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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
Fondaparinux MOA
Indirect thrombin inhibitor
26
Indications of Fondaparinux
VTE treatment and prophylaxis
27
Dose adjust fondaparinux
Reduce dose if CrCL
28
Monitor fondaparinux
renal function signs of bleeding Anti-Xa levels if warranted
29
ADE Fondaparinux
Bleeding
30
What is the MOA of Argatroban and Bivalirudin?
Direct Thrombin Inhibitors
31
Indications for Argatroban?
Prophylaxis or tx of suspected HIT | Anticoagulation in pt w/ or at risk for HIT undergoing PCI
32
Dose Adjust Argatroban
base on PTT/ACT | use caution in hepatic dysfxn
33
Monitor Argatroban
PTT/ACT hepatic function signs of bleeding (AH)
34
ADE Argatroban
Bleeding
35
Indications for Bilvalirudin
anticoag in pt undergoing PTCA or PCI or pt w/ or at risk for HIT undergoing PCI
36
Dose adjust Bilvalirudin
Based on PTT/ACT | reduce dose if CrCl 10-29 ml/min or hemodialysis dependent
37
Monitor Bilvalirudin
PTT/ACT signs of bleeding Renal function (BR)
38
ADE Bilalirudin
Bleeding
39
Antiplatelet agaents are:
``` Aspirin Cilostazol Clopidogrel Dipyridamole ER plus ASA (Aggrenox) Prasugrel Ticagrelor Eptifibatide Vorapaxar ```
40
MOA ASA
Inhibits cyclooxygenase
41
Indications of ASA
Primary and secondary prevent of MI treatments of ACS peripheral arterial disease Chronic stable angina Acute stroke/TIA
42
Monitors for ASA ADE ASA
Signs of bleeding Bleeding
43
Cilostazol MOA
inhibits platelet phosphodiesterase III
44
indications of Cilostazol
intermittent claudication
45
Dose adjust Cilostazol
CYP3A4 and 2C19 drug interactions
46
Clopidogrel MOA
inhibits platelet ADP P2Y12 receptor
47
Indications of Clopidogrel
ACS Secondary prevention of stroke/TIA and MI Peripheral arter disease
48
Clopidogrel dose adjust
CY2C19 drug and pharmacogenetic interactions
49
Clopidogrel monitoring? ADE?
Signs of bleeding Bleeding
50
Dipyridamole ER plus ASA (Aggrenox)
Inhibits platelet adenosine and phosphodiesterase
51
Aggrenox dose adjust
do not use in severe renal or hepatic impairment
52
Aggrenox monitoring
renal and hepatic function | signs of bleeding
53
Aggrenox ADEs
bleeding headache GI upset
54
Prasugrel MOA
inhibits platelet ADP P2Y12 receptor
55
Prasugrel Indications
ACS managed with PCI
56
Prasugrel Dose adjust
Do NOT use in patients with previous stroke/TIA | reduce dose if wt
57
Prasugrel Monitoring ADE's
signs of bleeding Bleedings
58
Ticagrelor MOA Indications
inhibits platelet ADP P2Y12 receptor ACS
59
Ticagrelor Dose adjust
Do NOT use in severe hepatic impairment | CYP3A4 drug interactions
60
Ticagrelor Monitoring
Signs of bleeding | Hepatic function
61
Ticagrelor ADE
Bleeding | GI upset
62
Eptifibatide MOA
**ONLY IV AGENT** | Inhibits platelet GP IIb/IIIa receptor
63
Eptifibatide indications
PCI in conjunction with heparin
64
Eptifibatide Dose Adjust
Reduce dose if CrCl
65
Eptifibatide Monitoring ADEs
Signs of bleeding Renal function Bleeding
66
Vorapaxar MOA
Inhibits protease activated receptor-1 (PAR-1)
67
Vorapaxar Indications
Secondary prevention of MI (w/ ASA and clopidogrel) | PAD
68
Vorapaxar Dose Adjustment
Do NOT use in pts with previous stroke/TIA/ intracranial hemorrhage/active bleeding Do NOT use in severe hepatic impairment CYP3A4 drug interactions
69
Vorapaxar Monitoring ADE
Signs of bleeding Hepatic function Bleeding
70
Oral Anticoagulant agents
``` Apixaban Dabigatran Edoxaban Rivroxaban Warfarin ```
71
Apixaban Edoxaban Rivaroxaban MOA:
Direct Factor Xa inhibitor Xa ban Like Xa inhibit
72
Apixaban Indications
prevention of stroke with nonvalvular Afib prevention of VTE after hip/knee replace or after having a VTE tx of VTE
73
Apixaban dose adjust
do not use in sever renal or hepatic impairment P-glycoprotein and CYP3A4 interactions
74
Apixaban monitoring
Renal Function hepatic function signs of bleeding
75
Apixaban ADE
Bleeding | no reversal
76
Dabigatran MOA Indications
Direct thrombin inhibitor prevention of stroke with nonvascular Afib Tx of VTE prevention of VTE after having a VTE
77
Dabigatran dose adjustments
use 1/2 dose if CrCL 15-30mL/min (Afib only) | Do NOT used if CrCL
78
Dabigatran Monitoring
Renal function initially and when clinically indicated Hepatic function Signs of bleeding
79
Dabigatran ADE
Bleeding GI upset (no reversal)
80
Edoxaban indications
prevention of stroke with nonvalvular Afib | treatment of VTE
81
Edoxaban dose adjustments
use 1/2 dose if CrCL 15-30mL/min (Afib only) | Do NOT used if CrCL
82
Edoxaban monitoring
renal functions initially and when clincally indicated Hepatic function Signs of bleeding
83
Edoxaban ADE/reversal
bleeding no reversal
84
Rivaroxaban indications
prevention of stroke with nonvalvular Afib Prevention of VTE after hip/knee replacement or after having a VTE Treatment
85
Rivaroxaban dose adjustments
reduce dose if CrCl 12-50 mL/min (Afib only) | Do not use if CrCl
86
Rivaroxaban Monitroing
renal function initially and when clinically indicated Hepatic function Signs of bleeding
87
Rivaroxaban ADE reversal
Bleeding no reversal
88
Warfarin MOA
Inhibits formation of vitamin K dependent clotting factors II, VII, IX, X and proteins C and S
89
Warfarin Indications
Prevention and treatment of VTE (including VTE from atrial fibrillation or prosthetic heart valve)
90
Warfarn Dose Adjusment
Adjust based on INR Many ADEs with CYP2C9, 2C19, 1A2, 3A4 and foods containing Vit K
91
Warfarin Monitoring ADE Reversal
INR Bleeding Vitamin K

Pharm 2 Exam 2 (10 decks)

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