antiplatelet

Question 1

aspirin MOA

Answer 1

Inhibits thromboxane A2 synthesis by inhibition of
COX-1
Impedes platelet aggregation

Question 2

clopidogrel MOA

Answer 2

• interfere with binding of ADP to platelet receptors (P2Y12)thus inhibiting activation of GP IIb/IIIa
• Uses: acute coronary syndrome, recent MI, stroke, or established peripheral arterial disease
• caution w/PPIs

Question 3

Abciximab

Answer 3

Given IV with heparin or aspirin as an adjunct to percutaneous coronary intervention (PCI) for prevention of cardiac ischemic complications

Question 4

Eptifibatide and Tirofiban

Answer 4

Block GP IIb/IIIa receptor

Decrease incidence of thrombotic complications associated with acute coronary syndromes

Question 5

Dipyridamole

Answer 5

Coronary vasodilator
Prophylactic use to treat angina pectoris
Usually given in combination with ASA
Ineffective when given alone

Question 6

Vorapaxar

Answer 6

MOA - protease-activated receptor-1 (PAR-1) antagonist
inhibits thrombin-induced and thrombin receptor agonist peptide (TRAP)-induced platelet aggregation
Indication
reduction of thrombotic cardiovascular events in patients with a history of MI or PAD

Question 7

thrombin inhibitors

Answer 7

• heparin, inpt

- LMWH (enoxaparin/lovenox) can be used outpt

Question 8

heparin MOA

LMWH MOA

Answer 8

thrombin (Factor IIa) and Factor Xa

LMWH only affects Factor Xa

Question 9

how to reverse heparin?

Answer 9

protamine sulfate

Question 10

heparin induced thrombocytopenia

Answer 10

degradation of platelets from heparin use, need to monitor the platelets, d/c if platelet levels drop

Question 11

danaparoid

fondaparinux

Answer 11

Uses: prophylaxis of DVT in hip-replacement surgery and can be effective in treating HIT type II
ADR-pork allergy

low risk of HIT

Question 12

Direct Factor Xa Inhibitors

Answer 12

• Rivaroxaban (Xarelto), Apixaban (Eliquis)
• Act directly on Factor X without using antithrombin
• Can be used as substitutes for vitamin K antagonists or LMWH
• no reversal

Question 13

direct thrombin inhibitors

Answer 13

Bivalirudin,no risk of HIT, bivalent Uses: unstable angina undergoing percutaneous transluminal coronary angioplasty (PTCA), with glycoprotein IIb/IIIa inhibitor (GPI) in percutaneous coronary intervention (PCI), patients with, or risk of HIT undergoing PCI

argatroban, univalent, Uses: IV prophylaxis or treatment of thrombosis in patients with HIT (and when undergoing percutaneous coronary intervention (PCI))

Dabigatran (Pradaxa)
Uses: (PO - bid) reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation

Question 14

how to reverse dabigatran

Answer 14

Idarucizumab

Question 15

Vit K antagonist

Answer 15

• warfarin
• monitor INR 2-3
• 99% bound to albumin

Question 16

warfarin is reversible with…

Answer 16

vit K

Question 17

Prothrombin Complex Concentrate

Answer 17

Kcentra, replacement product indicated for the urgent reversal of acquired coagulation factor deficiency induced by Vitamin K antagonist (VKA, e.g., warfarin) therapy in adult patients with acute major bleeding or need for an urgent surgery/invasive procedure

Question 18

thrombolytic MOA

Answer 18

Activate the conversion of plasminogen to plasmin in acute thromboembolic disease

Question 19

alteplase

Answer 19

-Rapidly activates plasminogen bound to fibrin in a thrombus or hemostatic plug (“fibrin selective”)
-Uses: MI, massive PE and acute ischemic stroke
Administered within 3 hours of onset of ischemic stroke significantly improves outcomes (ADL)

Question 20

streptokinase MOA

Answer 20

forms active one-to-one complex with plasminogen converting uncomplexed plasminogen to the active enzyme plasmin, which breaks down fibrin as well as fibrinogen and Factors V and VII
Creates general fibrinolytic state