Cardio Drugs Flashcards
Unfractionated Heparin
MOA:
Complex with AT and inhibits factors Xa and IIa.
-Monitored by APTT (2-2.5x PTT is baseline therapeutic)
**Protamine antagonist (hep 2500, prt 25)
Route- IV or Sub Q
Indication-
- Surgical Anti-coagulation,
- Does not cross placenta barrier (pregnancy okay)
Adverse-
- HIT (Hep- PF4 complex, Ab form)
- Bleeding, osteoporosis, alopecia
Low Molecular Weight Heparins
(Branded and Generic)
Dalteparin
Nadroparin
Tinzaparin
Enoxaparin
MOA-
Complex with AT and inhibits factors Xa and IIa-Monitored by anti-Xa
-Kidney Excretion
Route: Subcutaneous-(better bioavailability than heparin)
Indication:
Prophylaxis and Treatment of DVT and ACS, Does not cross placenta barrier
Adverse- Bleeding
Fondaparinux
Pentasaccharide
MOA- Complex with AT and inhibits factor Xa
Route- Sub Q
Indication: Management of DVT
Adverse- Bleeding
Argatroban
MOA-
Directly Inhibits IIa, liver excretion, short T1/2
Route- Sub Q
Indication- Anticoagulant management of HIT patients
Adverse- Bleeding
Argatroban
MOA- Directly Inhibits IIa, liver excretion, short T1/2
Route- IV
Indication- Anticoagulant management of HIT patients
Adverse- Bleeding
Bivalirudin
MOA- Directly Inhibits IIa, renal excretion, short T1/2
Route- IV
Indication-Anticoagulant management of HIT patients
Adverse- Bleeding
Hirudin
MOA- Directly Inhibits IIa, no cofactor, renal excretion, short T1/2
Route- IV
Indication- Anticoagulant management of HIT patients
Adverse- Bleeding, 40% pt antibodies
Antithrombin Concentrate
MOA- Directly Inhibits IIa
Route- IV
Indication-
DIC, Sepsis, thrombophilia, hypercoagulable state
Adverse- none
Protamine Sulfate
MOA- Heparin Antagonist
Route- IV
Indication- Antagonist for unfractionated heparin -(only partial for LMW Heparin)
Adverse- bradycardia, hypotension
(needs to be administered slowly)
Warfarin
MOA-
Competitive antagonist of vitamin K. Suppresses the synthesis of functional forms of factors II, VII, IX and X by blocking enzyme epoxide reductase in liver
Monitoring- Prothrombin time (INR)
Indications- Prolonged treatment of DVT and Atrial Fibrillation
Adverse-
Bleeding, coumadin induced necrosis
Has interaction with several medications which can either potentiate the effects or inhibit the effects. Crosses placental barrier causing birth defects
Vitamin K
MOA- Cofactor in the synthesis of functional forms of factors II, VII, IX and X
Monitoring- not required
Indication-
Hypoprothrombinemia, intestinal disorders and gastrectomy, reverses the effects of warfarin
Adverse- Hemolysis
Oral Anti-Xa
Rivaroxaban (R) Apixaban (A) Edoxaban (E) Betrixaban (B)
MOA- inhibits factor Xa
Monitored- not required
Indication-
- Stroke prevention in pt with AF-R,A,E,B
- R & A,B also approved for prophylaxis and treatment of DVT.
- R approved for ACS
Adverse- Bleeding, liver toxicity (R, A, E)
Oral Antithrombin
Dabigatran
MOA- inhibits thrombin
Monitoring- not required
Indication-Stroke prevention in pt with AF
Adverse-
Bleeding, liver toxicity,
Cleared by kidney could problems in patients with abnormal kidney function.
Aspirin
MOA- COX inhibitor
ORAL
Indication- ACS, stroke, arterial thrombosis
Adverse-
Bleeding, GI irritation
Clopidogrel
ADP Receptor Inhibitor
ORAL
Indication- ACS, stroke, in stent thrombosis
Adverse-
Bleeding, TTP (thrombotic thrombocytopenic purpura)
Prasugrel, Ticagrelor
ADP receptor inhibitor
ORAL
Indication-
ACS, stroke, in stent thrombosis
Adverse- bleeding