Antiplatelets/coags/thrombolytics

Question 1

Aspirin:

MOA:

Answer 1

inhibits thromboxane A2 synthesis by inhibition of COX 1

Question 2

Aspirin: uses

Answer 2

prophylaxis of transient cerebral icchemia, reduce incidence of MI, decrease mortality in pre and post MI patients

Question 3

aspirin is frequenty used with what?

ADRs:

Answer 3

other anticlotting drugs (heparin/clopidogrel)

NSAIDs/acetaminophen inhibit COX1 and can antagoinze platelet inhibition by aspirin

Question 4

prasugrel, cangrelor, clopidogrel MOA:

Answer 4

interfere with binding of ADP to platelet receptors thus inhibiting activtion of GP IIb/IIIa

Question 5

prasugrel, cangrelor, clopidogrel uses:

Answer 5

acute coronary syndrome, recent MI, CVA, PAD, stent insertion during MI

Question 6

prasugrel, cangrelor, clopidogrel which is not effect by food?

ADRs of these drugs?

Answer 6

clopidogrel

prolonged bleeding time with no antidote, thrombocytopenia purpura

Question 7

prasugrel, cangrelor, clopidogrel which is not effect by food?

ADRs of these drugs?

use caution clopidogrel in pts on what?

Answer 7

clopidogrel

prolonged bleeding time with no antidote, thrombocytopenia purpura

inhibit cyp450: interfere with metabolism of phenytoin, tolbutamide, warfarin, fluvastatin, tamoxifen

on PPIs

Question 8

Ticagrelor: similar to prasugrel, clopidogrel, ticlopidine

prevention of what?

Answer 8

thrombiotic events in pts with acute coronary syndrome or MI with ST elevations

Question 9

Abciximab: MOA?

given with what?

ADRs?

how long do antiplatelet effects last?

Answer 9

monoclonal AB directed against GP IIb/IIIa receptors

IV heparin/ASA as adjunct to percutaneous coronary intervention for provention of cardiac ischemic comps

bleeding

24-48 hours

Question 10

eptifibatie/tirofiban: MOA

use?
effect can last for how long after d/c

major SE?

Answer 10

block GP IIb/IIIa receptor

decreases incidence of thrombiotic compls associated with acute coronary syndromes

4 hours

bleeding

Question 11

Dipyridamole:

MOA?

use?

Answer 11

coronary vasodilator, phosphodiesterase inhibitor decreasing thromboxane A2 (inhibits thrombus)

prophylactic used to tx angina pectoris

Question 12

Varapaxar:

MOA?

indication?

CI?

DDI?

Answer 12

protease activated receptor-1 antagonist

(does not effect ADP, collagen or thromboxane aggregation) (does not affect coagulation parameters or bleeding time)

reduction of thrombotic CV events in pts w/history of MI or PAD

hx of CVA, TIA or ICH, or active bleeding

ADR: bleeding

DDI- cyp3A4

Question 13

Heparin: MOA:

Answer 13

binds to antithrombin III and potentiates its inactivation effects on serine proteases (factos IIa and Xa)

LMWH only affects Factor Xa!!

Question 14

Heaprin uses:

Answer 14

DVT, PE, prophylactic to prevent post op VE in elective surgery, MI and a fib

reduced coronary artery rethrombosis, DOC in pregnancy for prosthetic heart valves and VE (doesnt cross placenta)

LMWH: (weight based, predictable effects very useful in outpt)

Question 15

what is a dose based on for heparin?

Answer 15

aPTT

LMWH does not need aPTT

Question 16

half life of heparin is increased when?

Answer 16

pts with cirrhosis, renal insufficiency and is dose related with heparin

Question 17

ADRs of heparin?

Answer 17

bleeding (manage by admin of protamine sulfate, hypersensitivity, thrombosis (minimized with low dose), hyperkalemia, THROMBOCYTOPENIA (type 1: immunoloigc occurs within first 5 days, type 2: IgG, degradation of platelets can result in thrombocytpenia and thrombosis, occurs 5-14 days and can range fro mild to life threatening, platelets count can drop more than 50% but this is very rare)

Question 18

CI of heparin:

Answer 18

IM injection hematoma, HSN, bleeding, ETOH, brain/eye/spinal cord surgery

Question 19

Danaparoid: MOA?

uses?
ADRs?

Answer 19

Anti Factor Xa and antithrombin

prophylaxis of DVT in hip replacement surgery and can tx HIT type II

pork allergy, hemorrhage

Question 20

Fondaparinux:

MOA?

Answer 20

synthetic pentasaccharide factor Xa inhibitor

low risk of HIT, renally excreted

Question 21

Direct factor Xa inhibitors:

(rivaroxaban, apixaban, edoxaban, betrixaban)

MOA?

substitute for?

Answer 21

act directly on factor X without using antithrombin

vit K antagonists or LMWH

prophylaxis/tx for DVT/PE in adults undergoing hip/knee replacement, long term tx to prevent recurrence, CVA prophylaxis in pts with non valvular afib

Question 22

Direct factor Xa inhibitors:

(rivaroxaban, apixaban, edoxaban, betrixaban)

ADRs:

Answer 22

no way to reverse

bleeding, fainting, itching, anemia, muscle spasms

edoxaban not to be used in pts with non valvular afib

Question 23

bivalirudin: 
MOA?
uses? 
half life? 
ADR:

Answer 23

direct thrombin inhibitor (potent, reversible)

unstable angina undergoing percutaenous transluminal coronary angioplasty, protein IIb/IIIa inhibitor in percutaenous coronary intervention, pts with or at risk of HIT undergoing percutaneous cocornary intervention

25 min

bleeding, HA, hypotension

Question 24

Argatroban: MOA:

Answer 24

direct thrombin inhibitor

IV prophylaxis or tx of throbmosis in pts with HIT

bleeding, dyspnea, hypotension

Question 25

Dabigatran: MOA?

Answer 25

direct thrombin inhibitor

reduce risk of CVA and systemic embolism in pts with non valvular a fib

reduce dose in renal impairment

bleeding

Question 26

Idarucizumab:

MOA:

Answer 26

human monoclonal AB fragment

indicated in pts tx with dabigatran when reversal of anticoagulant effects is needed!!!!!!!!!!

for emergency procedures in life threatening uncontrolled bleeding

IV-higher affinity than the binding affinity of dabigatran to thrombin

Preacution:

thromboembolic risk, HSN, pts with heredity fructose intolerance

ADR-hypokalemia, deleirum, constipation, pyrexia, pneumonia