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MI Immuno/Heme > Anticoagulants > Flashcards

Anticoagulants Flashcards

1
Q

What test is used to monitor heparin therapy?

A

aPTT

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2
Q

What test is used to monitor warfarin therapy?

A

PT-INR

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3
Q

MOA of heparin

A

Binds to antithrombin III, enhancing its inhibition of factors IIa (thrombin), Xa, and IXa.

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4
Q

Method of heparin administration

A

Intravenously or subcutaneously (not absorbed orally).

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5
Q

Primary adverse effect of heparin therapy

A

Bleeding, followed by heparin-induced thrombocytopenia (HIT)

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6
Q

What is used to Tx heparin overdose?

A

Protamine sulfate

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7
Q

How does low-molecular weight heparin differ from UFH?

A

LMWHs are more selective for factor Xa and have more predicatable pharmocokinetics

LMWHs - i.e. Enoxaparin and dalteparin

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8
Q

When is routine monitoring required in LMWH therapy?

A

Renal impairment

Pregnancy

Obesity

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9
Q

What is fondaparinux and how does it work?

A

Synthetic heparin derivative that selectively inhibits factor Xa

There is no antidote for bleeding cuased by fondaparinux

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10
Q

Two main types of direct oral anticoagulants

A

Factor Xa inhibitors and direct thrombin (factor IIa) inhibitors

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11
Q

Name three examples of direct oral anticoagulants that inhibit Xa

A
  1. Rivaroxaban
  2. Apixaban
  3. Edoxaban
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12
Q

What is an example of a direct thrombin inhibitor

A

Dabigatran

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13
Q

What should be monitored during direct oral anticoagulant therapy?

A

Kidney function

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14
Q

What is the antidote for dabigatran

A

Idarucizumab

Dabigatran = direct thrombin inhibitor

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15
Q

What is the antidote for rivaroxaban and apixaban?

A

Andexanet alfa

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16
Q

What DOAC has the lowest risk of GI bleeding?

A

Apixaban

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17
Q

Contraindications for DOAC therapy

A

Severe renal impairment and CYP450 inhibitors

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18
Q

MOA of warfarin

A

Inhibits vitamin K epoxide reductase, preventing the synthesis of factors II, VII, IX, and X

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19
Q

Why is warfarin’s onset of action delayed?

A

It only affects the synthesis of new clotting factors - takes 4-5 days

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20
Q

Rare but serious side-effects of warfarin

A

Skin necrosis and purple-toe syndrome

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21
Q

Why is warfarin contraindicated in pregnancy?

A

It is teratogenic and increases the risk of fetal bleeding

22
Q

What food/supplements increase bleeding risk w/ warfarin

A
  1. Garlic
  2. Ginger
  3. Ginkgo biloba
  4. Ginseng
23
Q

INR target for most warfarin Pt’s

A

2-3

24
Q

INR target for Pt’s w/ mechanical heart valves

A

2.5-3.5

25
Q

Antidote for warfarin overdose

A

Vitamin K

In ermergent situations - fresh-frozen plasma or PCC

26
Q

Most common side-effect of long-term heparin use?

A

Osteoporosis

27
Q

Preferred anticoagulant used during pregnancy

A

LMWHs (i.e. enoxaparin)

28
Q

Preferred anticoagulant for Pt’s with mechanical heart valves

A

Warfarin

29
Q

What anticoagulant is used to Tx heparin-induced thrombocytopenia?

A

Direct thrombin inhibitors like argatroban

30
Q

How are DOACs superior to warfarin in atrial fibrillation?

A

The require no routine monitoring and have fewer drug/food interactions

31
Q

What is the target range for PTT when using heparin?

A

1.5-2.5 times the Pt’s baseline PTT

32
Q

Why is anti-factor Xa activity monitored in some LMWH Pt’s?

A

To ensure efficacy in special populations (i.e. pregnancy/obesity)

33
Q

What test is used to monitor dabigatran effects?

A

Thrombin time or ecarin clotting time (ECT)

34
Q

Method of excretion of DOACs

A

Renal - why kidney Fx is monitored

35
Q

What reversal agent is used for excessive bleeding w/ rivaroxaban

A

Andexanet alfa

36
Q

Risk of using idarucizumab to reverse dabigatran

A

HA

Hypokalemia

Allergic rx’ns

37
Q

Why does efficacy of warfarin therapy vary between Pt’s?

A

Genetic differences in CYP2C0 and vitamin K epoxide reductase

38
Q

Heparin indications

A

DVT

PE

MI

39
Q

Dilitazem (used for AF) interacts with what DOACs?

A

Rivaroxaban and apixaban

40
Q

Edoxaban and kidney function

A

Avoid edoxaban if kidney function is too good (i.e. CrCl > 95 mL/min)

41
Q

What type of bleeding risks is diminished in DOAC therapy compared to other anticoagulation?

A

Intracranial bleeding

42
Q

Indications for DOAC therapy

A

DVT/PE

and prevent clots in A-fib

43
Q

Parenteral direct thrombin inhibitors

A

Lepirudin
Bivalirudin
Argatroban

Commonly used in Pt’s w/ prior Hx of heparin-induced thrombocytopenia (HIT) or during angioplasty

44
Q

Dabigatran

A

PO direct thrombin inhibitor

45
Q

Indications for warfarin therapy

A

DVT/PE

A-fib and rheumatic heart disease to reduce stroke risk

Mechanical heart valves or moderate-to-severe stenosis (warfarin should be selected insteads of DOACs in these Pts)

Blocked coronary arteries (as an adjunctive therapy)

46
Q

To Tx major bleeding associated w/ warfarin use

A

Administer vitamin K (aka phytonadione) - slow reversal

Fresh-frozen plasma or prothrombin complex concentrate (PCC)

47
Q

Hemostatic agents

A

Tranexamic acid

Aminocarpoic acid

Displace plasminogen from fibrin

48
Q

How to differentiate between warfarin therapy and DIC?

A

Only DIC diminishes fibrinogen serum concentration

Warfarin inhibits Vit K epoxide reductase, and consequently diminished production of factors II, VII, IX, and X

Low fibrinogen is one of the hallmarks of DIC - indicates widespread clotting and consumption of clotting factors

49
Q

How are unfractionated heparin’s actions terminated?

A

Locally in endothelial cells and liver heparinases

50
Q

Which of the following is the most likely reason why lepirudin would be selected over heparin?

A

D) Previous episode of heparin-induced thrombocytopenia

51
Q

Which of the following inhibits thrombin exclusively?

A

C. Dabigatran

52
Q

Why is concurrent Tx w/ clarithromycin and apixiban contraindicated?

A

Clarithromycin inhibits cyp3A4 and P-glycoprotein which may increase risk of bleeding

MI Immuno/Heme (35 decks)

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