)

Class: anticoagulant

Indication: Anticoagulation

Mechanism of Action: Facotr Xa inhibitor. Factor Xa is an enzyme apart of the coagulation cascade that is responsible for cleaving prothrombin, into thrombin.

Effects of mechanism of Action: Increase bleeding time

Route of administration: SubQ and IV. no oral option

Adverse Effects: –

Absolute Contraindications:–

Half life: 17-21 hours

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations: avoid weight <50 kg

Renal Adjustments: avoid use in CrCl < 30 mL/min

Monitoring Parameters:
1. Monitorhgb, hematocrit

Pearls: Does not contain pork, can be used for select patients wishing to avoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Warfarin

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Route of administration:

Adverse Effects:–

Absolute Contraindications: –

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI:

Body Weight Considerations:

Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Warfarin

Class: Oral Anticoagulant

Indication: Prophylaxis and treatment of thromboembolic disorders (eg venous, pulmonary) and embolic complications arising from a fib, or cardiac valve replacement

Mechanism of Action:Vitamin K antagonist->which intern reduces hepatic synthesis of coagulation factors II, VII, IX, X, as well as proteins C and S (natural anticoagulants) by blocking carboxylation.

Effects of mechanism of Action: Increase bleeding time

Route of administration: Oral

Adverse Effects:–

Absolute Contraindications: –

Half life: 20-60 hours (variable)

Pregnancy: –

Warning/ Precautions:–

DDI: substrate of CYP1A2 (minor), CYP2C19 (minor), CYP3A4 (minor
CYP2C9: MAJOR!!–> causes interactions with Amiodarone, macrolide ABX, -azole antifungals, sulfa ABX, rifampin

Body Weight Considerations: Higher body weight may require higher dosing

Renal Adjustments: None

Monitoring Parameters:

  1. INR for therapeutic Level (usually 2-3)
  2. Monitor hgb, hematocrit, platelets

Pearls:

  1. Frequent INR monitoring. may initiate as twice per week. if pt is stable, can go longer btw intervals. if INR is variable, may test INR weekly
  2. Bridging Requirements: until Warfarin gets to steady state, pts have an increased risk for clotting due to initial rapid blocking of proteins C and S. so pt must be on warfarin AND UFH, or LMWH for first 5 days of Warfarin Therapy
  3. Peri Procedural anticoagulation: if patient needs surgery, wash out period of Warfarin is 5 days before surgery, and then 5 day bridging with UFH or LMWH to get back on it.
  4. DDI: has major interactions
  5. Drug food interactions: Patient do not need to avoid Vitamin K completely, but they do need to be consistent with vitamin intake (dark leafy greens)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how to dose warfarin

A

Initial Warfarin Dosing

INR standard Dosing reduced dosing for pts expected to be more sensitive to warfarin

initial Dose 5 mg for 3 days 2.5 mg for 3 days

                            CHECK INR THE MORNING OF DAY 4

<1.5 7.5 TO 10 mg qd for 2-3 days 5 to 7.5 mg qd for 2-3 days

1.5-1.9 5 mg qd for 2-3 days 2.5 mg qd for 2-3 days

              IF INR IS >2 AFTER 4 DAYS, THAT MEANS YOU ARE GOING TOO FAST

2-3 2.5 mg for 2-3 days 1.25 mg qd for 2-3 days
3.1-4 1.25 mg for 2-3 days 0.5 mg qd for 2-3 days
>4 Hold until INR is <3 Hold until INR <3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

maintenance adjustment for subtherepeutic INR

A

Maintenance Adjustment For Subtherapeutic INR

INR Suggested adjustments to warfarin

<1.5 Increase weekly maintenance dose by 10-20%. (example: if 5mg qd. 7x5=35. 10%of 35=3.5. 3.5+35=38.5. 38.5/7=5.5 mg a day.
Consider a one time supplemental dose: 1.5-2 times the daily dose

1.5-1.9 increase weekly maintenance dose by 5-15%
consider a one time supplemental dose: 1.5-2 times the daily dose

2-3 no dosage adjustment may be necessary if the last 2 INRs were in range
if adjustment needed, increase weekly maintenance dose by 5-10%
Consider a one timesuplemental dose 1.5-2x the daily dose

if factor causing supratherepeutic INR is transient (ex missed dose, temporary DDI) consider resumption of prior maintenance dose following a one time supplemental dose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

maintenance adjusrtment for supratherpeutic INR

A

Maintenance Adjustment For Supratherapeutic INR

INR Suggested adjustments to warfarin

3.1-3.2 no dosagee adjustment may be necessary if the last 2 INRs were in range
if dosage adjustment needed, decrease weekly maintenance dose by 5-10%

3.3-3.4 decrease weekly maintenance dose by 5-10%

3.5-3.9 consider holding 1 dose
decrease weekly maintenance dose by 5-15%

> /=4 but Hold until INR is below upper limit of therepeutic range
=10 and decrease weekly maintenance dose 5-20%
no bleeding if pt at significant risk for bleeding, administer oral vitamin K

> 10 and no hold until IKR below upper limit of therapeutic range
bleeding administer vitamin K orally
decrease weekly maintenance dose by 5-20%

   if factor causing supratherepeutic INR is transient (ex missed dose, temporary DDI) consider resumption of prior maintenance dose following a one time held dose.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Apixaban (Eliquis)

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Route of administration:

DOSE: AFIB:

Absolute Contraindications: –

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI:

Body Weight Considerations:

Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Apixaban (Eliquis)

Class: Direct Oral Anticoagulant (DOAC)

Indication: Anticoagulation

Mechanism of Action:Facotr Xa inhibitor. Factor Xa is an enzyme apart of the coagulation cascade that is responsible for cleaving prothrombin, into thrombin.

Effects of mechanism of Action: Increase bleeding time

Route of administration: Oral

DOSE: AFIB: 5 MG bid
VTE: 10 mg bid, x1 week, then 5 mg BID
Adverse Effects:–

Absolute Contraindications: –

Half life: 12 hours

Pregnancy: –

Warning/ Precautions:–

DDI: major substrate of CYP3A4

Body Weight Considerations: May require a dose Adjustment if <60 kg (as below)

Renal Adjustments: a fib: adjust dose to 2.5 mg twice daily if 2 or 3 of criteria are met. 1. SCr>1.5, 2. weight < 60 kg 3. Age > 8- years

Monitoring Parameters:
1Monitor HGB, meatocrit, platelets, serum creatinine

Pearls:
Best DOAC in patients with poor renal function/ ESRD dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Rivaroxaban (Xarelto)

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Route of administration:

DOSE:

Absolute Contraindications: –

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI:

Body Weight Considerations:

Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Rivaroxaban (Xarelto)

Class: Direct Oral Anticoagulant (DOAC)

Indication: Anticoagulation

Mechanism of Action:Facotr Xa inhibitor. Factor Xa is an enzyme apart of the coagulation cascade that is responsible for cleaving prothrombin, into thrombin.

Effects of mechanism of Action: Increase bleeding time

Route of administration: Oral

DOSE: AFIB: 20 mg qd
VTE: 15 mg qd, x21 days, then 20 mg qd
Adverse Effects:–

Absolute Contraindications: –

Half life:5-9 hours

Pregnancy: –

Warning/ Precautions:–

DDI: major substrate of CYP3A4

Body Weight Considerations: okay in use >120 kg or BMI >/= 40 kg/ m^2

Renal Adjustments: a fib: doe adjust CrCl 15-50 mL/ min: 15 mg daily
avoid use CrCl<15 mL/min

Monitoring Parameters:
1Monitor HGB, meatocrit, platelets, serum creatinine

Pearls:
Best studied DOAC in obese patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Edoxaban (Savaysa)

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Route of administration:

DOSE:

Absolute Contraindications: –

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations:

Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Edoxaban (Savaysa)

Class: Direct Oral Anticoagulant (DOAC)

Indication: Anticoagulation

Mechanism of Action:Facotr Xa inhibitor. Factor Xa is an enzyme apart of the coagulation cascade that is responsible for cleaving prothrombin, into thrombin.

Effects of mechanism of Action: Increase bleeding time

Route of administration: Oral

DOSE: AFIB: 60 mg qd
VTE (after 5 days parental): >60 kg-60 mg daily; <60 kg: 30mg daily
Adverse Effects:–

Absolute Contraindications: –

Half life: 10-14hours

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations: VTE doses varies depending on weight > or < 60 kg;
Not well studied in those >120 kg or BMI > 40kg/m^2

Renal Adjustments: only use in patients with CrCL 15-95 mL/min
a fib: 15-50 mL/min: 30 mg daily

Monitoring Parameters:
1Monitor HGB, meatocrit, platelets, serum creatinine

Pearls:
raily used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dabigatran (Pradaxa)

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Route of administration:

DOSE: AFIB:

Adverse Effects:–

Absolute Contraindications: –

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations:
Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Dabigatran (Pradaxa)

Class: Direct Oral Anticoagulant (DOAC)

Indication: Anticoagulation

Mechanism of Action:Direct Thrombin Inhibitor

Effects of mechanism of Action: Increase bleeding time

Route of administration: Oral

DOSE: AFIB: 150 mg bid
VTE (after 5 days parental): 150 mg bid

Adverse Effects:–

Absolute Contraindications: –

Half life: 12-17hours

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations: afib: Poor outcomes in those > 120 kg or BMI >/= 40 kg/m^2

Renal Adjustments: afib: CRcL 15-29 mL/min: 75 mg bid, AVOID f < 15 mL/min
VTE: Avoid use CrCl <30 mL/min

Monitoring Parameters:
1Monitor HGB, meatocrit, platelets, serum creatinine

Pearls:
rarely used due to increased risk of GI bleeds compared to warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

WHat are anticoagulants

A

drugs that inhibit atleast one step of the coagulation cascade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Parenteral anticoag examples

A

heparin
LMWH (enoxaparin
Fondaparunix (Arixtra)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Oral Anticoagulants

A 
warfarin
apixiban (eliquis)
Rivaroxaban (xarelto)
Edoxaban (Savaysa)
Dabigatran (Pradaxa)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

DOACs

A

diriect oral anticoagulant

apixaban
rivaroxaban
edoxaban
dabigatran

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

warfarin major interactions

A

CYP2C9: MAJOR!!–> causes interactions with Amiodarone, macrolide ABX, -azole antifungals, sulfa ABX, rifampin

C/R (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions