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Pharm 2 Exam 2 > Antithrombotics > Flashcards

Antithrombotics Flashcards

1
Q

What are the antithrombotic categories?

A

Anticoagulants
Fibrinolytics
Antiplatelets

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2
Q

what does TXA2 do?

A

causes vessel wall contraction

vasoconstriction

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3
Q

what does vWF do?

A

binds to collagen at wound surface

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4
Q

what does fibrinogen do?

A

bridges btwn platelets– aggregate of platelets to stop bleedings
(unstable plug)

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5
Q

What are anticoagulants?

A

stop clot formation and extension

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6
Q

What are fibrinolytics

A

break up existing clots

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7
Q

what are antiplatelets?

A

stop platelet aggregation

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8
Q

what does thrombin (FIIa) do?

A

converts fibrinogen to fibrin

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9
Q

What is the result of the coagulation cascade?

A

fibrin stabilizes the plug

stable clot

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10
Q

What is the platelet cascade after a cut?

A

Injury
Collage and vWF exposed
Platelet adherence and activation
Vasoconstrictors- platelet recruiters and activatior
conformational change to IIb/IIIa
fibrinogen binds
aggregation of platelets and plug formation

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11
Q

What are indirect thrombin inhibitors?

A

Unfractionated heparin
Low Molecular weight heparin (enoxaparin)
Fondaparinux

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12
Q

How does UFH, LMWH and Fondaparinux work?

A

act as anticoagulants by helping antithrombin de-activate clotting factors

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13
Q

MOA Heparin

A

Indirect thrombin inhibitor

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14
Q

Indications of Heparin

A

VTE tx and prohylaxis in the US

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15
Q

Dose adjust Heparin

A

Adjust dose based on PTT

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16
Q

Monitor Heparin

A

PTT leves

signs of bleeding

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17
Q

ADE heparin

A

Bleeding, HIT, Osteoporosis

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18
Q

Reversal of Heparin?

A

Protamine!

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19
Q

MOA Enoxaparin

A

Indirect thrombin inhibitor/ LMWH

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20
Q

Indications of Enoxaparin

A

VTE tx and prophylaxis

Tx of ACS (med manage or PCI)

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21
Q

Dose adjust Enoxaparin

A

Reduce dose if CrCl

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22
Q

Monitor Enoxaparin

A

Renal function
signs of bleeding
Anti-Xa levels only if clinically warranted

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23
Q

ADE enoxaparin

A

Bleeding

HIT (very rare)

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24
Q

Reversal enoxaparin

A

Protamine

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25
Q

Fondaparinux MOA

A

Indirect thrombin inhibitor

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26
Q

Indications of Fondaparinux

A

VTE treatment and prophylaxis

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27
Q

Dose adjust fondaparinux

A

Reduce dose if CrCL

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28
Q

Monitor fondaparinux

A

renal function
signs of bleeding
Anti-Xa levels if warranted

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29
Q

ADE Fondaparinux

A

Bleeding

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30
Q

What is the MOA of Argatroban and Bivalirudin?

A

Direct Thrombin Inhibitors

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31
Q

Indications for Argatroban?

A

Prophylaxis or tx of suspected HIT

Anticoagulation in pt w/ or at risk for HIT undergoing PCI

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32
Q

Dose Adjust Argatroban

A

base on PTT/ACT

use caution in hepatic dysfxn

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33
Q

Monitor Argatroban

A

PTT/ACT
hepatic function
signs of bleeding
(AH)

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34
Q

ADE Argatroban

A

Bleeding

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35
Q

Indications for Bilvalirudin

A

anticoag in pt undergoing PTCA or PCI or pt w/ or at risk for HIT undergoing PCI

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36
Q

Dose adjust Bilvalirudin

A

Based on PTT/ACT

reduce dose if CrCl 10-29 ml/min or hemodialysis dependent

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37
Q

Monitor Bilvalirudin

A

PTT/ACT
signs of bleeding
Renal function
(BR)

38
Q

ADE Bilalirudin

A

Bleeding

39
Q

Antiplatelet agaents are:

A 
Aspirin
Cilostazol
Clopidogrel
Dipyridamole ER plus ASA (Aggrenox)
Prasugrel
Ticagrelor
Eptifibatide
Vorapaxar
40
Q

MOA ASA

A

Inhibits cyclooxygenase

41
Q

Indications of ASA

A

Primary and secondary prevent of MI treatments of ACS peripheral arterial disease
Chronic stable angina
Acute stroke/TIA

42
Q

Monitors for ASA

ADE ASA

A

Signs of bleeding

Bleeding

43
Q

Cilostazol MOA

A

inhibits platelet phosphodiesterase III

44
Q

indications of Cilostazol

A

intermittent claudication

45
Q

Dose adjust Cilostazol

A

CYP3A4 and 2C19 drug interactions

46
Q

Clopidogrel MOA

A

inhibits platelet ADP P2Y12 receptor

47
Q

Indications of Clopidogrel

A

ACS
Secondary prevention of stroke/TIA and MI
Peripheral arter disease

48
Q

Clopidogrel dose adjust

A

CY2C19 drug and pharmacogenetic interactions

49
Q

Clopidogrel monitoring?

ADE?

A

Signs of bleeding

Bleeding

50
Q

Dipyridamole ER plus ASA (Aggrenox)

A

Inhibits platelet adenosine and phosphodiesterase

51
Q

Aggrenox dose adjust

A

do not use in severe renal or hepatic impairment

52
Q

Aggrenox monitoring

A

renal and hepatic function

signs of bleeding

53
Q

Aggrenox ADEs

A

bleeding
headache
GI upset

54
Q

Prasugrel MOA

A

inhibits platelet ADP P2Y12 receptor

55
Q

Prasugrel Indications

A

ACS managed with PCI

56
Q

Prasugrel Dose adjust

A

Do NOT use in patients with previous stroke/TIA

reduce dose if wt

57
Q

Prasugrel Monitoring

ADE’s

A

signs of bleeding

Bleedings

58
Q

Ticagrelor MOA

Indications

A

inhibits platelet ADP P2Y12 receptor

ACS

59
Q

Ticagrelor Dose adjust

A

Do NOT use in severe hepatic impairment

CYP3A4 drug interactions

60
Q

Ticagrelor Monitoring

A

Signs of bleeding

Hepatic function

61
Q

Ticagrelor ADE

A

Bleeding

GI upset

62
Q

Eptifibatide MOA

A

ONLY IV AGENT

Inhibits platelet GP IIb/IIIa receptor

63
Q

Eptifibatide indications

A

PCI in conjunction with heparin

64
Q

Eptifibatide Dose Adjust

A

Reduce dose if CrCl

65
Q

Eptifibatide Monitoring

ADEs

A

Signs of bleeding
Renal function

Bleeding

66
Q

Vorapaxar MOA

A

Inhibits protease activated receptor-1 (PAR-1)

67
Q

Vorapaxar Indications

A

Secondary prevention of MI (w/ ASA and clopidogrel)

PAD

68
Q

Vorapaxar Dose Adjustment

A

Do NOT use in pts with previous stroke/TIA/
intracranial hemorrhage/active bleeding

Do NOT use in severe hepatic impairment

CYP3A4 drug interactions

69
Q

Vorapaxar Monitoring

ADE

A

Signs of bleeding
Hepatic function

Bleeding

70
Q

Oral Anticoagulant agents

A 
Apixaban
Dabigatran
Edoxaban
Rivroxaban
Warfarin
71
Q

Apixaban
Edoxaban
Rivaroxaban
MOA:

A

Direct Factor Xa inhibitor

Xa ban
Like Xa inhibit

72
Q

Apixaban Indications

A

prevention of stroke with nonvalvular Afib
prevention of VTE after hip/knee replace or after having a VTE
tx of VTE

73
Q

Apixaban dose adjust

A

do not use in sever renal or hepatic impairment

P-glycoprotein and CYP3A4 interactions

74
Q

Apixaban monitoring

A

Renal Function
hepatic function
signs of bleeding

75
Q

Apixaban ADE

A

Bleeding

no reversal

76
Q

Dabigatran MOA

Indications

A

Direct thrombin inhibitor

prevention of stroke with nonvascular Afib
Tx of VTE
prevention of VTE after having a VTE

77
Q

Dabigatran dose adjustments

A

use 1/2 dose if CrCL 15-30mL/min (Afib only)

Do NOT used if CrCL

78
Q

Dabigatran Monitoring

A

Renal function initially and when clinically indicated
Hepatic function
Signs of bleeding

79
Q

Dabigatran ADE

A

Bleeding
GI upset

(no reversal)

80
Q

Edoxaban indications

A

prevention of stroke with nonvalvular Afib

treatment of VTE

81
Q

Edoxaban dose adjustments

A

use 1/2 dose if CrCL 15-30mL/min (Afib only)

Do NOT used if CrCL

82
Q

Edoxaban monitoring

A

renal functions initially and when clincally indicated
Hepatic function
Signs of bleeding

83
Q

Edoxaban ADE/reversal

A

bleeding

no reversal

84
Q

Rivaroxaban indications

A

prevention of stroke with nonvalvular Afib
Prevention of VTE after hip/knee replacement or after having a VTE
Treatment

85
Q

Rivaroxaban dose adjustments

A

reduce dose if CrCl 12-50 mL/min (Afib only)

Do not use if CrCl

86
Q

Rivaroxaban Monitroing

A

renal function
initially and when clinically indicated
Hepatic function
Signs of bleeding

87
Q

Rivaroxaban ADE

reversal

A

Bleeding

no reversal

88
Q

Warfarin MOA

A

Inhibits formation of vitamin K dependent clotting factors II, VII, IX, X and proteins C and S

89
Q

Warfarin Indications

A

Prevention and treatment of VTE (including VTE from atrial fibrillation or prosthetic heart valve)

90
Q

Warfarn Dose Adjusment

A

Adjust based on INR
Many ADEs with CYP2C9, 2C19, 1A2, 3A4
and foods containing Vit K

91
Q

Warfarin Monitoring

ADE

Reversal

A

INR

Bleeding

Vitamin K

Pharm 2 Exam 2 (10 decks)

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