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Pharmacology quiz 3 > anticoagulants > Flashcards

anticoagulants Flashcards

1
Q

What is a thrombosis

A

a normal response to hemorrhage when a blood clot forms in the vascular system

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2
Q

what can thrombosis lead to

A

PE, Stroke, MI

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3
Q

signs of PE?

A

dyspnea, tachycardia, (massive = dyspnea, syncope, HOTN, cyanosis) (small = pleuritic pain, cough, hemoptysis)

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4
Q

what is virchow’s triad?

A

hypercoagulability, stasis, endothelial injury

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5
Q

what can help prevent DVT?

A

ambulation, compression stockings, anticoagulants

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6
Q

risk factors for developing PE

A

CHD, stroke, paralysis

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7
Q

name the indirect thombin inhibitors

A

heparin, Lovenox, Fondaparinux

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8
Q

Where is most heparin derived from?

A

pigs

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9
Q

MOA of indirect thrombin inhibitors?

A

conformational change binds antithrombin, inactivates factor Xa and thrombin (II)

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10
Q

what factor is most closely related to bleeding risk?

A

focus on factor Xa

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11
Q

what should the CrCl be above to use direct thrombin inhibitors?

A

30%

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12
Q

What indirect thrombin inhibitor can be used in pregnancy?

A

Lovenox

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13
Q

which indirect thrombin inhibitor does not require close monitoring

A

enoxaparin, fondaparinux

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14
Q

half life of heparin?

A

1-5 hours

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15
Q

half life of lovenox?

A

4-6 hours

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16
Q

half life of fondaparinux?

A

17 hours

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17
Q

how are indirect thrombin inhibitors monitored?

A

aPTT, anti-factor Xa levels

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18
Q

reversal agent for heparin?

A

protamine sulfate

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19
Q

what is HIT?

A

heparin induced thrombocytopenia, drop in platelets 5-10 days after exposure (150k-200k)

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20
Q

What is HITT?

A

heparin induced thrombocytopenia with thrombosis - Ab against heparin/platelet factor 4 results in platelet activation

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21
Q

Can patients with HITT use heparin again?

A

NO

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22
Q

what labs should be ordered for baseline before starting heparin therapy?

A

platelets

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23
Q

What are the oral factor Xa inhibitors

A

rivaroxaban, apixaban

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24
Q

how are oral direct factor Xa inhibitors different from warfarin?

A

shorter half-lives

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25
Q

Which direct factor Xa inhibitor can be used prophylactically with sx?

A

Rivaroxaban

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26
Q

What oral direct factor Xa inhibitor can reduce stroke risk in nonvalvular Afib?

A

Apixaban

27
Q

how are direct factor Xa inhibitors excreted?

A

renally, dose adjust for renal impairment

28
Q

How are direct factor Xa inhibitors metabolized?

A

CYP3A4, p-glycoprotein

29
Q

ADR of direct factor Xa inhibitors

A

peripheral edema, dizziness, HA, diarrhea, bleeding

30
Q

what factor does rivaroxaban work on?

A

factor Va

31
Q

what factor do oral direct thrombin inhibitors work on?

A

factor Iia

32
Q

Name the oral direct thrombin inhibitor

A

Dabigatran (pradaxa)

33
Q

MOA of dabigatran

A

sits on exosite 1 of thrombin

34
Q

uses for dabigatran?

A

prevention of stroke and systemic embolism in pts with nonvalvular Afib

35
Q

Do bleeding rates differ between dabigatran and warfarin?

A

no

36
Q

when does dabigatran need to be dose adjusted?

A

renal impairment - 75mg

37
Q

ADR of dabigatran

A

bleeding, dyspepsia, gastritis-like sxs, GI hemorrhage

38
Q

what can be used as an anti-coagulant in HIT/HITT?

A

argatroban

39
Q

what lab is used to monitor direct/indirect thrombin inhibitors?

A

aPTT (should be 1.5-3x the normal)

40
Q

how do oral antiplatelets work?

A

bind to ADP and downregulate Iib/IIIa which decreases platelet sticking to each other

41
Q

name the oral antiplatelets

A

ticlid, plavix, effient, brillinta

42
Q

what metabolizes clopidogrel?

A

2C19 (2 step reaction)

43
Q

how is brillinta metabolised and dosed?

A

it is an active drug (faster onset) and needs to be taken twice a day

44
Q

what drug can decrease clopidogrel efficacy?

A

nexium, PPIs

45
Q

what causes clopidogrel resistance?

A

genetic basis that increases CYP2C19

46
Q

according to the CHARISMA study, do oral antiplatelets decrease risk of death?

A

nope

47
Q

ADR for antiplatelets

A

bleeding, rash, pruritis, GI hemorrhage, TTP

48
Q

how soon does clopidogrel begin to work?

A

10-11 days

49
Q

why is ticlid not used?

A

BID, life-threatening hematologic reactions

50
Q

Which oral antiplatelet is weight-based?

A

effient

51
Q

Who should not use effient?

A

>75 y/o, <60kg

52
Q

uses for oral antiplatelets

A

recent MI, stroke prevention

53
Q

what oral antiplatelet is used for prophylactic treatment with a stent for 1 year?

A

clopidogrel

54
Q

Name a vitamin K antagonist

A

warfarin

55
Q

what does warfarin have no effect on?

A

fully carboxylated molecules (anticoagulants)

56
Q

how long does it take for warfarin to work?

A

3-5 days

57
Q

What is the protein C phenomenon?

A

reduced levels with warfarin

58
Q

What does warfarin bind to?

A

albumin

59
Q

Target INR

A

2 through 3

60
Q

How many INRs need to be above 2 to be stabilized on warfarin?

A

2

61
Q

what drugs increase warfarin effect?

A

amiodarone, ginkgo, omeprazole

62
Q

what drugs decrease warfarin effect?

A

estrogens, protease inhibitors, st john’s wart

63
Q

reversal agent for warfarin

A

phytonadione (vitamin K)

Pharmacology quiz 3 (4 decks)

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