Blood Thinners Flashcards
Arterial thrombosis usually consist of what type of clot?
Platelet-rich
Venous thrombosis is commonly triggered by what?
Blood stasis
Inappropriate activation of the coagulation cascade
What are the 2 types of anti-hemostatics?
Anticoagulants
Platelet inhibitors
Drugs that act within the extrinsic pathway affect what?
Synthesis of vitamin K dependent coagulation factors
What do drugs that act within the intrinsic pathway inhibit?
Activity of coagulation factors
What are the 2 anticogulent drug classes?
Vitamin K antagonists
Coagulation factor antagonists
What type of drug is Coumadin?
Vitamin K antagonist
What is the MOA of Coumadin?
Inhibits vitamin K dependent coagulation factor synthetis (II, VII, IX, X, proteins C and S)
What are the 9 common adverse effects of Coumadin?
Bleeding/bruising Headache Dizziness Puritis Edema Dermatitis Fever Paresthesias Alopecia
What are the 5 serious side effects of Coumadin?
Syncope Vasculitis Hemorrhage Cholesterol embolism Anemia
What is the antidote for Coumadin?
Vitamin K or prothrombin complex concentrate
What may occur if Coumadin interacts with Azoles, Macrolides, Fluoroquinolones, or Tetracyclines?
Impaired Coumadin metabolism
What may occur if Coumadin interacts wieh NSAIDs, Omega-3s/6s?
Additive blood thinning
Which 4 drug types can interact with Coumadin to impair metabolism?
Azoles
Macrolides
Fluoroquinolones
Tetracyclines
Which 2 drug types may interact with Coumadin to increase blood thinning effects?
NSAIDs
Omega3/6
What is the vitamin K antagonist?
Coumadin
What are the 3 indications for Enoxaparin?
Post-op DVT
Unstable angina
What is the delivery route for Enoxaparin?
IV
What are the two drugs that are delivered by IV?
Enoxaparin
Abciximab
What is the MOA of Enoxaparin?
Low MW heparin
Binds to circulating antithrombin and accelerates the irreversible inactivation of factor Xa
What are the 2 side effects of Enoxaparin?
Hemorrhage
Fever
What is the 1 serious side effect of Enoxaparin?
Anemia
What are the 2 antidotes for Enoxaparin?
Heparin
Protamine sulfate
What drug types interact with Enoxaparin to cause additional blood thinning?
NSAIDs or Omega 3/6s
When does caution need to be had with Enoxaparin?
Recent ocular surgery
Diabetic retinopathy
HTN
Diabetes
What kind of drug is Rivaroxaban?
Vitamin K inhibitor - blood thinner
What are the indications of Rivaroxaban?
DVT and stroke prophy
What is the MOA of Rivaroxaban?
Factor Xa inhibitor
Selectively blocks the active site of factor Xa, inhibiting blood coagulation
What are the 2 common side effects of Rivaroxaban?
Hemorrhage
Pruritis
What is the possible hypersensitivity to Rivaroxaban?
Steven’s-Johnson syndrome
What is the antidote for Rivaroxaban?
None!
What happens when Macrolides, Fluoroquinolones, Cyclosporine, or Azoles interact with Rovaroxaban?
Decreased metabolism
What happens when NSAIDs interact with Rivaroxaban?
Hemorrhage
What are the 2 types of platelet inhibiting blood thinners?
Adenosine Receptor Blockers
Glycoprotein IIb/IIa Receptor Antagonists
What type of drug is Clopidrogrel?
Adenosine Receptor Blocker - blood thinner
What are the indications for Clopidrogrel?
Acute coronary syndrome
Thrombotic even prohpylaxis
What is the MOA of Clopidrogrel?
Prodrug, metabolised by CYP450 enzyme CYP2C19
Irreversible inhibition of platelet ADP receptors - stops the activation of GPIIb/IIIa complex
What are the 6 common side effects of Clopidrogrel?
Hemorrhage Pruritis Cough Bronchitis Dizziness Headache
What are the 3 possible hypersensitivity reactions to Clopidrogrel?
Angioedema
SJS
TEN
What things interact with Clopidrogrel to cause active bleeding?
Evening primrose oil
Flaxseed
Omega-3
NSAIDs
What happens when Clopidrogrel interacts with Detoconozole?
Reduced metabolism
What kind of drug is Abciximab?
Glycoprotein IIb/IIa receptor antagonist - blood thinner
What are the 2 indications for Abciximab?
Prevention of cardiac ischemic complications
Unstable angina
How is Abciximab administered?
IV
What is the MOA of Abciximab?
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
What are the 4 common side effects of Abciximab?
Hemorrhage
Hypotension
Dizziness
Headache
What drugs interact with Abciximab to cause additive bleeding?
Omega-3/6, NSAIDs
What are the 2 contraindications for Abciximab?
Recent surgery/trauma
Uncontrolled HTN