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Pharm Exam 4 > Anticoagulants > Flashcards

Anticoagulants Flashcards

1
Q

8 Anticoagulants

WHED RADF

A 
Warfarin
Heparin
Enoxaparin - LMWH
Dalteparin - LMWH
Fondaparinux - Indirect Xa + Antithrombin
Dabigatran - IIa 
Rivaroxaban- Xa
Apixaban - Xa
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2
Q

MOA of Warfarin

A

Inhibits Vitamin K reductase activity

which inhibits clotting factor formation in liver

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3
Q

Factors which require vitamin K for synthesis

A

II, VII, IV, X

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4
Q

About how long until anticoagulant effects of warfarin take hold

A

15-20 hours
(factors must drop by 25%)

measured by INR **goal = 2-3 **

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5
Q

Warfarin for ACS

A

After Aspirin / Clopidogrel has been used OR when there are additional comorbidities

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6
Q

Warfarin for DVT / PE

A

2nd line

2016 CHEST guideline?

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7
Q

Warfarin 1st line

A

A fib

Mechanical Valv

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8
Q

Warfarin drug interactions

A 
NSAIDs
Antiplatelet agents
SSRIs
St John's Wort
Tramadol
CoQ10
Ginger
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9
Q

Warfarin ABX interactions

A 
Cephalosporins
Bactrim
Metronidazole
Fluoroquinalones
Amoxacillin
Doxycycline 
Fluconazole
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10
Q

Tx Warfarin toxicity

A

Stable patients: single dose activated charcoal, if recently ingested. Vitamin K1, IV slow drip

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11
Q

INR for holding warfarin dose

A

INR > 4.5 - 10, no bleeding

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12
Q

INR >10, no bleeding

A

hold warfarin, give vitamin K po

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13
Q

Weird warfarin issues

A

Purple toe syndrome

Skin necrosis - protein C deficiency, breasts buttocks abdo thigh

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14
Q

Unfractionated Heparin MOA

A

Accelerating binding of Antithrombin III to factor IIa

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15
Q

Time to anticoagulation effect w Heparin

A

1-3 hours

short half life, Rapid metabolism in liver

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16
Q

Anticoagulants in STEMI

A

Aspirin, chewed 160-325mg, ASAP

P2Y Inhibitor (Clopidogrel, Prasugrel, Ticagrelor) - especially patients undergoing PCI or Fibrinolysis

UFH if undergoing PCI
UFH, Enoxaparin, or Fondaparinux if Fibrinolysis

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17
Q

LMWH and Fondaparinux

A

Enoxaparin
Dalteparin
Tinzaparin

Fondaparinux

Sub Q, doesn’t need monitoring, less risk of HIT and bleeding

18
Q

Heparin antidote

A

Protamine

1mg for 100 u heparin
30-60 s onset

19
Q

Heparin ADRs

A

Bleeding
HIT
Osteoporosis
Elevated LFTs

20
Q

Alternative anticoagulant in patients w Type II HIT

A

Lepirudin
Argatroban
Fondaparinux

21
Q

Anticoags for Afib > 48 hrs or unknown duration

A

Warfarin (INR 2-3)

LMWH (Enoxaparin, Dalteparin, Fondaparinux)

or Dabigatrin

for 3 weeks before cardioversion, continued Dabi or Warf for a least 4 weeks after

22
Q

Anticoags for Afib <48 hours

A

UFH or LMWH (Enoxaparin, Dalteparin, Fondaparinux) at presentation prior to cardioversion, continued at least 4 weeks after

23
Q

Long term anticoagulation w nonvalvular Afib, CHADs2 risk

A

Dabigatran (DOAC) must have CrCl > 30

Rivaroxaban (Xa) best for high risk

Apixaban (Xa)

24
Q

VTE /PE Anticoags

A

LMWH (Enoxaparin, Dalteparin, Tinzaparin, Fondaparanux

UFH (if CrCL <30)

Warfarin or Rivaroxabin (Xa) for maintenance

25
Q

Rivaroxaban / Apixaban (Xa) ADRs

A

Spinal /epidural hematoma, risk w spinal procedures or injuries

26
Q

Reduced efficacy in NVAF in patients with NORMAL renal function

A

Edoxaban

27
Q

When to choose Warfarin over newer agents

A

Patients w Renal Insufficiency, Prosthetic Heart Valves

Cost

28
Q

Higher GI bleed risk w which agents?

A

Dabigatran, Rivaroxaban

29
Q

CHADS 2 VASC treatment

A 
Score = 0
No treatment or ASA 75 – 325 mg/day
Score = 1
Anticoagulant preferred
Or ASA + clopidogrel (Plavix)
Score > 1
Oral anticoagulant (warfarin INR 2 – 3, dabigatran, apixaban or rivaroxaban)
30
Q

P2Y12 Inhibitors, Thienopyridines

A

Clopidogrel (Plavix)

Prasugrel

31
Q

P2Y 12 Inhibitors, Thienopyridines (Clopidogrel, Prasugrel) MOA

A

Irreversibly blocks platelet aggregation and adhesion by blocking ADP receptor

32
Q

Clopidogrel and poor metabolizers and drug interactions

A

efficacy dependent on activation to an active metabolite by CYP2C19, 30-50% of people

Drug Interactions
CYP 2C19
Omeprazole (Prilosec), esomeprazole (Nexium)

33
Q

** Prasugrel contraindications**

A

Active bleed

Past TIA or CVA

34
Q

Other PY2 Platelet Inhibitors Reversible

A

Ticagrelor - Hepatic metabolism CYP 3A4

Cilostazol

35
Q

Anticoag indicated for intermittent claudication

A

Cilostazol

contraindicated in HF

36
Q

PAD anticoag treatment

A

ASA or Clopidogrel, if symptomatic, or asympt but ABI <90

Statins, treat HTN (ACEI, or ARB)

37
Q

Fibrinolytic Agents

A

TPA

Alteplase
Reteplase
Tenecteplase (TNKase)

38
Q

TPA MOA

A

Activates fibrin-enhanced conversion of plasminogen to plasmin

39
Q

TPA Absolute Contraindications

A

Absolute contraindications
h/o intracranial hemorrhage, ischemic stroke or closed head injury within past 3 months
Intracranial malignancy
Intracranial or intraspinal surgery within past 2 months
Suspected Aortic dissection
Active bleeding
Severe uncontrolled hypertension

40
Q

Clot Buster Antidotes

A

Aminocaproic acid
tranexamic acid (Cyclokapron)
Lysine analogs

41
Q

Dabigatran drug interactions

A

Rifampin - Avoid using together

Amiodarone
Ketoconazole
Verapamil
Proton pump inhibitors

Pharm Exam 4 (3 decks)

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