Anticoagulants

Question 1

Heparin

Answer 1

MOA: Bind Antithrombin, inhibit thrombin and Xa
Use: immediate anticoag, PE, ACS, MI, DVT, pregnancy
SE: Bleeding, HIT (IgG against heparin on platelets->thrombosis and thrombocytopenia), osteoporosis,
Antidote=Protamine sulfate*

Question 2

LMWH (enoxaprin, dalteparin)

Answer 2

MOA: Inhibit Xa
Use: Better Bioavailability, SubQ, no monitor

Question 3

Argatroban, bivalirudin

Answer 3

MOA: Inhibit Thrombin (derived from leeches)
Use: Patients with HIT

Question 4

Warfarin

Answer 4

MOA: Prevents Vit K activation of Factors II, VII, IX, X, proteins c and s
Use: Chronic anticoags post STEMI, Stroke, DVT
SE: Bleeding, teratogen (CI in preganancy), skin/tissue necrosis

Notes: Increase PT, must monitor with PT/INR, Vit K is antidote

Question 5

Apixaban, rivaroxaban

Answer 5

MOA: Inhibit Xa
Use: Prophylaxis and Tx for DVT and PE and Stroke (a fib)
SE: bleeding, NO REVERSAL

Question 6

tPA, (alteplase)

Answer 6

MOA: Thrombolytic: convert plasminogen to plasmin, cleaves thrombin and fibrin
Use: Acute MI, stroke, severe PE
SE: Bleeding, CI in active bleeds, Hx of intracranial bleeds, recent surgery, bleeding disorders

Question 7

Aspirin (ASA)

Answer 7

MOA: Irreversibly inhibit COX1 and 2, Decrease TXA2, PGEs, no effect on PT/PTT
Use: antipyretic, analgesic, antiplatelet, anti-inflam
SE: Gastric ulcers, tinnitus, ARF, interstitial nephritis, REYE syndrome in kids, metabolic acidosis

Question 8

Clopidogrel, ticlopidine, prasugrel, ticagrelor

Answer 8

MOA: Inhibit Platelet aggregation, blocks ADP receptor, prevent gpIIa/IIIb binding fibrinogen
Use: ACS, coronary stent, stroke
SE: Neutropenia, TTP/HUS

Question 9

Cilostazol, Dipyridamole

Answer 9

MOA: PDE III inhibitor, increase cAMP in platelets, inhibits aggregation, vasodilation
Use: Claudication, Coronary vasodilation, prevent stroke, angina
SE: Nausea

Question 10

Abciximab, eptifibatide, tirofiban

Answer 10

MOA: Inhibit binding at gpIIa/IIIb
Use: Unstable angina
SE: bleeding, thrombocytopenia