Blood Thinners

Question 1

Arterial thrombosis usually consist of what type of clot?

Answer 1

Platelet-rich

Question 2

Venous thrombosis is commonly triggered by what?

Answer 2

Blood stasis

Inappropriate activation of the coagulation cascade

Question 3

What are the 2 types of anti-hemostatics?

Answer 3

Anticoagulants

Platelet inhibitors

Question 4

Drugs that act within the extrinsic pathway affect what?

Answer 4

Synthesis of vitamin K dependent coagulation factors

Question 5

What do drugs that act within the intrinsic pathway inhibit?

Answer 5

Activity of coagulation factors

Question 6

What are the 2 anticogulent drug classes?

Answer 6

Vitamin K antagonists

Coagulation factor antagonists

Question 7

What type of drug is Coumadin?

Answer 7

Vitamin K antagonist

Question 8

What is the MOA of Coumadin?

Answer 8

Inhibits vitamin K dependent coagulation factor synthetis (II, VII, IX, X, proteins C and S)

Question 9

What are the 9 common adverse effects of Coumadin?

Answer 9

Bleeding/bruising
Headache
Dizziness
Puritis
Edema
Dermatitis
Fever
Paresthesias
Alopecia

Question 10

What are the 5 serious side effects of Coumadin?

Answer 10

Syncope
Vasculitis
Hemorrhage
Cholesterol embolism
Anemia

Question 11

What is the antidote for Coumadin?

Answer 11

Vitamin K or prothrombin complex concentrate

Question 12

What may occur if Coumadin interacts with Azoles, Macrolides, Fluoroquinolones, or Tetracyclines?

Answer 12

Impaired Coumadin metabolism

Question 13

What may occur if Coumadin interacts wieh NSAIDs, Omega-3s/6s?

Answer 13

Additive blood thinning

Question 14

Which 4 drug types can interact with Coumadin to impair metabolism?

Answer 14

Azoles
Macrolides
Fluoroquinolones
Tetracyclines

Question 15

Which 2 drug types may interact with Coumadin to increase blood thinning effects?

Answer 15

NSAIDs

Omega3/6

Question 16

What is the vitamin K antagonist?

Answer 16

Coumadin

Question 17

What are the 3 indications for Enoxaparin?

Answer 17

Post-op DVT

Unstable angina

Question 18

What is the delivery route for Enoxaparin?

Answer 18

IV

Question 19

What are the two drugs that are delivered by IV?

Answer 19

Enoxaparin

Abciximab

Question 20

What is the MOA of Enoxaparin?

Answer 20

Low MW heparin

Binds to circulating antithrombin and accelerates the irreversible inactivation of factor Xa

Question 21

What are the 2 side effects of Enoxaparin?

Answer 21

Hemorrhage

Fever

Question 22

What is the 1 serious side effect of Enoxaparin?

Answer 22

Anemia

Question 23

What are the 2 antidotes for Enoxaparin?

Answer 23

Heparin

Protamine sulfate

Question 24

What drug types interact with Enoxaparin to cause additional blood thinning?

Answer 24

NSAIDs or Omega 3/6s

Question 25

When does caution need to be had with Enoxaparin?

Answer 25

Recent ocular surgery Diabetic retinopathy HTN Diabetes

Question 26

What kind of drug is Rivaroxaban?

Answer 26

Vitamin K inhibitor - blood thinner

Question 27

What are the indications of Rivaroxaban?

Answer 27

DVT and stroke prophy

Question 28

What is the MOA of Rivaroxaban?

Answer 28

Factor Xa inhibitor | Selectively blocks the active site of factor Xa, inhibiting blood coagulation

Question 29

What are the 2 common side effects of Rivaroxaban?

Answer 29

Hemorrhage | Pruritis

Question 30

What is the possible hypersensitivity to Rivaroxaban?

Answer 30

Steven's-Johnson syndrome

Question 31

What is the antidote for Rivaroxaban?

Answer 31

None!

Question 32

What happens when Macrolides, Fluoroquinolones, Cyclosporine, or Azoles interact with Rovaroxaban?

Answer 32

Decreased metabolism

Question 33

What happens when NSAIDs interact with Rivaroxaban?

Answer 33

Hemorrhage

Question 34

What are the 2 types of platelet inhibiting blood thinners?

Answer 34

Adenosine Receptor Blockers | Glycoprotein IIb/IIa Receptor Antagonists

Question 35

What type of drug is Clopidrogrel?

Answer 35

Adenosine Receptor Blocker - blood thinner

Question 36

What are the indications for Clopidrogrel?

Answer 36

Acute coronary syndrome | Thrombotic even prohpylaxis

Question 37

What is the MOA of Clopidrogrel?

Answer 37

Prodrug, metabolised by CYP450 enzyme CYP2C19 | Irreversible inhibition of platelet ADP receptors - stops the activation of GPIIb/IIIa complex

Question 38

What are the 6 common side effects of Clopidrogrel?

Answer 38

``` Hemorrhage Pruritis Cough Bronchitis Dizziness Headache ```

Question 39

What are the 3 possible hypersensitivity reactions to Clopidrogrel?

Answer 39

Angioedema SJS TEN

Question 40

What things interact with Clopidrogrel to cause active bleeding?

Answer 40

Evening primrose oil Flaxseed Omega-3 NSAIDs

Question 41

What happens when Clopidrogrel interacts with Detoconozole?

Answer 41

Reduced metabolism

Question 42

What kind of drug is Abciximab?

Answer 42

Glycoprotein IIb/IIa receptor antagonist - blood thinner

Question 43

What are the 2 indications for Abciximab?

Answer 43

Prevention of cardiac ischemic complications | Unstable angina

Question 44

How is Abciximab administered?

Answer 44

IV

Question 45

What is the MOA of Abciximab?

Answer 45

Fragment - a chimeric humaneomurine mAB Binds to GP IIb/IIa receptor of platelet - inhibits platelet aggregation Binds to vitronectin receptor on platelets, vessel wall, and endothelial smooth muscle

Question 46

What are the 4 common side effects of Abciximab?

Answer 46

Hemorrhage Hypotension Dizziness Headache

Question 47

What drugs interact with Abciximab to cause additive bleeding?

Answer 47

Omega-3/6, NSAIDs

Question 48

What are the 2 contraindications for Abciximab?

Answer 48

Recent surgery/trauma | Uncontrolled HTN