Blood Thinners Flashcards
When is Coumadin [Warfarin®] indicated?
Vitamin K antagonist
Anticoagulation
When is Enoxaparin (Lovenox) indicated?
Coagulation factor Antagonist
Post-op Deep Vein Thrombosis prophylaxis (commonly given with ASA)
Unstable Angina
When is Rivaroxaban indicated?
Coagulation factor antagonist
DVT & Stroke Prophylaxis (can be administered orally VS Enoxaparin)
When is Clopidogrel (PLAVIX) indicated?
Adenosine Receptor Blocker
Platelet inhibitor
Acute Coronary Syndrome, Thrombotic Event Prophylaxis
When is Abciximab indicated?
Glycoprotein IIb/IIIa Receptor Antagonists
Platelet inhibitor
An adjunct to percutaneous coronary intervention (PCI) for the prevention of cardiac ischemic complications
Unstable angina
Drug interactions with Coumadin?
Azole antifungals, Macrolides, Fluoroquinolones, Tetracyclines (Impair Coumadin metabolism)
NSAIDs, Omega-3 & Omega-6 fatty acids (Additive blood thinning effects)
Drug interactions with Enoxaparin?
NSAIDs, Omega-3 & Omega-6 fatty acids (Additive)
Drug interactions with Rivaroxaban?
Macrolides, Fluoroquinolones , Cyclosporine, Azoles (increased Rivaroxaban levels)
NSAIDs (additive hemorrhage)
Ophthalmic NSAIDs, Omega fatty acids (additive hemorrhage)
Drug interactions with Clopidogrel?
Evening Primrose Oil, Flaxseed, Omega-3 FA, NSAIDs (Additive)
Ketoconazole (Reduced metabolism/activation)
Drug interactions with Abciximab?
Omega-3 & Omega-6 fatty acids, NSAIDs (Additive) Ophthalmic NSAIDs (Additive)
Contraindications of Abciximab?
Recent surgery or trauma
Uncontrolled hypertension
Contraindications of Clopidogrel?
Caution:
Ocular disease
Contraindications of Rivaroxiban?
Caution:
Active major bleeding
Contraindications of Enxaparin?
Caution: Recent ocular surgery Diabetic retinopathy Hypertension Diabetes
Contraindications of Coumadin?
Recent ocular surgery
Hypertension
Diabetes
What are the side effects of Coumadin?
ADVERSE EFFECTS
Common: Bleeding/bruising, headache, dizziness, pruritus, edema, dermatitis, fever, paresthesias, alopecia
SERIOUS ADVERSE EFFECTS
CV: syncope, vasculitis, hemorrhage, cholesterol embolism
Hematology: anemia
Antidote: Vitamin K or prothrombin complex concentrate
What are the side effects of Enoxaparin?
ADVERSE EFFECTS Common: hemorrhage, fever SERIOUS ADVERSE EFFECTS Hematology: Anemia Antidote: Heparin or protamine sulfate
What are the side effects of Rivaroxiban?
ADVERSE EFFECTS Common: hemorrhage, pruritus SERIOUS ADVERSE EFFECTS Severe hemorrhage Hypersensitivity: SJS No antidote!
What are the side effects of Clopidogrel?
ADVERSE EFFECTS
Common: hemorrhage, pruritus, cough, bronchitis, dizziness, headache
SERIOUS ADVERSE EFFECTS
Hypersensitivity: Angioedema, SJS, Toxic epidermal necrolysis (TEN)
Hematology: thrombotic thrombocytopenic purpura (TTP)
What are the side effects of Abciximab?
ADVERSE EFFECTS
Common: hemorrhage, hypotension, dizziness, headache
What is the mechanism of action of Clopidogrel?
Platelet Inhibitor
Prodrug: metabolized to active metabolite by the CYP450 enzyme CYP2C19*
Irreversible inhibition of platelet ADP receptors which normally trigger platelet activation and aggregation via downstream activation of the GPIIb/IIIa complex
What is the mechanism of action of Rivaroxiban?
Coagulation factor antagonist
Factor-Xa inhibitor
Selectively blocks the active site of Factor-Xa, inhibiting blood coagulation
What is the mechanism of action of Enoxaparin?
Coagulation factor antagonist
Fractionated, heterogeneous low molecular weight heparin (LMWH) extracted from porcine intestinal mucosa
Binds to the circulating anticoagulant antithrombin and accelerates its irreversible inactivation of clotting Factor-Xa much more so than Factor-IIa (thrombin)
What is the mechanism of action of Coumadin?
Vitamin K antagonist
Inhibits vitamin K-dependent coagulation factor synthesis (II, VII, IX, X, proteins C and S)
