Anticoagulants

Question 1

Indications for anticoagulants

Answer 1

Question 2

Parenteral anticoagulants

Answer 2

Question 3

MOA of anticoagulants

Answer 3

Question 4

Three phases of coagulation

Answer 4

Question 5

MOA of heparin

Answer 5

Question 6

Coagulation cascade

Answer 6

Question 7

Effects of thrombin

Answer 7

Question 8

Effects of antithrombin III

Question 9

Fractionated vs. unfractionated heparin

Answer 9

Question 10

HMWH has effect on _________ and factor X

Answer 10

Question 11

Low molecular weight heparins

Answer 11

Enoxaparin, dalteparin, tinzaparin

Administered SubQ with more predictable bioavailability
Longer half life and less need to monitor (unless child or obese)
Cleared by the kidneys and low risk of HIT

Question 12

Indications and use for heparin and warfarin

Answer 12

Binds to endothelium and to plamsa proteins
Levels of heparin-binding proteins vary from person to person so there is an upredictable anticoagulant response
Monitoring and titration required

Question 13

How is heparin monitored, and what is the reversal?

Answer 13

Question 14

Major adverse effect of heparin

Answer 14

Heparin-induced thrombocytopenia

Risk of clots because of antibody production that creates a prothrombotic environment, incidence is ~5%

Question 15

Low molecular weight heparin indications

Answer 15

Question 16

LMWH boxed warning

Answer 16

Spinal/epidural hematoma that could lead to paralysis

Question 17

Risks of Fondaparinux

Answer 17

Question 18

Indication for Argatroban

Answer 18

Treatment for heparin-induced thrombocytopenia

Question 19

Indication for Bivalirudin

Answer 19

IV infusion used as alternative to heparin in patients undergoing PCI

Question 20

Direct oral anticoagulants
Direct thrombin inhibitor/Factor Xa inhibitors

Answer 20

Question 21

Indications for oral anticoagulants

Answer 21

Question 22

MOA of warfarin

Answer 22

Question 23

Impact of genotype on S-warfarin clearance

Answer 23

Question 24

How long does warfarin typically take effect?

Answer 24

About 7 days

Question 25

How is warfarin managed, and what is the recommended INR level to be at?

Answer 25

INR

Question 26

Warfarin dosing and monitoring

Answer 26

Question 27

Factors that correlate with warfarin dose

Answer 27

Question 28

Warfarin adverse effects

Answer 28

Hypercoaguable state

Question 29

What is warfarin purple toe syndrome

Answer 29

Question 30

Reversal for warfarin

Answer 30

Question 31

How do the novel anticoagulants compare with warfarin

Answer 31

Question 32

Dabigatran clearance and absorption

Answer 32

80% renally cleared

Requires an acidic environment for absorption

Question 33

Consideration when taking Rivaroxaban?

Answer 33

Take it with food

Question 34

Boxed warning of the novel oral anticoagulants

Answer 34

Increased risk of thrombotic events/stroke in clinical trials

Question 35

Antidotes for novel oral anticoagulants

Answer 35