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IBI Test 3 > B3-087 Anticoagulant Therapies > Flashcards

B3-087 Anticoagulant Therapies Flashcards

1
Q

heparins

[3]

A

unfractionated heparin

Low molecular weight heparins:
-enoxaparin
-dalteparin

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2
Q

direct thrombin inhibitors

[3]

A

argatroban
bivalirudin
dabigatran

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3
Q

Factor Xa inhibitors

[4]

A

fondaparinux
rivaroxaban
apixaban
edoxaban

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4
Q

vitamin K antagonist

A

warfarin

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5
Q

antiplatelets

[5]

A

aspirin
prasugrel
ticlopidine
clopidogrel
dipyridamole

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6
Q

forms complex with antithrombin and neutralizes thrombin

prevents growth of clot but does not dissolve

A

unfractionated heparin

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7
Q

IIa and Xa are most sensitive to complex

A

unfractionated heparin

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8
Q

indications:
unstable angina and ACS
prophylaxis and treatment of DVT
maintenance

A

unfractionated heparin

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9
Q

unfractionated heparin is ….. in renal impairment

A

preferred

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10
Q

adverse effects:
bleeding, bruising
induced thrombocytopenia

A

unfractionated heparin

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11
Q

when using unfractionated heparin, do a

A

baseline CBC, at 24 hours, then every other day

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12
Q

contraindication: unfractionated heparin

A

history of HIT

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13
Q

reversible with protamine sulfate

A

unfractionated heparin

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14
Q

indications:
prophylaxis and treatment of DVT/PE

A

enoxaparin

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15
Q

indications:
prophylaxis and treatment of DVT/PE in cancer

A

dalteparin

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16
Q

preferred anticoagulant in pregnancy

A

enoxaparin

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17
Q

renal adjustment needed when creatine clearance less than 30mL/min

A

enoxaparin

give 30 mg instead of 40

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18
Q

parenteral direct thrombin inhibitors

[2]

A

argatroban
bavalirudin

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19
Q

oral direct thrombin inhibitor

A

dabigatran

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20
Q

target factor IIa (thrombin)

[3]

A

argatroban
bivalirudin
dabigatran

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21
Q

indications:
adults with HIT
PCI patients with HIT

[2]

A

argatroban
bivalirudin

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22
Q

direct thrombin inhibitor requiring hepatic adjustment

A

argatroban

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23
Q

special considerations when switching to Warfarin (alters INR)

A

argatroban

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24
Q

indications:
prevention and treatment of thromboembolism
stroke prevention in nonvalvular atrial fibrillation
post operative thromboprophylaxis after hip replacements

A

dabigatran

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25
Q

VTE treatment requires 5-10 days of parenteral agent prior to starting

A

dabigatran

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26
Q

contraindication: mechanical heart valve replacement

A

dabigatran

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27
Q

dose adjustments with P-glycoprotein inducers and inhibitors

A

dabigatran

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28
Q

separate from antacids

A

dabigatran

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29
Q

P-gp inducers

A

barbituates
carbamazepine
phenytoin
rifampin
ritonavir
St. Johns Wort

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30
Q

p-gb inducers

A

amiodarone
ketoconazole
carvedilol
lopinavir
conivaptan
macrolides
cyclosporines
non-dihydropyridine CCB
dronedarone
itraconazole
quinindine
ritonavir

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31
Q

parenteral Factor Xa inhibitor

A

fondaparinux

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32
Q

oral Factor Xa inhibitors

[3]

A

rivaroxaban
apixaban
edoxaban

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33
Q

2nd preferred agent in pregnancy if patient has history of HIT

A

fondaparinux

34
Q

contraindication: mechanical heart valve

A

Factor Xa inhibitors

35
Q

doses >10mg must be taken with food

increases absorption

A

rivaroxaban

36
Q

VTE treatment requires 5-10 days of paenteral agent prior to starting

A

edoxaban and dabigatran

37
Q

VTE treatment utilizes weight based dosing

A

edoxaban

38
Q

targets factors II, VII, IX, X and proteins C and S

A

warfarin

39
Q

narrow therapeutic window

A

warfarin

40
Q

VTE treatment requires administration of parenteral agent plus warfarin for 5 days and until INR>2

A

warfarin

41
Q

many dietary and drug interactions

vitamin K, alcohol

A

warfarin

42
Q

ask about CBD used

A

warfarin

43
Q

reversal agents:
fresh frozen plasma
prothrombin complex concentrate

A

warfarin

44
Q

measure of patients coagulation status

A

INR

45
Q

high INR

A

increased risk of bleed

46
Q

low INR

A

increased risk of clot

47
Q

INR>10 without bleeding

A

hold warfarin until INR falls into therapeutic range

48
Q

INR 4.5-10 without bleeding

A

hold warfaring temporarily (1-2 doses)

consider dosage reduction

49
Q

INR <4.5 without bleeding

A

hold 1 dose of warfarin

consider dosage reduction

50
Q

INR goal range:
DVT or PE
atrial fibrillation or flutter
bioprosthetic valve
mechanical aortic valve

A

2-3

51
Q

INR goal range: mechanical mitral valve

A

2.5-3.5

52
Q

targets COX1

A

aspirin

53
Q

indications:
acute coronary syndrome
CABG or stroke prevention

A

aspirin

54
Q

inhibits the binding of ADP to its platelet P2Y12 receptors

[3]

A

prasugrel
ticlopidine
clopidogrel

55
Q

targets phosphodiesterase III

A

dipyridamole

56
Q

monitor for GI ulceration

A

aspirin

57
Q

inhibitors reduce active metabolite concentrations

A

clopidogrel

58
Q

<60kg reduce maintenance dosage

A

prasugrel

59
Q

contraindicated in patiets with stroke history and TIA

A

prasugrel

60
Q

not recommended for patients >75 years old

A

prasugrel

61
Q

BBW for hematologic toxicities (aplastic anemia, TTP)

A

ticlopidine

62
Q

BID dosing, frequent CBCs

A

ticlopidine

63
Q

binds to fibrin in clot and converts entrapped plasminogen to active plasmin

A

altepase

64
Q

hold all antiplatelets and anticoagulation for

A

at least 24 hrs post tPA

65
Q

is warfarin teratogenic

A

yes

66
Q

LMWH are preferred for

A

outpatient therapy

67
Q

do heparins cross the placental barrier

A

no

68
Q

indirectly blocks thromboxane production

A

aspirin

69
Q

warfarin inhibits factors

A

II
VII
IX
X
C
S

70
Q

only orally administered direct thrombin inhibitors

A

dabigatran

71
Q

what is administred to immediately lower INR

A

plasma

contains functional clotting factors

72
Q

lowers INR over several days

A

d/c warfarin
or
vitamin K

73
Q

plasma contains

A

functional, calcium responsive clotting factors

lowers INR immediately

74
Q

plasma contains

A

functional, calcium responsive clotting factors

lowers INR immediately

75
Q

inhibits CYP2C9

A

clopidogrel

ticlopidine may be prescribed if potential interactions are problematic

76
Q

alteplase is a

A

thrombolytic

77
Q

heparin is administered

A

IV

78
Q

requires PT/PTT monitoring

A

heparin

79
Q

oral anticoagulant

A

rivaroxaban

80
Q

all antiplatelet drugs can be administered

A

orally

81
Q

enoxaparin is administered

A

subq

82
Q

does exonaparin require PT/PTT monitoring?

A

no

IBI Test 3 (20 decks)

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