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Pharm > Anticoagulants: vit K antagonists > Flashcards

Anticoagulants: vit K antagonists Flashcards

1
Q

What is the first MOA of warfarin

A

Inhibits post-translational carboxylation of coag factors II (protrombin), VII, IX, and X

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2
Q

What is the 2nd MOA of warfarin

A

Inhibits 2 vit-k sensitive synthetic enzymes

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3
Q

How is warfarin reversed?

A

Pharmacological doses of Vit K

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4
Q

What is the Vit K agent used to reverse warfarin?

A

Phytonadione

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5
Q

What is the risk with IV phyotonadion?

A

Rare risk of anaphylaxis with rapid infusion

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6
Q

How do you start warfarin?

A

With heparin in cases of A-fib, DVT, PE

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7
Q

How long does it take warfarin to provide full anticoagulation?

A

5-7 days

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8
Q

How do you measure warfarin effects?

A

With prothrombin time (PT) and international normalized ration (INR)

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9
Q

What is the therapeutic INR range for AFib, DVT, PE?

A

2-3

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10
Q

What is the therapeutic INR range for mechanical heart valves?

A
  1. 5-3.5

* not porcine*

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11
Q

How long does it take a dose of warfarin to become effective?

A

48 hours

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12
Q

What is a complication of starting 10 mg of warfarin daily?

A

Warfarin induced skin necrosis

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13
Q

What drug interaction can cause increased risk of bleeding with warfarin and what do they do to the INR?

A

Drugs that inhibit CYP2C9

Increase INR

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14
Q

What drugs inhibit CYP2C9 and negatively interact with warfarin?

A

Bactrim

Flagyl

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15
Q

What drug interaction can cause increase risk of thrombosis with warfarin and what do they do to the INR?

A

Drugs that induce CYP2C9

Decrease the INR

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16
Q

What drugs induce CYP2C9 and negatively interact with warfarin?

A

Contraceptives

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17
Q

What are some sources of high dietary folate

A 
Beef
Pork liver
Green teas
Leafy green vegetables
Spinach
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18
Q

Supratherapeutic INR treatments

A

See slide 47

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19
Q

What is an example of an anti-factor XA inhibitor and how does it come?

A

Fondaparinux

Pre-filled syringes

20
Q

What is fondaparinux?

A

Synthetic pentasaccharide

21
Q

How is fondaparinux eliminated?

A

Mainly renally

22
Q

When is fondaparinux contraindicated?

A

CrCL<30

23
Q

What is an unlabled use of fondaparinux?

A

DVT prophylaxis in pts w/ a h/o HIT

24
Q

What is Rivaroxaban (Xarelto)?

A

An oral direct Xa inhibitor

25
Q

What is a benefit of Rivaroxaban?

A

No lab monitoring

26
Q

What is the reversal agent of Rivaroxaban?

A

Andexanet alfa

27
Q

What is the MC adverse effect of rivaroxaban?

A

Bleeding

> 5%

28
Q

What are some examples of bivalent direct thrombin inhibitors (DTIs)

A

Lepirudin
Bivalrudin
Desirudin

29
Q

What are some examples of univalent DTIs

A

Argatroban

Dabigatran

30
Q

What is an advantage of DTIs

A

They can be used in pts w/ h/o HIT-II

31
Q

What is argatroban used for?

A

To treat HIT

32
Q

How is argatroban given and how is it monitored?

A

IV

Monitored w/ PTT

33
Q

What is an advantage of argatroban?

A

It is not renally eleminated so it can be used in pts w/ HIT and poor renal fxn

34
Q

Which drug was withdrawn by AstraZenaca in 2006?

A

Ximelagatran

35
Q

What DTI is given orally?

A

Dabigatran

36
Q

What lab testing does dabigatran require?

A

None :D

37
Q

Does dabigatran have a reversal agent?

A

Yes!

FDA approved 2015

38
Q

What is the dabigatran reversal agent?

A

Idarucizumab

39
Q

What is idarucizumab?

A

Human monoclonal antibody

40
Q

What is the MOA of idarucizumab?

A

It binds to pradaxa

41
Q

How do you deliver idarucizumab?

A

Two consecutive 2.5 gram doses IV

42
Q

What is a negative of idarucizumab?

A

$3500 for 1 dose

43
Q

What is andexanet alfa?

A

A factor xa decoy protein

factor Xa inhibitor reversal agent

44
Q

What drugs does andexanet alfa correct?

A 
Apixaban
Rivaroxaban
Edoxaban
Enoxaparin
Fondaparinux
45
Q

What are the doses of phytonadione?

A

2.5-10 mg po (5 mg tablet)

1-10 mg IVPB

Pharm (32 decks)

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