Antiplatelets and Anticoagulants

Question 1

What are the Antiplatelet Medications?

Answer 1

1. Plavix
2. Effient
3. Brillinta
4. Kengreal
5. Zontivity

Question 2

What are the CI’s of Antiplatelets?

Answer 2

Active Bleeding

Question 3

What is a major DDI for Antiplatelets?

Answer 3

NSAIDs = Increased GI bleeding
ASA = Increased bleeding

Question 4

How long do you hold antiplatelets prior to CABG?

Answer 4

Plavix: 5 days
Ticagrelor: 5 days
Prasugrel: 7 days

Question 5

What is the indication for Plavix?

Answer 5

Post ACS, PCI, and CVA

Question 6

What is the pharmacology of Plavix?

Answer 6

Irreversible binding/platelet ADP receptor

Question 7

What is the Black Box Warning for Plavix?

Answer 7

CYP2C19 Poor Metabolizers = Asians
this patient population cannot convert prodrug plavix to its active form

Question 8

What are drugs that can interact with Plavix?

Answer 8

1. Omeprazole
2. Esomeprazole
3. Fluoxetine
4. Grapefruit

Question 9

What is the indication for Prasugrel?

Answer 9

Post ACS and PCI

Question 10

What is the pharmacology of Prasugrel?

Answer 10

Irreversible binding/platelet ADP receptors

Question 11

What is the Black Box Warning for Prasugrel?

Answer 11

AVOID with age >75 yrs unless DM s/p MI (high risk)

Question 12

When is Prasugrel use CI’d?

Answer 12

Prior TIA (transient ischemic attack)/CVA (cerebrovascular accident)

Question 13

What is the indication for Ticagrelor?

Answer 13

ACS with PCI

Question 14

What is the pharmacology of Ticagrelor?

Answer 14

Reversible binding/platelet ADP receptors

Question 15

What is the Black Box Warning for Ticagrelor?

Answer 15

ASA >100 mg/day decrease ticagrelor effectiveness

Question 16

What should be avoided when using Ticagrelor?

Answer 16

Strong 3A4
AVOID Lovastatin or Simvastatin >40 mg/day

Question 17

What is an Intermittent Claudication Agent?

Answer 17

Cilostazol

Question 18

What is the Indication for Intermittent Claudication Agents?

Answer 18

Decrease symptoms, increasing symptom free walking duration/time

Question 19

What drugs interact with Cilostazol?

Answer 19

1. Diltiazem
2. Grapefruit

Question 20

What is CI’d with use of Cilostazol?

Answer 20

CHF of ANY SEVERITY

Question 21

When should you DC Cilostazol?

Answer 21

Use with ASA or Plavix with no improved symptoms in >3 months

Question 22

How should you administer Cilostazol?

Answer 22

Taken on empty stomach 30 mins before or 2 hrs after meals

Question 23

How long does it take to see effect of Cilostazol?

Answer 23

May see effects in 2 weeks, up to 12 weeks for full effect

Question 24

Cilostazol may induce or produce what A/Es?

Answer 24

1. Diarrhea
2. Dizzy
3. Palpitations
4. Tachycardia
5. Arrhythmia
6. Hypotension
7. Thrombocytopenia

Question 25

What are the CI's for Anticoagulants?

Answer 25

Active Bleeding

Question 26

What are the DDIs for Anticoagulants?

Answer 26

NSAIDs Concomitant Antiplatelet therapy = increased bleeding risk

Question 27

What are the Anticoagulant Agents of CHOICE for Nonvalvular AF/VTE/Cancer associated VTE?

Answer 27

DOACS, but not Pradaxa

Question 28

What is the Anticoagulant Agent of CHOICE for Valvular AF?

Answer 28

Warfarin

Question 29

Valvular AF is defined as what when warfarin is the preferred choice?

Answer 29

Moderate/Severe Mitral Valve Stenosis, Mechanical Values and Hypercoagulable disorders (anti phospholipid syndrome)

Question 30

Warfarin acts on what clotting factors?

Answer 30

X, Prothrombin II, and VII

Question 31

Apixaban, Betrixaban, Edoxaban, and Rivaroxaban acts on what clotting factors?

Answer 31

Xa

Question 32

Dabigatran acts on what clotting factors?

Answer 32

Thrombin IIa

Question 33

What are the indications for Warfarin?

Answer 33

AF, Mechanical Valves, and VTE

Question 34

What are the DDIs of Warfarin?

Answer 34

FAB5 and BAMIF

Question 35

What is BAMIF?

Answer 35

Bactrim Amiodarone Metronidazole Itraconazole Fluconazole

Question 36

What is CI'd with Warfarin?

Answer 36

Pregnancy

Question 37

What is the INR Goal for AF/VTE when on Warfarin?

Answer 37

2-3

Question 38

What is the INR Goal for Mechanical Mitral Valve when on Warfarin?

Answer 38

2.5-3.5

Question 39

If a patient is >80 yrs which DOAC should you dose adjust with?

Answer 39

Apixaban

Question 40

For patients <60 kg which DOAC should you dose adjust with?

Answer 40

Apixaban and Edoxaban

Question 41

At what BMI would DOACs demonstrate minimal efficacy?

Answer 41

>40

Question 42

Pradaxa has indications for what?

Answer 42

Nonvalvular AFib, VTE, DVT, Knee/Hip Replacement

Question 43

Rivaroxaban and Apixaban has indications for what?

Answer 43

Nonvalvular AFib, VTE, DVT, Knee/Hip Replacement

Question 44

Edoxaban has indications for what?

Answer 44

Nonvalvular AFib and VTE

Question 45

What is the pharmacology for Pradaxa?

Answer 45

Reversible Direct Thrombin Inhibitor

Question 46

What are the patient counseling points of Pradaxa?

Answer 46

Store and administer from original container (stable 4 months) Swallow whole

Question 47

What is the reversal agent for Pradaxa?

Answer 47

Idarucizumab/Praxbind

Question 48

What is the absolute bioavailability for Rivaroxaban?

Answer 48

Dose dependent, lower bioavailability with doses <15

Question 49

What are the patient counseling points of Rivaroxaban?

Answer 49

10 mg tabs can be taken w/ or w/o food 15-20 mg tabs should be taken with evening meal for best absorption

Question 50

What is the reversal agent for Rivaroxaban and Apixaban?

Answer 50

Andexanet Alfa/Andexxa

Question 51

What is the main difference between dosing for Apixaban?

Answer 51

Prevention: 2.5 BID Treatment: 10 BID then 5 BID

Question 52

When should you initiate Edoxaban after VTE?

Answer 52

After 5-10 days of parenteral anticoagulant

Question 53

When is Edoxaban CI'd?

Answer 53

CrCl >95 or <15

Question 54

What drugs cause a dose limit of 30 mg/day to Edoxaban?

Answer 54

1. Verapamil 2. Azithromycin 3. Clarithromycin 4. Eythromycin

Question 55

Does Edoxaban have a reversal agent?

Answer 55

NO