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Cardiovascular > Antithrombotic agents > Flashcards

Antithrombotic agents Flashcards

1
Q

Anticoagulant agents drug of choice for prevention/treatment of _____ and prevention of _____ in patients with _____

A

venous thromboembolism
Cardioembolic event with atrial fibrillation
(Also can use for arterial thrombosis + antiplatelet)

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2
Q

anti-platelet agents drug of choice for prevention/treatment of ___

A

arterial thrombosis (primary/secdonary prevention of ACS)

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3
Q

Primary prevention with risk factor - give

A

aspirin

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4
Q

primary prevention with no risk factors - give

A

aspirin (men>45, women>65)

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5
Q

Secondary prevention with recent MI - give ___

A

aspirin (clopidogrel)

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6
Q

Secondary prevention with ischemic stroke - give ___

A

aspirin +/- clopidogrel

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7
Q

Unstable angina - give

A

aspirin

+/- clopidogrel/prasugrel/ticagrelor, UFH/LMWH/fondaparinux, GPIIb/IIIa inhibitor

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8
Q

NSTEMI - give ___

A

aspirin

+/- clopidogrel/prasugrel/ticagrelor, UFH/LMWH/fondaparinux, GPIIb/IIIa inhibitor

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9
Q

STEMI (aka ___) - give

A

acute MI
aspirin
+/- clopidogrel/prasugrel/ticagrelor, UFH/LMWH/FONDAPARINUX, GPIIb/IIIa inhibitor

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10
Q

Peripheral critical ischemia - give __

A

aspirin

+/- clopidogrel/prasugrel/ticagrelor, UFH/LMWH/BIVALIRUDIN, GPIIb/IIIa inhibitor

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11
Q

Atrial Fibrillation - give ___

A

Warfarin/Dabigatran/rivaroxaban/apixaban

Low risk = aspirin

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12
Q

GP1a bind to ___

A

collagen

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13
Q

GP1b bind to ___

A

GPIIb/IIIa + vWF

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14
Q

GPIIb/IIIa bind to ___

A

fibrinogen

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15
Q

aPTT = aka + ref range

A

activated partial thromboplastin time; 26-33 sec

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16
Q

prolonged aPTT indicates defects in ____ pathway and used to monitor ___ therapy

A

intrinsic
Heparin
(note: aPTT not affected by LWMH)

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17
Q

PT = aka + ref reange

A

prothrombin time/ 12-14 sec

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18
Q

prolonged PT = defect in ___ pathway, used to monitor ___ therapy based on ___

A

extrinsic
warfarin
INF (international normalized ratio)

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19
Q

Ecarin clotting time (ECT) uses ecarin derived from ___

A

venom of saw-scaled viper

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20
Q

ECT prolonged = increasing concentration of ___ or ___ in plasma; used to monitor anticoagulant therapy with _______

A

hirudin/dabigatran

Direct thrombin IIa inhibitors

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21
Q

Fibrinolysis central process is the activation of ____ to _____ by ___

A

plasminogen –> plasmin by tPA

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22
Q

plasmin _________

A

proteolyzes fibrin/limits thrombosis

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23
Q

Fibrin inhibition by _____ and _____

A 
antithrombin III (accelerated by heparin)
Protein C (Ccofactor protein S)
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24
Q

Protein C inactivates: _____ and ____

A

Va, VIIIa

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25
Q

Unfractionated heparin binds to ____ and _____

A

antithrombin III and

IIa, Xa, (IX, XI, XII, XIII)

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26
Q

Enoxapirin is a ____

A

LMWH

27
Q

LMWH binds to ___

A

Xa only (not IIa)

28
Q

Fondaparinux is a ______ binds to __

A

pentasaccharide activator of ATIII, inactivates Xa only

29
Q

Argatroban is a ___

A

direct thrombin IIa inhibitor

30
Q

Bivalirudin is a ___

A

direct thrombin IIa inhibitor

31
Q

Lepirudin is a ___

A

direct thrombin IIa inhibitor

32
Q

Desirudin is a ___

A

direct thrombin IIa inhibitor

33
Q

direct thrombin IIa inhibitor are given ____

A

parenterally

34
Q

Heparin is given ___ (route of admin)

A

IV or SC

35
Q

Heparin ____ placenta

A

does NOT cross

36
Q

Most heparin (except LMWH) is cleared via

A

RES system/hepatic

37
Q

LMWH compared to UFH

A

less thrombocytopenia, less variable response

slower, cannot be reversed by protamine, may adverse affect renal (UFH is not renal)

38
Q

heparin is used adjunct in treatment of _____?

A

coronary occlusion in unstable angina/acute MI
Prophylaxis/treat VTE
Cerebral thrombosis (stroke)
Post op

39
Q

Adverse effect of heparin are typically

A

hemorrhage, hypersensitivity, thrombocytopenia (not fondaparinux), osteoporsis

40
Q

_____ is used to reverse heparin

A

protamine

41
Q

Heparin acts in ___ to inhibit ____

A

plasma

activated clotting factors

42
Q

Warfarin acts in the ___ to inhibit ____

A

liver

synthesis of clotting factor

43
Q

onset of warfarin effect is ___

A

delayed (3-5 days steady state)

44
Q

Warfarin is metabolized by ___ which has ____

A

CYP2C9

Genetic polymorphism

45
Q

Warfarin can be given ___

A

orally (100% bioavailability)

46
Q

Warfarin ____ placenta

A

does cross

DO NOT USE

47
Q

Warfarin prophylaxis used mostly for ___ and ____

A

Afib

Prosthetic heart valves

48
Q

Warfain can be reversed by ___

A

vit K

PCC/FFP (prothrombin complex concentrate/fresh frozen plasma)

49
Q

Warfarin affects which factors?

A

2, 7, 9, 10, C, S

50
Q

DDI: increase warfarin effect?

A

amiodarone, cimetidine, fluconazole, fluoxetine, metronidazole, rosuvastatin, aspirin, oral antibiotics

51
Q

DDI: decrease warfarin effect?

A

Barbiturates, carbamazepine, phenytoin, rifampin, st john’s worts, cholestyramine, colestipol, vit K

52
Q

Dabigatran acts in ___ to inhibit ___

A

plasma

(directly inhibit) activity of thrombin

53
Q

Dabigatran compared with warfarin

A

no frequent monitoring/dosage adjustment, expensive, no antidote for rapid reversal

54
Q

Dabigatan is absorbed ___, eliminated by ___

A

as a prodrug - plasma/liver esterases

Renal excretion

55
Q

Dabigatan is used in place of warfarin for patient with ___

A

non-valvular atrial fibrillation

56
Q

Rivaroxaban/apixaban/edoxaban acts in __ to ____

A

plasma

directly inhibit factor Xa

57
Q

Rivaroxaban/apixaban/edoxaban eliminated

A

hepatic and renal/ renal

58
Q

apixaban dosing

A

BID

59
Q

Rivaroxaban/apixaban/edoxaban used to prevent ___ and reducing risk of ___

A

DVT after hip/knee

Stroke, systemic embolism with non-vavlular a fib

60
Q

Warfarin used in ___ associated with ___

A

afib

mechanical valve, bioprosthtic valve, prior mitral repair, mitral valve stenosis

61
Q

Dabigatran dosing

A

BID

62
Q

Warfarin is ___ ($) than NOAC (newer oral anticoagulants)

A

cheaper (6 vs 290$/mo)

63
Q

Warfarin is (preferred/not preferred) in pt with chornic kidney disease

A

preferred

Cardiovascular (11 decks)

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