Blood Thinners

Question 1

When is Coumadin [Warfarin®] indicated?

Answer 1

Vitamin K antagonist

Anticoagulation

Question 2

When is Enoxaparin (Lovenox) indicated?

Answer 2

Coagulation factor Antagonist
Post-op Deep Vein Thrombosis prophylaxis (commonly given with ASA)
Unstable Angina

Question 3

When is Rivaroxaban indicated?

Answer 3

Coagulation factor antagonist

DVT & Stroke Prophylaxis (can be administered orally VS Enoxaparin)

Question 4

When is Clopidogrel (PLAVIX) indicated?

Answer 4

Adenosine Receptor Blocker
Platelet inhibitor
Acute Coronary Syndrome, Thrombotic Event Prophylaxis

Question 5

When is Abciximab indicated?

Answer 5

Glycoprotein IIb/IIIa Receptor Antagonists
Platelet inhibitor
An adjunct to percutaneous coronary intervention (PCI) for the prevention of cardiac ischemic complications
Unstable angina

Question 6

Drug interactions with Coumadin?

Answer 6

Azole antifungals, Macrolides, Fluoroquinolones, Tetracyclines (Impair Coumadin metabolism)
NSAIDs, Omega-3 & Omega-6 fatty acids (Additive blood thinning effects)

Question 7

Drug interactions with Enoxaparin?

Answer 7

NSAIDs, Omega-3 & Omega-6 fatty acids (Additive)

Question 8

Drug interactions with Rivaroxaban?

Answer 8

Macrolides, Fluoroquinolones , Cyclosporine, Azoles (increased Rivaroxaban levels)
NSAIDs (additive hemorrhage)
Ophthalmic NSAIDs, Omega fatty acids (additive hemorrhage)

Question 9

Drug interactions with Clopidogrel?

Answer 9

Evening Primrose Oil, Flaxseed, Omega-3 FA, NSAIDs (Additive)
Ketoconazole (Reduced metabolism/activation)

Question 10

Drug interactions with Abciximab?

Answer 10

Omega-3 & Omega-6 fatty acids, NSAIDs (Additive)
Ophthalmic NSAIDs (Additive)

Question 11

Contraindications of Abciximab?

Answer 11

Recent surgery or trauma

Uncontrolled hypertension

Question 12

Contraindications of Clopidogrel?

Answer 12

Caution:

Ocular disease

Question 13

Contraindications of Rivaroxiban?

Answer 13

Caution:

Active major bleeding

Question 14

Contraindications of Enxaparin?

Answer 14

Caution:
Recent ocular surgery
Diabetic retinopathy
Hypertension
Diabetes

Question 15

Contraindications of Coumadin?

Answer 15

Recent ocular surgery
Hypertension
Diabetes

Question 16

What are the side effects of Coumadin?

Answer 16

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

Question 17

What are the side effects of Enoxaparin?

Answer 17

ADVERSE EFFECTS
Common: hemorrhage, fever
SERIOUS ADVERSE EFFECTS
Hematology: Anemia
Antidote: Heparin or protamine sulfate

Question 18

What are the side effects of Rivaroxiban?

Answer 18

ADVERSE EFFECTS
Common: hemorrhage, pruritus
SERIOUS ADVERSE EFFECTS
Severe hemorrhage
Hypersensitivity: SJS
No antidote!

Question 19

What are the side effects of Clopidogrel?

Answer 19

ADVERSE EFFECTS
Common: hemorrhage, pruritus, cough, bronchitis, dizziness, headache
SERIOUS ADVERSE EFFECTS
Hypersensitivity: Angioedema, SJS, Toxic epidermal necrolysis (TEN)
Hematology: thrombotic thrombocytopenic purpura (TTP)

Question 20

What are the side effects of Abciximab?

Answer 20

ADVERSE EFFECTS

Common: hemorrhage, hypotension, dizziness, headache

Question 21

What is the mechanism of action of Clopidogrel?

Answer 21

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

Question 22

What is the mechanism of action of Rivaroxiban?

Answer 22

Coagulation factor antagonist
Factor-Xa inhibitor
Selectively blocks the active site of Factor-Xa, inhibiting blood coagulation

Question 23

What is the mechanism of action of Enoxaparin?

Answer 23

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)

Question 24

What is the mechanism of action of Coumadin?

Answer 24

Vitamin K antagonist

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

Question 25

What is the mechanism of action of Abciximab?

Answer 25

Platelet inhibitor
Fab fragment: a chimeric human-murine mAB
Binds to the GP IIb/IIIa receptor of human platelets and inhibits platelet aggregation
Binds to the vitronectin (αvβ3) receptor on platelets and vessel wall endothelial and smooth muscle cells