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PHM601 UB Pharmacy > Anticoagulation > Flashcards

Anticoagulation Flashcards

1
Q

Heparin MOA

A

Potentiates antithrombin → decreased transformation of prothrombin to thrombin

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2
Q

Heparin Route of Administration

A

SQ (prophylaxis) or IV Continuous Infusion (treatment)

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3
Q

Heparin Half-Life

A

1-2 hours (IV)

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4
Q

Heparin Monitoring (efficacy)

A

Either Anti-Xa levels (~0.3-0.7 units/mL) or aPTT levels (ranges vary per lab) need to be within therapeutic range

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5
Q

Low molecular weight hearpin (LMWH) MOA

A

Potentiates antithrombin → decreased transformation of prothrombin to thrombin AND inactivates factor Xa

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6
Q

Examples of LMWH

A

Enoxaparin (Lovenox)
Dalteparin (Fragmin)

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7
Q

LMWH Route of Administration

A

SQ (rarely can be given IV)

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8
Q

LMWH Half-Life

A

~12 hours

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9
Q

LMWH Dose Adjustments

A

CrCl < 30 mL/min

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10
Q

LMWH Efficacy Monitoring

A

Anti-Xa levels only in specific populations - obese, renal dysfunction, pregnant

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11
Q

List the Direct acting oral anticoagulants

A

Apixaban (Eliquis), Rivaroxaban (Xarelto), Edoxaban (Savasya), Dabigatran (Pradaxa)

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12
Q

List Factor-Xa inhibitors

A

Apixaban (Eliquis), Rivaroxaban (Xarelto), Edoxaban (Savasya), Fondaparinux (Arixtra)

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13
Q

List Factor IIa inhibitors (direct thrombin inhibitors)

A

Dabigatran (Pradaxa) (Direct thrombin inhibitor)

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14
Q

Warfarin indications

A
  1. Valvular Afib
  2. Mechanical heart valves
  3. Some hypercoagulable states
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15
Q

Warfarin MOA

A

Vitamin K antagonist->decreases hepatic synthesis of factors 2,7,9, and 10, protein C and S by blocking carboxylation

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16
Q

Warfarin route of administration

A

Oral

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17
Q

Warfarin half-life

A

20-60 hours~

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18
Q

Warfarin DDI

A
  • CYP1A2, CYP2C19, and MAJOR (CYP2C9 and (CYP3A4)
  • Amiodarone
  • Macrolide Antibiotics (Azithromycin, Erythromycin)
  • -azole antifungals (fluconazole)
  • Sulfa antibiotics (Bactrim)
  • Rifampin
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19
Q

Warfarin monitoring parameters

A

INR 2-3 (1 considered normal)
Hgb, Hct, platelets

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20
Q

What is the brand name of Apixaban?

A

Eliquis

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21
Q

Apixaban route of administration

A

oral

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22
Q

Apixaban AFib Dosing

A

5 mg twice daily

23
Q

Apixaban VTE Dosing

A

10mg twice daily x 1 week, then 5 mg twice daily

24
Q

Apixaban dose adjustment

A

AFib:

  1. 5mg BID if 2/3 criteria are met:
  2. SCr > 1.5
  3. Weight < 60 kg
  4. Age > 80 years old
25
Q

Apixaban DDI

A

Major substrate of CYP3A4

26
Q

Rivaroxaban brand name

A

Xarelto

27
Q

Rivaroxaban route of administration

A

PO

28
Q

Rivaroxaban AFib Dosing

A

20 mg daily WITH FOOD

29
Q

Rivaroxaban VTE Dosing

A

15 mg twice daily x 21 days then 20 mg daily WITH FOOD

30
Q

Rivaroxaban dose adjustment

A

Afib Only: CrCl 15-50 mL/min then 15 mg daily with food

Avoid use CrCl < 15 mL/min

31
Q

Rivaroxaban DDI

A

Major substrate of CYP3A4

32
Q

Brand name of Edoxaban

A

Savaysa

33
Q

Edoxaban route of administration

A

Oral

34
Q

Edoxaban dose AFIB

A

60 mg PO QD

35
Q

Edoxaban dose in VTE

A

After 5 days of parenteral anticoagulation: >60kg = 60 mg PO QD ≤60kg = 30 mg PO QD

36
Q

Edoxaban renal dose adjustment

A

AFIB: 15-50 ml/min: 30 mg PO QD

37
Q

Edoxaban use caveat (Renal)

A

Only use in patients with moderate kidney function CrCl 15-95 ml/min

38
Q

Fondaparinux brand name

A

Arixtra

39
Q

Fondaparinux route of administration

A

Parenteral: SQ and IV

40
Q

Avoid fondaparinux in these populations

A

CrCl < 30 mL/min

Weight < 50 kg

41
Q

Dabigatran route of administration

A

Oral

42
Q

Dabigatran AFib Dosing

A

150 mg twice daily

43
Q

Dabigatran VTE Dosing

A

5 days parenteral then 150 mg twice daily

44
Q

Dabigatran renal adjustment

A

Afib:
CrCl 15-29 mL/min 75 mg twice daily
Avoid CrCl < 15 mL/min

VTE:
Avoid CrCl < 30 mL/min

45
Q

Dabigatran weight consideration

A

Avoid > 120 kg, BMI ≥ 40 kg/m2

46
Q

Bivalirudin MOA

A

Direct thrombin inhibitor

47
Q

Bivalirudin route of administration

A

Continuous IV infusion

48
Q

Bivalirudin half-life

A

10-24 minutes

49
Q

Argatroban MOA

A

Direct Thrombin Inhibitor

50
Q

Argatroban Route of Administration

A

Continuous IV Infusion

51
Q

Argatroban Half-Life

A

39-51 minutes

52
Q

Heparin-Induced Thrombocytopenia (HIT) Risk Factors

A
  1. Source: Bovine > Porcine
  2. UFH > LMWH
  3. IV > SQ
  4. Surgical patients > Medical/Obstetric
  5. Longer exposure = higher risk
53
Q

4T Score Components

A
  1. Thrombocytopenia
  2. Timing
  3. Thrombosis
  4. Other Cause
54
Q

HIT is an indication for therapeutic anticoagulation (T/F)

A

TRUE!

PHM601 UB Pharmacy (6 decks)

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