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AdvPharmExam2 > Anticogulants > Flashcards

Anticogulants Flashcards

1
Q

MOA of Warfarin

A

-Inhibit the hepatic synthesis of several clotting factors, including factor X.
-Inhibits vitamin K-dependent synthesis of clotting factors

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2
Q

Absorption and Distribution of Warfarin

A

rapidly and completely absorbed orally
highly bound to plasma protein.

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3
Q

Warfarin in pregnancy?

A

Big No. crosses the placenta and can cause hemorrhagic disorders in the fetus and serious birth defects

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4
Q

Oral factor Xa inhibitors, rivaroxaban, apixaban, have a boxed warning indicating?

A

premature discontinuation of anticoagulants may lead to thrombotic events

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5
Q

Can warfarin cause skin rash?

A

Although rare, allergic reactions do occur with warfarin, characterized by symmetrical, maculopapular, erythematous lesions

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6
Q

Is warfarin considered the first choice for DVT or PE?

A

guidelines recommend apixaban, dabigatran, edoxaban, or rivaroxaban over warfarin as treatment-phase (first 3 months) anticoagulant therapy for DVT of the leg or PE

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7
Q

Normal INR - not on warfarin

A

0.8-1.1

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8
Q

Warfarin INR goal

A

2-3

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9
Q

When should INR goal 2.5-3.5?

A

mechanical valves and high risk

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10
Q

Protocol for warfarin stop/start when having a procedure

A

Patients who are having surgery should stop warfarin 5 or more days before elective surgery and resume within 24 hours after surgery - unless low bleeding risk

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11
Q

Warfarin Contraindications

A

Pregnancy, recent surgery, severe hypertension.

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12
Q

MOA of Heparin

A

Enhances the activity of antithrombin III, inhibiting clotting factors.

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13
Q

MOA of LMWH - enoxaparin (lovenox)

A

LMWH enoxaparin (Lovenox) potentiates the activity of antithrombin III and inactivates factors Xa and IIa (thrombin)

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14
Q

Difference in distribution between heparin and LMWH

A

heparin is distributed in plasma and extensively protein bound. The LMWHs are distributed in plasma and have limited or no protein binding

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15
Q

LMWHs are contraindicated in?

A

contraindicated for patients with allergies to pork, sulfites, or benzyl alcohol; for patients with uncontrolled bleeding; and in patients who have antiplatelet antibodies

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16
Q

Can LMWH be used in pregnancy

A

yes first-line drug for women who require antithrombotic therapy during pregnancy

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17
Q

is heparin and LMWH absorbed in GI tract?

A

no - must be given IV or Sq

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18
Q

Heparins are contraindicated in which disease states

A

advanced hepatic or renal disease.

19
Q

Unfractionated heparin use in pregnancy?

A

risk must outweigh benefit

20
Q

When will thrombocytopenia occur if HIT is going to happen. When should heparin be d/c’d

A

Early thrombocytopenia occurs 2 to 3 days after initiating therapy, and a delayed form occurs 7 to 12 days after initiation. If the platelet count falls below 100,000/mm3, the heparin should be discontinued.

21
Q

How many hours before surgery should IV heparin be stopped? SQ?

A

4-6 hours IV
SQ - 24 hours

22
Q

MOA of dabigatran

A

a direct thrombin inhibitor. Thrombin is required for the conversion of fibrinogen to fibrin in the clotting cascade, thus dabigatran’s inhibition of thrombin prevents thrombi from forming

23
Q

reversal agent for dabigatran if excessive bleeding occurs is

A

idarucizumab (Praxbind)

24
Q

Dabigatran has a boxed warning concerning?

A

increasing risk of thrombotic events upon discontinuation

25
Q

Angioedema and thrombocytopenia have been reported with which oral anticog?

A

Dabigatran

26
Q

2021 ACCP guidelines recommend apixaban, dabigatran, edoxaban, or rivaroxaban over warfarin as treatment-phase, how long?

A

3 months

27
Q

patients with AF, the ACCP recommends against antiplatelet therapy alone. For patients with persistent or paroxysmal AF at high risk for stroke, which drugs are recommended?

A

apixaban, edoxaban, or dabigatran , warfarin 2-3

28
Q

MOA apixaban(eliquis), Xerelto

A

Oral direct factor Xa inhibitors selectively inactivate circulating Xa

29
Q

What is the reversal for eliquis?

A

there isnt one!

30
Q

MOA of Plavix (clopidegrel)

A

Reduce platelet aggregation by inhibiting the ADP pathway of platelets.

31
Q

MOA Ticagrelor (Brilinta)

A

reversibly interacts with the platelet P2Y12 ADP receptor to prevent platelet activation.

32
Q

Is clopidegrel a prodrug?

A

yep, converts in the liver to active

33
Q

clopidogrel is not recommended for patients with

A

severe hepatic disease

34
Q

ACCP guidelines recommend the combination of aspirin and extended-release __________over aspirin alone be used as preventive therapy for TIA or stroke

A

dipyridamole or clopidogrel

35
Q

Clopidogrel should not be taken with _____ because it decreases its effectiveness

A

proton pump inhibitors (PPIs), such as OTC omeprazole (Prilosec OTC)

36
Q

MOA of aspirin

A

It inhibits the production of prostaglandins but inhibits cyclooxygenase (COX), reducing thromboxane A2 production.

37
Q

What syndrome has been associated in children with aspirin use

A

Reye Syndrome

38
Q

Should you take aspirin and NSAIDs together

A

no no no

39
Q

What can aspirin do to GI?

A

cause gastric erosion

40
Q

Liver function and aspirin relatoinship

A

use cautiously in hepatic impairment

41
Q

Signs of aspirin toxicity

A

In addition to tinnitus, indications of aspirin toxicity are headache, hyperventilation, agitation, mental confusion, lethargy, diarrhea, and sweating.

42
Q

is aspirin antiplatelt or anticoag?

A

antiplatelet

43
Q

Should you stop low dose aspirin before surgery?

A

No

44
Q

How far in advance should you stop plavix before surgery

A

5 days

AdvPharmExam2 (17 decks)

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