Anticoagulants

Question 1

Warfarin 1st oral anticoagulant 1954. What is the MOA?

Answer 1

It does not bind to active clotting factors to induce anticoagulation, it reduces the total amount of clotting factors in circulation, specifically inhibiting the C1 subunit of vitamin K epoxide reductase enzyme complex. Therefore the liver is unable to produce vitamin K depending clotting factors II, VII, IX and X and the endogenous anticoagulant proteins C and S

Question 2

Name most common NOAC and state MOA

Answer 2

1. dabigatran (Pradaxa) (2010)- binds clotting factor IIa (thrombin) (direct thrombin inhibitor) 2. rivaroxaban (Xarelto) (2011)- binds directly to clotting factor Xa (direct Xa inhibitor) (responsible for activating prothrombin to thrombin) 3. apixaban (Eliquis) - same as Xarelto direct Xa inhibitor

Question 3

What is the MOA of Heparin and Heparin derivatives

Answer 3

Works by binding to antithrombin III to induce anticoagulation (indirect thrombin inhibitors)

Question 4

Reversal agent of Warfarin

Answer 4

Vit K

Question 5

Reversal agent of UFH and LMWH

Answer 5

Protamine Sulfate

Question 6

Reversal agent of Fondaparininux

Answer 6

Not reversible by protamine. No reversal agent

Question 7

Name 3 direct 10 A inhibitors

Answer 7

1. rivaroxaban (Xarelto) 2. apixaban (Eliquis) 3. edoxaban (Savaysa)

Question 8

Name 3 direct thrombin inhibitor

Answer 8

1. dabigatran (Pradaxa) 2. bivalirudin (Angiox, Angiomax) 3. argatroban (no brand name)

Question 9

What are the 3 primary categories of antiplatelets?

Answer 9

1. Cox inhibitors 2. Glycoprotein IIb/IIIA inhibitors 3. ADP inhibitors

Question 10

What is the MOA of aspirin

Answer 10

Cox 1 & 2 inhibitor- Cox 1>>Cox 2

Question 11

What is the MOA of clopidogrel (Plavix)

Answer 11

ADP inhibitor

Question 12

Drug prescribed for HIT (heparin induced thrombocytopenia)

Answer 12

argatroban ( direct thrombin inhibitor that reversibly binds to the thrombin active site. It does not require the co-factor antithrombin III)

Question 13

Does argatroban increase INR

Answer 13

Yes, it can increase INR when overlapped with warfarin

Question 14

What is the MOA of thrombolytics?

Answer 14

1 primary mechanism of action. Plasminogen activators.

Question 15

Name 4 thrombolytics

Answer 15

1. streptokinase (numerous brands) 2. alteplace (Activase) 3. reteplase (Retavase) 4. tenecteplase (TNKase)

Question 16

2 Common medications used in heart failure

Answer 16

1. sacubitril/valsartan (Entresto) 2. ivabradine (Corlanor)

Question 17

Explain how ivabradine (Corlanor) works to help heart failure pts

Answer 17

It acts by reducing the heart rate via specific inhibition of the pacemaker current, a mechanism different from that of beta blockers and calcium channel blockers, two commonly prescribed antianginal drugs. Ivabradine is a cardiotonic agent.