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therapeutics 2 > Anticoagulation > Flashcards

Anticoagulation Flashcards

1
Q

overall steps of bridging therapy

A

stop warfarin 5 days prior to surgery
give LMWH or UFH until surgery (last dose 24 hours prior)
resume warfarin 24 hours after
overlap warfarin and LMWH for at least 5 days and INR therapeutic

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2
Q

what are the drugs for post-op prophylaxis

A

dabigatran (hip only)
rivaroxaban
apixaban

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3
Q

what are the drugs for non-valve Afib

A

dabigatran
rivaroxaban
apixaban
edoxaban

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4
Q

what are the drugs for DVT/PE treatment

A

dabigatran
rivaroxaban
apixaban
edoxaban

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5
Q

what are the drugs for secondary prevention of DVT/PE

A

rivaroxaban
apixaban

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6
Q

what are the drugs for VTE prophylaxis

A

rivaroxaban

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7
Q

Dabigatran MOA, reversal agent, and considerations

A

direct thrombin inhibitor
reversal = idarucizumab
avoid w/ renal impairment

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8
Q

Rivaroxaban MOA, reversal agent, and considerations

A

Direct Xa inhibitor
reversal = adexanet
decrease dose with renal impairment

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9
Q

Apixaban MOA, reversal agent, and considerations

A

Direct Xa inhibitor
reversal = adexanet
decrease dose with renal impairment

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10
Q

Edoxaban MOA, reversal agent, and considerations

A

Direct Xa inhibitor
no reversal agent
cannot use if CrCl > 95 (afib only)
increased risk of hematoma

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11
Q

what is the initial warfarin dosing

A

5mg PO daily
overlap with UFH/LMWH/Xa for at least 5 days and until INR is therapeutic

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12
Q

what is the main INR goal

A

2.0-3.0

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13
Q

what is the INR goal for aortic valve replacement and mechanical heart valve (mitral/high risk)

A

2.5-3.5

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14
Q

INR less than 2.o

A

increase dose by 5-15%

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15
Q

INR 3.1-3.5

A

decrease dose by 5-15%

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16
Q

INR 3.5-4.O

A

hold 1 dose
decrease dose by 10-15%

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17
Q

INR > 4

A

hold 0-2 doses
decrease dose by 10-15%

18
Q

what are the questions to ask a warfarin patient

A

Drugs?
Diseases?
Doses missed?
Diet?
Drinking?
Signs of bleeding/bruising?

19
Q

UHF dosing, administration, reversal agent, and AEs

A

weight based dosing
IV bolus or infusion (rapid)
reversal = protamine sulfate
AE: thrombocytopenia

20
Q

LMWH dosing, admin, reversal agent

A

fixed or weight based dosing
longer half life so can be SQ
reversal = protamine sulfate

21
Q

HAT definition

A

mild decrease of platelets (<100,000)
occurs 48-72 hours
do not need to d/c heparin

22
Q

HIT definition

A

Platelet drops >50% baseline or > 100,000)
stop all heparin/warfarin and give alternative anticoag therapy
evaluate for thrombosis

23
Q

INR 4.5-10 + no evidence of bleeding

A

avoid VIT k

24
Q

INR > 10 + no evidence of bleeding

A

PO vitamin K

25
Q

major bleeding on warfarin

A

Prothrombin complex concentrate or fresh frozen plasma
pcc is preferred and is faster

26
Q

CHADSVASc conditions and points

A

congestive HF = 1
hypertension = 1
age (75+) = 2
diabetes = 1
Stroke/TIA = 2
vascular disease = 1
age (65-74) = 1
female = 1

27
Q

what are the 3 phases of platelet activation

A

adhesion: intact cells secrete PGI2 to inhibit thrombogenesis
secretion: degranulation (ADP, TXA2, 5-HT vasoconstrictors) factors are secreted to recruit other platelets
aggregation: factor activation induced confirmation for binding to fibrinogen to form clot

28
Q

MOA of ADP inhibitors

A

P2Y12 is coupled to Gi and inhibits adenylyl cyclase. these drugs block P2Y12 and block aggregation

29
Q

ADP inhibitor drugs

A

clopidogrel
prasugrel
ticagrelor
cangrelor

30
Q

MOA of GP iib/iiia receptor inhibitors

A

stops fibrinogen cross-linking at GPiib/iiia site

31
Q

GP iib/iiia inhibitor drugs

A

eptifibatide
tirofiban
abciximab

32
Q

MOA of PDE-3 inhibitors

A

platelet aggregation inhibitor
inhibition of adenosine uptake

33
Q

PDE-3 inhibitor drugs

A

dipyridamole
cilostazol

34
Q

Heparin (UFH) MOA

A

binds to free antithrombin
changes confirmation
increases interaction of AT with target factors

35
Q

Heparin side effects

A

iatrogenic hemorrhage
HIT
osteoporosis

36
Q

LMWH drugs

A

enoxaparin
daltaparin

37
Q

LMWH MOA

A

binds to antithrombin
smaller so only binds to Factor Xa

38
Q

LMWH side effects

A

HIT
osteoporosis
CI w/ renal failure

39
Q

warfarin MOA

A

inhibits synthesis of factors II, VII, IX, and X

40
Q

direct thrombin inhibitor drugs

A

bind to active site of thrombin
inhibit soluble and fibrin-bound thrombin

41
Q

direct thrombin drugs

A

bivalirudin
argatroban
dabigatran

42
Q

Factor Xa inhibitors drugs

A

Fondaparinux
Edoxaban
Rivaroxaban
Apixaban

therapeutics 2 (24 decks)

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