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Blood & Lymph > Antiplatelets, Anticoagulants & Thrombolytics 2 > Flashcards

Antiplatelets, Anticoagulants & Thrombolytics 2 Flashcards

1
Q

EdoXAban should NOT be used with ______ (4).

A
  1. Rifampin
  2. SSRI/SNRI
  3. Anticoagulants
  4. Antiplatelets
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2
Q

EdoXAban & Betrixaban contraindications (3)

A
  1. lactation
  2. renal impairment
  3. liver impairment
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3
Q

BetriXAban dosing must be reduced for patients taking ______ (rx).

A

P-glycoprotein (P-gp) inhibitors

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4
Q

Dabigatran reduces the risk of _____ & treats ____.

A
  • stroke, PE in nonvalvular a-fib
  • DVT & PE recurrence (or following surgery)

(also prevents thromboembolic events in peds pts)

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5
Q

Dabigatran binds ______.

A

free and clot-bound thrombin

(is not a substrate, inhibitor or inducer of CYP450)

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6
Q

Dabigatran increases risk of _____ if d/c early.

A

thrombotic events

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7
Q

Dabigatran is contraindication

A

mechanical prosthetic heart valve

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8
Q

________ gene is associated w/variable warfarin dose requirements

A

VKORC1 gene

(CYP2C9*2 vs CYP2C9*3 alleles associated w/decreased activity)

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9
Q

Warfarin onset of action:

Peak effect?

A
  • 24 hours
  • delayed 72-96 hours
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10
Q

What is the cause of tissue necrosis as a side effect of Warfarin?

A

Lack of protein C & S

(aka “purple toe syndrome”)

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11
Q

Adverse effects of warfarin include: tissue necrosis, _______ (2).

A
  1. calciphylaxis
  2. acute kidney disease
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12
Q

Warfarin contraindications

A
  1. pregnancy (abnormal bone formation)
  2. malignant hypertension
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13
Q

______ (3) should not be taken with warfarin?

A
  1. amiodarone
  2. cotrimoxazole
  3. caffeine
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14
Q

How do you decide on a does for warfarin?

A

genotype

(note: there can be as much as a 10x difference in dosage)

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15
Q

indirect thrombin inhibitor

(heparin & LMW heparins)

A

enhance activity of antithrombin → inhibits FX & II

(don’t inhibit coagulation factors)

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16
Q

Smaller size _______ (increases/decreases) half-life.

A

increases

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17
Q

_______ (Heparin/LMW heparin) may be used in renal failure, but ______ (Heparin/LMW heparin) may NOT.

A
  • heparin
  • LMW heparin
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18
Q

Heparin vs. LMW heparin route of administration

A
  • Heparin: IV, Sub-Q
  • LMW heparin: Sub-Q
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19
Q

LMW heparin contraindications

A

HIT w/in past 100 days or w/circulating ab

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20
Q

Disadvantage to using heparin

A

frequent monitoring needed for HIT, HITT

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21
Q

Why is heparin mostly used in the hospital setting?

A

heparin: IV or SubQ

(warfarin = PO)

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22
Q

Indications of heparin (5)

A
  1. venous or arterial thrombosis, PE
  2. a-fib
  3. DIC
  4. surgery
  5. blood transfusions, extracorporeal circulation & dialysis

(anticoagulant used in hospital setting)

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23
Q

Heparin MOA & half-life

A
  • binds antithrombin III → enhances protease activity
  • 0.2-2 hrs
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24
Q

Heparin AE (8)

A
  1. osteoporosis
  2. spontaneous vertebral fx
  3. hyperkalemia
  4. hyperlipidemia, rebound hyperlipidemia
  5. alopecia
  6. itching
  7. hyperkalemia
  8. priapism
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25
Q

HIT (heparin-induced thrombocytopenia)

A

AB formation with platelet factor 4 → thrombosis risk due to lowered platelet count

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26
Q

HIT can cause serious _____ events

A

thromboembolic events → amputation or death

(DVT, PE, cerebral vein thrombosis, limb ischemia, stroke, MI, mesenteric, renal artery, skin necrosis, gangrene)

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27
Q

Patients whose platelet count falls below ______ or who develop recurrent thrombosis should discontinue heparin.

A

100,000/mm3

(HIT or HITT can occur several weeks after medication discontinuation)

28
Q

HIT is treated with ______ (2).

A
  1. Argatroban
  2. Bivalirudin
29
Q

List 2 LMW Heparins

A
  1. Enoxaparin (Lovenox ®)
  2. Fondaparinux (Arixtra ®)
30
Q

What is the difference in the MOA of LWM Heparin or unfractionated (full sized Heparin)?

A

UFH: binds to antithrombins at a 1:1 complex to enhances the activity of antithrombin (1000x).

Inactivates complexes of factor IIa (thrombin), IX, and X.

LMWH: Shorter motif that reduces thrombin inhibition but rapidly inactivates factor X

31
Q

Which has a longer half life: Enoxaparin (Lovenox ®) or Fondaparinux (Arixtra ®) ?

A
  • Fondaparinux ~ 20 hrs
  • Enoxaparin ~ 5 hrs

(both are LMWH)

32
Q

LMWH Enoxaparin (Lovenox ®) & Fondaparinux (Arixtra ®) both treat DVT (prophylaxis & acute). Which treats MI and which treats PE?

A
  • Enoxaparin (Lovenox ®) : MI
  • Fondaparinux (Arixtra ®): PE
33
Q

Adverse effect of LMWH

A

thrombocytopenia

34
Q

List 2 direct thrombin inhibitors

A
  1. Argatroban
  2. Bivalirudin

(used to tx HIT)

35
Q

Bivalirudin (Angiomax ®) MOA

A

HIT & HITT

(HITT = heparin-induced thrombocytopenia and thrombosis)

36
Q

You must used caution in prescribing Bivalirudin to patients w/ ______ (2)

A
  1. geriatric → increased bleeding risk
  2. renal impairment
37
Q

Which anticoagulant is indicated for thromboprophylaxis after hip arthroplasty?

A

Desirudin

38
Q

Desirudin route of admin.

A

twice-daily Sub-Q

(dosage adjustment for renal impairment)

39
Q

Argatroban drug interactions (2)

A
  1. Heparin (wait for aPTT test)
  2. oral anticoagulant
40
Q

Argatroban MOA

A
  1. direct thrombin inhibitor
  2. reversible binding to thrombin active site

(work on free and clot bound thrombin)

41
Q

Argatroban half life

A

~ 1 hour

42
Q

Streptokinase (fibrinolytic Rx) is eliminated via the _______ (2 organs).

A
  1. intestines
  2. kidney

(protein produced by streptococci, used to tx thrombolysis)

43
Q

Antibodies to ______ (fibrinolytic rx) can last for months to years after administration.

A

Streptokinase

44
Q

Urokinase half-life?

A

~ 12 minutes

45
Q

Urokinase MOA

A

plasminogen → plasmin

46
Q

Urokinase indications

A

PE

(lysis when unstable hemodynamics - failure to maintain BP w/o support)

47
Q

Recombinant form of human tPA

A

Alteplase

48
Q

Alteplase MOA

A

selectively binds to fibrin in a thrombus

49
Q

Alteplase indications (3)

A
  1. STEMI (acute MI)
  2. PE
  3. Ischemic stroke
50
Q

Mutant tPA

A

Tenectaplase

51
Q

Tenecteplase (mutant tPA) contraindications

A

severe uncontrolled HTN

52
Q

Fibrinolytic inhibitors are ______ analogs.

A

lysine

53
Q

Fibrinolytic inhibitor contraindication

A

evidence of active intravascular clotting process

(these rx enhance hemostasis when bleeding continues)

54
Q

Reteplase & Tenecteplase both treat MI. Which treats PE?

A

Tenecteplase

(Fibrinolytic rx)

55
Q

Adverse effects of all 3 fibrinolytic Rx (Alteplase, Reteplase, Tenecteplase)?

A

major bleeding, including intracranial

56
Q

Andexxa indication & MOA

A
  • Rivaroxaban & Apixaban overdose
  • binds & sequesters them (also inhibits activity of Tissue Factor Pathway Inhibitor - TFPI
57
Q

Warfarin overdose tx. Indication for use?

A
  • Vitamin K1
  • anticoagulant-induced prothrombin deficiency, hemorrhagic disease of newborn, hypoprothrombinemia due ot abx
58
Q

How soon can hemorrhage be controlled with vitamin K1?

A

~4 hours

(normal prothrombin levels obtained in ~13 hours)

59
Q

Heparin overdose tx

A

Protamine Sulfate

60
Q

Indication for protamine sulfate

A

heparin overdose, cardiac surgery

61
Q

How soon can heparin be neutralized after protamine sulfate is administered?

A

5 min

62
Q

2 Adverse effects of protamine sulfate

A
  1. sudden drop of BP
  2. bradycardia
63
Q

Protamine sulfate drug interactions

A

abx: cephalosporins & penicillins

64
Q

Idarucizumab MOA

A

binds free & thrombin-bound Dabigatran → neutralization

(reverses anticoagulation effects of Dabigatran)

65
Q

When is Idarucizumab used (2)?

A
  1. emergency surgery/urgent procedures
  2. life-threatening uncontrolled bleeding

(Dabigatran reversal)

66
Q

Idarucizumab may cause adverse reactions in patients with ______.

A

fructose intolerance

Blood & Lymph (29 decks)

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