Anticoagulants Thrombolytics

Question 1

Name 4 adverse effects heparin

Answer 1

• Haemorrhage
• hypersensitivity
• Thrombocytopenia (paradoxically associated with arterial occlusion and thromboembolism)
• skin necrosis where injected

Question 2

Name 2 indications heparin

Answer 2

• Thromboembolism treatment and prophylaxis

* acute coronary syndrome

Question 3

Name 2 direct inhibitors of factor 10a

Answer 3

• Rivaroxaban
• apixaban
Anticoagulants that require no monitoring

Question 4

Name a direct thrombin inhibitor

Answer 4

Dabigatran

Question 5

Name the 3 treatment approaches VTE

Answer 5

• Standard treatment: with ufh/lmwh/ fondaparinux and warfarin
• dabigatran based: with warfarin
• rivaroxaban based: mono therapy

Question 6

Describe the standard treatment approach for VTE

Answer 6

• acute phase: UFH, lmwh or fondaparinax (factor 10 a inhibitor) ≥ 5 days
• intermediate phase: bridge into (so both for few days) early maintenance VKA warfarin > 3 months to achieve INR 2-3
• chronic phase: long term secondary prevention warfarin ≥ 3 months, years or indefinite with periodic assessment

Question 7

Describe the direct thrombin inhibitor approach VTE rx

Answer 7

• Lmwh ≥ 5 days then switch

* dabigatran ≥ 3 months

Question 8

Describe the direct factor 10 a inhibitor approach VTE rx

Answer 8

Monotherapy rivaroxaban

15 mg bd for 3 weeks then 20 mg od as long as risk persists

Question 9

Moa streptokinase?

Answer 9

Fibrinolytic

Form complex with and activates plasminogen into plasmin (fibrinolytic enzyme)

Question 10

What type of clots do antiplatelet treats and why?

Answer 10

Arterial only.

Venous clots fibrin rich while arterial clots platelet rich.

Question 11

Name 6 drug interactions with warfarin

Answer 11

• Oral antibiotics: inhibit cyp2c9 and kill gut flora - increased bleeding
• NSAIDs: additive/synergistic anticoagulant effects
• antiplatelet drugs: additive/synergistic anticoagulant effects
• ginger/garlic: additive/synergistic anticoagulant effects
• vitamin k: oversaturates coagulation cascade- thromboses, treatment failure
• St John wort; induce CYP 3a4 and cyp2c19 -thromboses, treatment failure

Question 12

How interpret INR?

Answer 12

Low = increased clotting risk
High = increased bleeding risk

Question 13

Name 3 non-vitamin k dependent oral anticoagulants noac

Answer 13

• Dabigatran
• rivaroxaban
• apixaban

Question 14

Indication noac non-vit k dependant oral anticoag?

Answer 14

Eg rivaroxaban, dabigatran, apixaban

Non-valvular afib (nvaf) to prevent stroke

Question 15

Safest anticoagulant in pregnancy?

Answer 15

Enoxaparin (LMWH)