Anticoagulants Deck 3

Question 1

Heparins clinical use and dosing

Answer 1

◦ Given 2 hours pre-operatively

◦ Maintenance every 8 to 12 hours for 7 days after surgery

Question 2

LMWH clincial use and dosing

Answer 2

◦ Enoxaparin
◦ DVT or PE
◦ Given 2 hours before surgery
◦ Fondaparinux
◦ DVT
◦ Hip fracture surgery or knee replacement
◦ Dalteparin
◦ Prevention of DVT after abdominal surgery or hip replacement

Question 3

Heprins each visit

Answer 3

◦ Lab*, History: side effects, injuries, lifestyle changes, med rec; PE: signs and symptoms of increased/decreased
INR

Question 4

Heprins administration

Answer 4

◦ Warfarin dosing may vary day to day

◦ SC administration instruction for LMWH at home

Question 5

Heprins ADR

Answer 5

◦ Risk for bleeding
◦ Vitamin K–containing foods
◦ Monitor for signs and symptoms

Question 6

Heperains monitoring

Answer 6

◦ More frequent INRs in beginning until stable and therapeutic 24h with warfarin
◦ Protamine Sulfate is antidote for heparin OD

Question 7

Antiplatelets: work

Answer 7

to prevent platelet adhesion at the site of injury before the coagulation cascade

Question 8

Aspirin MOA

Answer 8

◦ Inhibits cyclooxygenase ◦ Interferes with platelet aggregation

Question 9

◦ Ticlopidine and clopidogrel MOA

Answer 9

◦ Reduces platelet aggregation by inhibiting adenosine diphosphate pathway

Question 10

◦ Vorapaxar MOA

Answer 10

◦ Protease-activated receptor-1 antagonist ◦ Inhibits thrombin-induced and thrombin receptor agonist peptide-induced platelet aggregation
◦ Taken with aspirin or clopidrogrel thrombin receptor agonist peptide induced platelet aggregation

THROMPIN RECEPTOR ANTAGONIST

Question 11

Aspirin Pharmacokinetics

Answer 11

◦ Well absorbed when taken orally

◦ Metabolized in liver ◦ Renally excreted (pH affects excretion)

Question 12

Ticlopidine Pharmacokinetics

Answer 12

◦ Rapidly absorbed after oral administration
◦ Metabolized in liver ◦ Non-linear PK: Half-life lengthens with repeated dosing
◦ Decreased renal clearance with age

Question 13

Clopidogrel Pharmacokinetics

Answer 13

◦ Prodrug: metabolized into active metabolite

◦ Excreted in urine and feces

Question 14

Ticagrelor is heavily

Answer 14

Heavily metabolized in liver

Question 15

Vorapaxar pharmacokientics

Answer 15

◦ Metabolized by CYP3A4 and CYP2J2

◦ Half-life is 8 days

Question 16

ASA clinical use and dosing

Answer 16

◦ Myocardial infarction (MI) prevention low risk: 75 to 100 mg daily ◦ Persistent atrial fibrillation: 75 to 325 mg daily ◦ Stroke or TIAs: 50 to 100 mg daily

Question 17

Clopidogrel Clinical Use and Dosing

Answer 17

◦ MI prevention with history: 75 mg daily
◦ ST-elevation acute coronary syndrome: 300 mg daily if younger than 75 years of age and 75 mg daily if older than 75 years of age

Question 18

Ticlopidine Clincial Use and Dosine

Answer 18

◦ Prevents strokes in patients intolerant of acetylsalicylic acid: 250 mg twice daily

Question 19

Ticaragelor clinical use and dosing

Answer 19

◦ MI prevention (acute coronary symptoms): 90mg bid Plus low dose ASA

Question 20

ASA precautions

Answer 20

◦ Hypersensitivity ◦ Cross-sensitivity with nonsteroidal antiinflammatory drugs (NSAIDs) ◦ Pregnancy category C (D in thir

Question 21

Clopidogrel and ticlopidine precautions

Answer 21

◦ Avoid in patients with liver dysfunction

◦ Category B, but use only if clearly indicated

Question 22

Vorapaxar black box

Answer 22

warning not to use in patients with history of stroke or transient ischemic attack (TIA)

Question 23

ADR for ASA

Answer 23

◦ May cause gastrointestinal (GI) bleeding

◦ Salicylism (tinnitus) ◦ Potential for cross-sensitivity to NSAIDs

Question 24

ADR triclopidine ADR

Answer 24

◦ HIGH RISK* for life-threatening hematological adverse reactions including neutropenia, agranulocytosis, and thrombotic thrombocytopenic purpura (TTP) ◦ 50% experience GI side effects
◦ Increases lipid levels

Question 25

Ticagrelor black box

Answer 25

Black Box warning: no use if active bleeding, history intracranial hemorrhage

Question 26

Vorapaxar black box

Answer 26

◦ Black Box warning: no use if active bleeding, history CVA, intracranial hemorrhage

Question 27

general antiplatelet interacions

Answer 27

Concurrent use of other antiplatelet, anticoagulant, or fibrinolytic drugs, dipyridamole, quinidine, valproic acid

Question 28

asa INTERACIONS

Answer 28

rin

◦ Herbals (gingko, garlic, ginseng) ◦ NSAIDs

Question 29

clopidogrel interaconts

Answer 29

◦ Proton pump inhibitors (PPIs) ◦ CYP2C19 inhibitors

Question 30

ticlopidine interancions

Answer 30

◦ Antacids
◦ Digoxin
◦ Cimetidine

Question 31

ticargrelor interactions

Answer 31

◦ CYP3A4 inhibitors and inducers

Question 32

vorapaxar interaciosn

Answer 32

◦ Combined with aspirin or clopidogrel to prevent thrombotic cardiovascular (CV) events

Question 33

Take aspirin, ticlodipine with a

Answer 33

full glass of water

Question 34

Consider enteric coated

Answer 34

aspirin (cannot be crushed or chewed)

Question 35

Aspirin must be stopped

Answer 35

7 days before surgery

Question 36

Clopidogrel should not be taken with

Answer 36

PPIs (over-the-counter Prilosec or omeprazole)

Question 37

Ticragrelor should be stopped

Answer 37

5 days before surgery

Question 38

Take steps to minimize bleeding:

Answer 38

soft toothbrushes, avoid flossing, shaving. ◦ Apply pressure 5-10 minutes if cut