Anticoagulants

Question 1

<p>What class of drug is Heparin?</p>

Answer 1

<p>Anticoagulant</p>

Question 2

<p>What is Heparin's general MOA?</p>

Answer 2

<p>It prevents clot formation by inhibiting thrombin in the clotting cascade.</p>

Question 3

What are the two types of heparin?

Answer 3

Unfractionated heparin and Low-molecular-weight heparin (LMWH)

Question 4

What is another name for Low-molecular-weight Heparin (LMWH)?

Answer 4

Enoxaparin (Lovenox)

Question 5

What would Heparin or Lovenox be used for?

Answer 5

Patients with acute coronary syndrome (ACS)

Question 6

When is heparin used?

Answer 6

Early in the treatment of STEMI and non-STEMI ACS and is given concurrently with fibrinolytic drugs (like rTPA) and for those undergoing percutaneous coronary interventions.

Question 7

What other conditions besides ACS is Heparin recommended for?

Answer 7

High risk conditions including: left ventricular mural thrombus, deep vein thrombosis (DVT), and those on bed rest.

Question 8

Why is Heparin administered to patients with atrial fibrillation?

Answer 8

It helps minimize the risk of the formation of emboli

Question 9

What is a complication of heparin?

Answer 9

Increased risk of bleeding, including intracranial bleeding

Question 10

What are contraindications for heparin?

Answer 10

Patients who are:

• Actively bleeding
• Recent intracranial or intraspinal bleeding
• Recent eye surgery
• Severe hypotension
• Bleeding disorders (anemia)
• GI bleeding

Question 11

Can major bleeding occur in STEMI patients who receive heparin?

Answer 11

Yes

Question 12

How is heparin dosed?

Answer 12

According to the patients weight

Question 13

What prior illness requires special dosing for heparin?

Answer 13

Renal insufficiency (increased risk for hemorrhagic complications

Question 14

What does aPTT stand for?

Answer 14

Activated Partial Thromboplastin Time (clotting time of blood)

Question 15

What is normal aPTT time?

Answer 15

60-80 seconds

Question 16

What is the antidote for both unfractionated and LMW Heparin?

Answer 16

Protamine Sulfate

Question 17

What is Lovenox?

Answer 17

Anticoagulant

Question 18

How is lovenox different than heparin?

Answer 18

Lovenox is a lower molecular weight version of heparin

Question 19

What is lovenox half-life?

Answer 19

4.5-7 hours

Question 20

How long do the anticoagulant effects of lovenox work?

Answer 20

Up to 12 hours

Question 21

What is heparin’s MOA at low doses?

Answer 21

Inactivates factor Xa and inhibits conversion of prothrombin to thrombin

Question 22

What is heparin’s MOA at high doses?

Answer 22

Inactivates factors IX, X, XI, and XII and thrombin and inhibits conversion of fibrinogen to fibrin.

Question 23

What is the dose of heparin for a STEMI patient?

Answer 23

Initial IV bolus: 60 units/kg (max: 4000 units)

THEN: 12 units/kg/hr (max: 1000 units)

Question 24

What is the ideal aPTT in STEMI patients?

Answer 24

50-70 seconds

Question 25

What is the dose of heparin for unstable angina/NSTEMI?

Answer 25

Initial IV bolus: 60-70 units/kg (max: 5000 units)

THEN: 12-15 units/kg/hr (max: 1000 units/hr)

Question 26

How is heparin administered?

Answer 26

Often times IV infusion or Subcutaneously

Question 27

How is lovenox administered?

Answer 27

Subcutaneous injection into the right and left abdominal walls.

Question 28

What is lovenox MOA?

Answer 28

LMWH: Antithrombotic that inhibits factor Xa by increasing inhibition rate of clotting proteases that are activated by antithrombin III, does not increase PT or PTT.

Question 29

What are contraindications of lovenox?

Answer 29

Patients with:

• Active major bleeding
• Thrombocytopenia (HIT)
• History of heparin induced HIT within the last 100 days
• Hypersensitivity to enoxaparin, heparin, pork products, benzyl alcohol