Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm Quiz 3 > Anticoagulation > Flashcards

Anticoagulation Flashcards

1
Q

Thrombosis

A

Formation of a blood clot within the vascular system
Occurs normally in response to hemorrhage

May lead to:

  • Stroke
  • Pulmonary embolism
  • Myocardial infarction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What do you do if you suspect a DVT or PE

A

Assess clinical likelihood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

For DVT what if low likelihood?

For PE what if not high likelihood?

A

Get D-Dimer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

If normal D-Dimer?

A

No DVT or No PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If High D-dimer or high likelihood of DVT or PE?

A

Imaging test needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DVT symptoms

A
  • Mild palpation discomfort lower calf

- Massive- marked thigh swelling and tenderness during palpation of the common femoral vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pulmonary embolism symptoms

A

Dyspnea
Tachypnea
Massive- dyspnea, syncope, hypotension, cyanosis
Small embolism- pleuritic pain, cough, hemoptysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What DVT imaging test should you get?

A

Venous Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Venous Ultrasound Diagnostic?

A

STOP

For PE, treat for PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Venous Ultrasound Nondiagnostic?

A

Get for DVT:
MRI
CT
Phelbography

Get for PE:
Transesophageal ECHO
MRI
Invasive pulmonary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What PE imaging test should you get?

A

Chest CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Chest CT Diagnostic?

A

STOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Chest CT Nondiagnostic, unavailable or unsafe?

A

Get a Lung Scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lung Scan Diagnostic?

A

STOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Lung Scan Nondiagnostic?

A

Get Venous ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Virchow’s triad

A
  • Hypercoagulability (Blood)
  • Stasis (Flow)
  • Endothelial Injury (Vessel)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Risk factors for Deep Vein Thrombosis

A

Previous thromboembolism
Age greater than 60 years or over 40 undergoing major operation
Major trauma
Prolonged immobilization (greater than 3 days)
Major orthopedic surgery
Major medical illness like CAD, HF, sepsis
Malignant disease
Hypercoagulable condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Preventing DVT

A

Multiple methods alone or in combination:

Ambulation
Compression stockings
Intermittent pneumatic compression
Anticoagulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Risk factors for Pulmonary Embolism

A

Same as DVT

Acute PE:
Immobilization
Surgery within the prior 3 months
Stroke
Paresis
Paralysis
Central venous instrumentation in prior 3 months
Malignancy
Chronic heart disease
Autoimmune diseases
History of venous thromboembolism
For women- obesity, heavy cigarette smoking and hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the Indirect thrombin inhibitors

A

Heparin Sodium
Enoxaparin (Lovenox)
Fondaparinux (Arixtra)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MOA of Heparin Sodium/Unfractionated Heparin (UFH)

A

Causes a conformational change in antithrombin so that it can better pick up Factor Xa and thrombin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MOA of Enoxaparin (Lovenox) or Low Molecular Weight Heparins

A

Causes a conformational change in antithrombin so that it can better pick up only Factor Xa

  • weighs less than UFH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Fondaparinux (Arixtra)

A

Causes a conformational change in antithrombin so that it can better pick up only Factor Xa

  • Just a little more specific
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Heparin Sodium Indications

A
  • Prophylaxis and treatment of thromboembolic disorders

- An anticoagulant for extracorporeal and dialysis procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Enoxaparin (Lovenox) Indications

A
  • DVT prophylaxis: Following hip or knee replacement surgery, abdominal surgery, or in medical patients with severely-restricted mobility during acute illness who are at risk for thromboembolic complications
  • DVT treatment: Inpatient treatment (patients with or without pulmonary embolism) and outpatient treatment (patients without pulmonary embolism)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Fondaparinux (Arixtra) Indications

A
  • Prophylaxis of deep vein thrombosis in patients undergoing surgery for hip replacement, knee replacement, hip fracture (including extended prophylaxis following hip fracture surgery), or abdominal surgery
  • Treatment of acute pulmonary embolism
  • Treatment of acute DVT without PE
27
Q

Heparin sodium dose for prophylaxis

A

5000 Units SC every 8 to 12 hours

28
Q

Enoxaparin (Lovenox) dose for prophylaxis

A

40 mg SC once daily

Knees:
30 mg SC twice a day

Bariatric:
BMI-based up to 60 mg SC twice a day

** need good kidney function
CRCL < 30 is bad!

29
Q

Fondaparinux (Arixtra) dose for prophylaxis

A

Adults 50 kg or greater:
2.5 mg SC once daily

** need good kidney function
CRCL < 30 is bad!

30
Q

Heparin sodium dose for treatment

A

80 units/kg IV push followed by a continuous infusion of 18 units/kg/hour

31
Q

Enoxaparin (Lovenox) dose for treatment

A

1 mg/kg SC every 12 hours

1.5 mg/kg SC once daily

32
Q

Fondaparinux (Arixtra) dose for treatment

A
  • Less than 50 kg: 5 mg once daily
  • 50-100 kg: 7.5 mg once daily
  • More than 100 kg: 10 mg once daily
33
Q

Kinetics of Indirect thrombin inhibitors

A

No oral absorption
Injection only; subcutaneous and intravenously
Biological half-lives:
- Heparin at 1 to 5 hours (dose dependent)
- Enoxaparin at 4 to 6 hours
- Fondaparinux at about 17 hours

34
Q

Monitoring for Indirect thrombin inhibitors

A

Activated partial thomboplastin time (aPTT)

Anti-factor Xa levels

35
Q

ADR of Indirect thrombin inhibitors

A
  1. Bleeding
    Rates and specificity of agents
    Reversal agent (Protamine Sulfate for heparin)
  2. Heparin-induced thrombocytopenia
    Drop in platelets within 5 to 10 days after exposure
    Thrombosis risk
    Antibodies against heparin/platelet factor 4 result in platelet activation, aggregation, increased platelet factor 4 and thrombin generation
36
Q

Oral Direct Factor Xa Inhibitors?

A

Rivaroxaban

Apixaban

37
Q

MOA of Oral Direct Factor Xa Inhibitors?

A

Drug sits directly in Factor Xa

38
Q

Differences between Oral Direct Factor Xa Inhibitors?

A

Kinetics:
Both have a rapid onset of action
Both have shorter half-lives than warfarin

39
Q

Rivaroxaban (Xarelto) Indications

A
  • Postoperative thromboprophylaxis in patients who have undergone hip or knee replacement surgery
  • Prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
  • Treatment of deep vein thrombosis and pulmonary embolism
  • Reduce the risk of recurrent DVT and/or PE
40
Q

Apixaban (Eliquis) Indications

A

To reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation

41
Q

oral direct factor Xa inhibitors Excretion

A

Both agents renally excreted requiring dose adjustments in renal impairment

42
Q

oral direct factor Xa inhibitors Drug Interactions

A

Both agents are substrates for CYP3A4, P-glycoprotein

Apixaban picks up minor status for CYP1A2, CYP2C19, CYP2C8, CYP2C9

43
Q

ADR for oral direct factor Xa inhibitors

A

Peripheral edema
Dizziness
Headache
Diarrhea
Blood in…
- Bleeding rates with rivaroxaban 21% (6% major)
- Bleeding rates with apixaban 5 to 12% (2% major

44
Q

Prescription for Xarelto™ (rivaroxaban)

A

20 mg

One tablet daily

45
Q

oral direct Thrombin inhibitors

A

Dabigatran (Pradaxa)

46
Q

oral direct Thrombin inhibitors MOA

A

Sits on thrombin (Factor IIa) and stops its effect

47
Q

Dabigatran (Pradaxa) Indication

A

Prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation

48
Q

ADR Dabigatran (Pradaxa)

A
  • Bleeding
    8 to 33% (major bleeds at 6% or less)
  • Gastrointestinal
    Dyspepsia
    Gastritis-like symptoms
    Gastrointestinal hemorrhage
49
Q

Dabigatran (Pradaxa) dose

A

150 mg

One capsule twice a day

50
Q

The injectable direct thrombin inhibitors

A

Bivalirudin (Angiomax™)
Argatroban (Argatroban™)::
- Used as an anticoagulant if HIT/HITT
Infusion titrated to aPTT value (1.5 to 3 times baseline)
- Critically ill patients with normal hepatic function
Much lower doses may be appropriate (one-tenth)
- Percutaneous coronary intervention
Larger infusions doses and use of bolus dosing

51
Q

Oral Antiplatelets

A

Ticlopidine
**Clopidogrel
Prasugrel
Ticagrelor

52
Q

Ticlopidine Indications

A
  • Stroke prevention

- Post-coronary artery stenting

53
Q

Clopidogrel Indications

A

Acute coronary syndrome (UA, NSTEMI, STEMI)

Recent myocardial infarction, recent stroke or established peripheral vascular disease

54
Q

Clopidogrel Metabolism

A

Prodrug- two step including 2C19***, 3A4, 2B6, 1A2

55
Q

Oral Antiplatelets ADR

A 
Adverse drug reactions
- Bleeding
Wide variances seen in studies
All significantly lower than 5%
Labeled at 4% major and 5% minor
- Rash, pruritus
- Gastrointestinal hemorrhage
- Thrombotic thrombocytopenic purpura
56
Q

Vitamin K Antagonist

A

Warfarin

57
Q

Warfarin MOA

A

Blocks Vitamin K –>↓Thrombin formation

58
Q

Indications for Warfarin

A
  • Prophylaxis and treatment of thromboembolic disorders and embolic complications arising from atrial fibrillation or cardiac valve replacement
  • Adjunct to reduce risk of systemic embolism (e.g., recurrent myocardial infarction, stroke) after myocardial infarction
59
Q

Dose for Warfarin

A

5 mg

1 tablet daily

60
Q

Warfarin “The time to effect”

A

No effect on fully carboxylated molecules
3 to 5 days to see full drug effect
The “Protein C” phenomenon

61
Q

Warfarin Plasma protein binding

A

Binds to albumin
99% binding
–> if decrease albumin, can increase free drug and cause bleeding

62
Q

Warfarin Monitoring the effect

A

International Normalized Ratio (INR)

Target for most disorders- 2 to 3

63
Q

Warfarin Drug-drug and drug-food interactions

A
  • Increase warfarin effect
    Amiodarone, ginkgo, statins, omeprazole, etc.

-Decrease warfarin effect
Estrogens, protease inhibitors, St Johns wort, etc.

64
Q

Warfarin ADR

A

Bleeding
- “Purple toe”
- Reversal with phytonadione (vitamin K)
Use of oral and intravenous forms: If INR 3.1, 3.2 just hold next dose.

Pharm Quiz 3 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions