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Pharmacology > Cardio: Drugs Used for PAD and DVT > Flashcards

Cardio: Drugs Used for PAD and DVT Flashcards

1
Q

MOA of Cilostazol

A

PDE-3 inhibitor

  • increase cAMP, decrease platelet aggregation
  • also works fo vasodilate
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2
Q

When would you use cilostazol?

A

Intermitten claudication

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3
Q

Adverse effects of cilostazol?

A

Headache, edema

-other non-specifics

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4
Q

Can you use cilostazol in pts with HF?

A

No, it is contraindicated

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5
Q

What are some pharm treatments for DVT? (parenteral, oral, clot busters)

A

parenteral: Heparin, LMWH, fondaparinux, hirudin analogs, argatroban

Oral: warfarin, thrombin inhibitors, factor Xa inhibitors

Clot busters: -plase (TPAs)

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6
Q

Non-pharm options to treat DVT?

A

Stockings, Stents, IVC filter

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7
Q

MOA of Heparin

A

Long polysaccharine that binds and activates ATIII to inhibit Factors Xa and IIa

Rapid onset in treating Red Clots in PE, stroke, DVT, DIC

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8
Q

Which is rapid onset: Heparin or Warfarin?

A

Heparin

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9
Q

Is heparin safe in pregnancy?

A

Yes, “Keep your baby Heppy with Heparin”

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10
Q

What is the antidote to heparin or Low Molecular Weight Heparin (LMWH) OD?

A

Protamine

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11
Q

Is heparin given orally or parenterally?

A

Perenterally. Only IV or SubQ

IM=hematoma

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12
Q

What do you monitor with heparin and warfarin?

A

Heparin: PTT

Warfarin: PT
-war takes place outside, extrinsic

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13
Q

What are contrainidcations for all the drugs used for DVT?

A

Bleeding (hemophilia/thrombocytopenia) and stroke

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14
Q

What specific reaction can happen with heparin?

A

HIT

-paradoxical increase in thrombotic events due to reduced platelet counts via activation

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15
Q

What drugs are LMWH?

A

Enoxaparin, Delteparin, tinazeparin

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16
Q

MOA of LMWH?

A

Inhibits Xa, prevents red clots

-little effect on existing thrombin

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17
Q

Clinical use of LMWH

A

Prevention of DCT after knee/hip surgery
Treatment of DVT w/ or w/o PE history
Prevention of ischemic events in ACS

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18
Q

Is enoxaparin safe in pregnancy?

A

Yes

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19
Q

Which is more reliable, LMWH or heparin?

A

LMWH is easier to use, has a longer half life, and is now the first choice to prevent DVT

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20
Q

Toxicities associated with LWMH?

A

Bleeding, HIT, neuro injury

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21
Q

MOA of fondaparinux

A

Binds Xa, preventing II->IIa

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22
Q

Which one is more effective, fondaparinux or LMWH?

A

Fondaparinux is more effective, but bleeding risk is higher

23
Q

How do you administer fondaparinux?

A

SubQ Everyday

-long half life (too long?)

24
Q

Clinical applications of fondaparinux

A

Prevention of DVT
Acute PE with warfarin
Acute DVT with warfarin

25
Q

Is fondaparinux reversible with protamine?

A

No

26
Q

Does fondaparinux cause HIT?

A

No

27
Q

What are the Hirudin analogs?

A

Bivalirudin

28
Q

MOA of Bilvalirudin?

A

Reversible inhibition of thombin

29
Q

Clinical applications of bivalirudin?

A

Limited, second line therapy combined with asparin for angioplasty

30
Q

Route of entry for bivalirudin?

A

Must be given IV

-parenteral

31
Q

Toxicities of bilvirudin

A

Bleeding, but much less than heparin

32
Q

MOA of argatroban

A

Binds catalytic site of thrombin

-can be used to restore platelet counts after HIT

33
Q

Clinical aplications for Argatroban

A

Prophylaxis and treatment of HIT
-monitored w PTT

Probably will be test Q

34
Q

Route of entry for argatroban

A

IV, short half life

35
Q

MOA of Warfarin

A

Oral Inhibitor of vitamin K y-epoxide reductase

-decreases factors II, VII, IX, X and protein C/S

36
Q

Clinical applications of Warfarin

A

Long term prophylaxis of thrombosis

-especially in those with a-fib and mechanical heart valves

37
Q

Contraindications of warfarin?

A

Active bleeds or factor deficiency

38
Q

How do you monitor warfarin?

A

PT/INR (eliminated by liver)

-goal=between 2-3

39
Q

Is warfarin safe in pregnancy?

A

No, crosses the placenta and disrupts bone formation

40
Q

What are the first two factors/proteins affected in warfarin?

A

Factor VII and Protein C

41
Q

Why does warfarin cause skin necrosis?

A

Protein C has a shorter half-life, so it creates a hypercoagulable state

42
Q

MOA of Rivaroxaban (and other xabans)

A

direct (oral) inhibitor of Factor Xa (activated factor X)

43
Q

What are the advantages of Rivaroxaban over Heparin?

A 
Rapid,
Fixed dose,
less bleeding,
Fewer interactions,
No need to monitor INR
44
Q

Clinical applications of rivaroxaban?

A

Prevention of DVT after knee/hip replacement

Prevention of stroke in a-fib

45
Q

What is important when taking rivaroxaban?

A

Must dose on time (short half life)

46
Q

Route of entry for the direct factor X inhibitors?

A

Orally, with high bioavailability

47
Q

Contraindications to rivaroxaban?

A

Bleeds
Renal/hepatic impairment
Pregnancy

48
Q

MOA of dabigatran

A

direct (oral) thrombin inhibitor

49
Q

Route of entry of warfarin?

A

Oral

50
Q

Clinical application of dabigatran

A

Prevention of stroke in those with non-valvular A-fib

51
Q

If dabigatran safe in those with mechanical heart valves?

A

Nope, recently contrainidcated

52
Q

Antidote to dabigatran toxicity?

A

Idarucizumab

53
Q

Antidote to Xa inhibitors?

A

Andexanet alfa

54
Q

What is important to remember when storing dabigatran?

A

Must keep it in the manufacturer bottle

-pills are unstable==keep dry and room temp

Pharmacology (50 decks)

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