Antithrombotics

Question 1

Aspirin MOA

Answer 1

COX inhibitor, inhibits thromboxane synthesis

Question 2

Aspirin indication

Answer 2

primary/secondary prevention

and acute coronary syndromes, PCI, recurrent stroke

Question 3

ADP Receptor Blocker MOA

Answer 3

prevent platelet aggregation; these are PRODRUGS

Question 4

ADP examples

Answer 4

irreversible=grel: clopidogrel, prasugrel

Reversible: Ticagrelor +aspirin

Question 5

ADP Use

Answer 5

Irreversibles:

Clopidigril :w aspirin during/after PCI or alone if aspirin isn’t tolerated
Prasugrel: PCI related thrombosis

Reversible: Ticagrelor w Aspirin for thombotic events with ACS or MI/ST elevation

Question 6

G2b3a inhibitors MOA

Answer 6

Bind GP IIb/IIIa – prevent fibrinogen binding and subsequent crosslinking of platelets

Question 7

G2b3a inhibitors examples

Answer 7

A: abciximab (irreversible)
T: tirofiban
E: eptifibatide

Question 8

G2b3a inhibitors indication

Answer 8

efficacious antiplatelets

Question 9

G2b3a inhibitors warnings

Answer 9

Thrombocytopenia

Question 10

Heparin MOA

Answer 10

heparin/enoxaparin

enhances antithrombin 3

Question 11

Heparin adverse effects

Answer 11

bleeding

HIT
Thombocytopenia

Question 12

Heparin indication

Answer 12

• Prophylaxis: DVTs and PE
• Thromboembolic events. related to unstable angina, MI, AF
• Acute DVT & PE
Acute Coronary Syndrome (+ antiplatelet)

Question 13

F10a inhibitors examples

Answer 13

rivaroxABAN (xarelto)

apixABAN

Question 14

F10a indication

Answer 14

-ABAN

Prophylaxis: DVT, PE
Stroke prevention with non-valvular A-fib

Question 15

F10a MOA

Answer 15

-ABAN

Inhibits free & clot-bound Xa

**no antidote to bleeding

Question 16

F10a interactions

Answer 16

CYP3A4, PGP

Renal elimination

Question 17

Parenteral direct thrombin inhibitors MOA

Answer 17

Inhibit Thrombin(IIa)
(thus preventing fibrinogenfibrin)

Question 18

Parenteral direct thrombin inhibitors examples

Answer 18

BivallRUDIN
agatroban
lepiRUDIN

Question 19

Parenteral direct thrombin inhibitors INDICATION

Answer 19

Lepirudin & Argatroban: Thrombosis due to heparin induced thrombocytopenia (HIT)

Bivalirudin: combine with antiplatelet having PCI

Question 20

Direct thrombin inhibitor MOA

Answer 20

Dabigantran

Prodrughydrolyzed to dabigatran and conjugated to acyl glucoronides (both are active)

Question 21

DIrect Thrombin inhibitor INDICATION

Answer 21

Dabigatran

Non-valvular A-fib assoc. stroke and embolism

Question 22

Warfarin MOA

Answer 22

Thrombin synthesis inhibitor

Inhibits Vit. K Reductase

Factors II, VII, IX, X & Proteins C & S aren’t regenerated

Question 23

Warfarin indication

Answer 23

Primary Prevention: DVT & PE
Only approved drug in patients with prosthetic valves
Secondary: Acute DVT & PE. Combine with heparin for fast onset, warfarin kicks in later

Question 24

Warfarin metabolism

Answer 24

40 hr half-life, binds plasma albumin

Metabolized by 3 enzymes:
CYP2C9, 3A4, 1A2
Many potential interactions leading to bleeding

Slow onset of action, often combined with faster-acting heparin

Question 25

warfarin side effects

Answer 25

bleeding, birth defects, do not use in pregnancy!

Question 26

Fibrinolytics- examples

Answer 26

-PLASE

alteplase
reteplase
tenectplase
streptokinase

Question 27

Fibrinolytics indication

Answer 27

-PLASE

activates plasminogen

opens clotted vessels

• Acute MI, especially if PCI unavailable
• PE, DVT
• Stroke

Question 28

Fibrinolytics AE

Answer 28

renal failure

Question 29

-PLASE

Answer 29

fibrinolytics

Question 30

-ABAN

Answer 30

F10a inhibitors

Question 31

-GREL

Answer 31

ADP receptor blockers

Question 32

Heparin antidote

Answer 32

protamine sulfate

Partially reverses LMWH effects but has no effect on fondaparinux

Question 33

warfarin antidote

Answer 33

vitamin K,
fresh frozen plasma,
prothrombin complex concentrates,
rFVIIa