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Pharmacology II > Anticoagulants, Thrombolytics, Antiplatelet Therapies > Flashcards

Anticoagulants, Thrombolytics, Antiplatelet Therapies Flashcards

1
Q

What are the 3 phases of coagulation

A
  1. Initiation
  2. Amplification
  3. Propagation
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2
Q

Anticoagulants

A
  • Heparin
  • Direct thrombin inhibitors
  • Direct factor Xa inhibitors
  • Warfarin
  • DOAC
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3
Q

Antiplatelet

A
  • Aspirin
  • ADP inhibitors (Clopidogrel)
  • Glycoprotein IIb/IIIa inhibitors
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4
Q

Which factors does Warfarin affect?

A

“1972”

2, 7, 9, 10

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5
Q

Which components does heparin affect?

A

2, 10

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6
Q

When should you put someone with a DVT or PE on aspirin?

A
  • if they’ve had a DVT/PE

- No contraindication

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7
Q

In a patient who has had their first DVT episode, how long should they be anticoagulated for?

A

3 months

Heparin or Warfarin or LMWH

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8
Q

Parenteral anticoagulation is given….

A

BEFORE: dabigatran, edoxaban

NOT GIVEN: rivaroxaban, apixaban

OVERLAP: Warfarin

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9
Q

How is heparin dose calculated?

A

actual body weight

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10
Q

How is heparin monitored?

A

activated partial thromboplastin time (aPTT)

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11
Q

How is heparin reversed?

A

protamine sulfate IV

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12
Q

Thrombocytopenia

A

<100,000/uL platelet count

-more common with unfractionated heparin than LMWH

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13
Q

What is the principle difference in pharmacologic activity between LMWH and UFH?

A

relative inhibition of factor Xa and thrombin

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14
Q

LMWH: advantages over UFH

A
  • more predictable dose response
  • clearance doesn’t depend on dose
  • less chance of thrombocytopenia
  • less need for monitoring
  • ->SAFER for extended administration
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15
Q

How is LMWH (Enoxaparin) dose determined?

A

weight based

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16
Q

If patient has pork allergy they can’t take heparin or LMWH. What should you put them on?

A

Fondaparinux

17
Q

Monitoring: LMWH versus Warfarin

A

LMWH: aPTT

Warfarin: Prothrombin time (INR)

18
Q

What is important to remember about starting Warfarin treatment?

A

when first initiated there is thrombosis due to protein C deficiency

19
Q

Which Factor is affected first with Warfarin initiation?

A

Factor 7

order: 7, 9, 10, 2

20
Q

Do DOACs have a reversal agent?

A

no

21
Q

Which DOAC is a prodrug, targets thrombin, and needs to be adjusted if the patient has renal impairment?

A

Dabigatran

22
Q

Which DOAC is most bioavailable ?

A

Rivaroxaban (xarelto)

23
Q

Which DOACs work on factor Xa

A

Rivaroxaban
Apixaban
Edoxaban

24
Q

Which DOAC is taken QD and must be taken with food?

A

Rivaroxaban (Xarelto)

25
Q

Which DOAC has to be taken twice a day, but can be taken with or without food?

A

Apixaban (Eliquis)

26
Q

How long is anticoag therapy recommended after DVT or PE?

A

at least 3 months

27
Q

How long must heparin and warfarin be overlapped?

A

7 days

28
Q

Does Rivaroxaban need to be used with heparin?

A

no

29
Q

What is the goal INR for a mechanical heart valve?

A

2.5-3.5

30
Q

What is the starting dose for Warfarin in a patient that can have daily INRs drawn?

A

5mg

31
Q

How many times is the INR checked in the first 5 days of warfarin therapy?

A

5x

32
Q

When should you get to INR goal for warfarin?

A

2-3 is only the goal on day 5. Before this you want it lower

33
Q

What are dose adjustments based on for Warfarin?

A

total weekly dose

34
Q

At what INR should you consider oral Vitamin K?

A

INR above 10

35
Q

When can LMWH be discontinued?

A

After 5 days and 24 hours of INR in correct range

36
Q

When should Warfarin be discontinued before a surgery?

A

4-5 days prior to surgery

37
Q

Which two DOACs can you start at INR <2 when switching from Warfarin?

A

Dabigatran

Apixaban

38
Q

Thrombolytics: MOA

A

convert plasminogen to plasmin

39
Q

Direct thrombin inhibitors

A

Ex. Bivalirudin**, Desirudin, Argatroban

MOA: binds to thrombin and inhibits its enzymatic action

indication: anticoagulation in patient with heparin-induced thrombocytopenia (HIT)**

Pharmacology II (31 decks)

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