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Pharmacology > Cardiovascular Meds: anticoagulants > Flashcards

Cardiovascular Meds: anticoagulants Flashcards

1
Q

Specify 3 laboratory tests to monitor the effectiveness of anticoagulants

A

PT/INR: patients who are taking Warfarin

aPTT: those who are taking Heparin

Heparin Anti-Xa level: those who are on unfractionated (UF) heparin and sometimes with low molecular weight (LMW) heparin

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2
Q

Describe the mechanisms of action of

  1. anticoagulants
  2. antiplatelets
  3. thrombolytics
A
  1. anticoagulants: disrupt the coagulation cascade, less fibrin is produced
  2. antiplatelets: inhibit platelet aggregation
  3. thrombolytics: lyse the clot
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3
Q

Recognize 3 major emergencies for patients on anticoagulants, antiplatelets, and thrombolytics

A
  1. shortness of breath or chest pain
  2. vital signs–low BP and high HR
  3. changes in level of consciousness/mental status
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4
Q

What are 4 examples of serious thrombi?

A
  1. pulmonary emboli
  2. myocardial infarction (MI)
  3. deep vein thrombosis (DVT)
  4. embolic stroke
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5
Q

Compare arterial blood clots with venous blood clots

A

Arterial blood clots:
damage to BV or rupture of plaques
–> platelets adhere to the site
–> platelets secrete ADP and TXA2 which attracts more platelets

Venous blood clots:
when venous flow is slow and stagnant, coagulation cascade occurs and fibrin is produced
–> fibrin attracts RBCs and platelets to make a clot

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6
Q

Specify whether anticoagulants treat thrombosis in arteries or veins

A

Anticoagulants treats THROMBOSIS IN VEINS !!!

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7
Q

Classify anticoagulants into 3 groups according to their mechanisms of action and give examples of each

A
  1. activates antithrombin: LMW heparin, UF heparin, and Fondaparinux
  2. Vitamin K antagonists: Warfarin
  3. Direct thrombin inhibitors: Bivalirudin
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8
Q

Specify whether antiplatelet drugs treat thrombosis in arteries or veins

A

Antiplatelets treat THROMBOSIS IN ARTERIES !!!

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9
Q

Classify antiplatelet drugs into 3 groups

A
  1. Aspirin
  2. P2Y12ADP receptor antagonists
  3. GP llb/lla receptor antagonists
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10
Q

Describe the mechanism of action of warfarin

A

Warfarin stops activation of Vitamin K

So there is less VK-dependent clotting factors (VII, IX, X< and prothrombin)

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11
Q

Specify the laboratory test to monitor therapeutic warfarin levels

A

PT/INR

*** monitor the lab work and adjust dosage –> the goal is to reach & maintain therapeutic warfarin level

*** normal INR level for someone not receiving warfarin is 1.0

*** patients with DVT, pulmonary embolism: target INR is 2-3

***patients with prosthetic aortic heart valves: 2.5-3.5

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12
Q

Recognize the dietary restrictions for patients on warfarin

A

Severely limit vitamin K rich foods!

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13
Q

List 3 contraindications of warfarin therapy

A
  1. current severe bleeding
  2. poor compliance to medication, INR monitoring, or dietary restrictions
  3. pregnant women
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14
Q

Identify 4 groups of patients who should take warfarin with caution

A
  1. uncontrolled hypertension
  2. severe liver disease
  3. recent surgery on brain, spinal column, or eye
  4. patients who are also taking OTC aspirin and NSAIDs
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15
Q

Describe the mechanism of action of “direct thrombin inhibitors”

A

Direct thrombin inhibitors are oral produrg:

dabigatran etexilate –> converted to dabigatran in the body
–> binds and inhibit prothrombin in the blood

***Fast onset
No lab monitoring, dietary restrictions, dosage is not weight dependent
Lower risk of serious bleeding

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16
Q

Name an example of direct thrombin inhibitors and specify the drug approved for its reversal

A

dabigatran etexilate

antidote for overdose: Idarucizumab

17
Q

3 therapeutic uses of direct thrombin inhibitors

A
  1. atrial fib
  2. knee/hip replacement (immobility –> risk of developing clots)
  3. DVT/PE
18
Q

Recognize the rationale for giving unfractionated heparin (UFH) subcutaneous or intravenous (IV)

A

No oral route for UF heparin!

Reason: UF heparin is a large polymer with negative charge –> cannot cross membrane!

19
Q

What is MOA of heparin?

A

Heparin is a helper to antithrombin, which inactivates factor Xa and thrombin)

20
Q

Describe the common laboratory test that is used to monitor UFH therapy and state its normal value and therapeutic target

A

aPTT monitoring (activated partial thromboplastin time)

Normal values: 40 sec
Therapeutic target: 60-80 sec (1.5-2x times normal)

21
Q

Identify 6 factors that affect the bioavailability of heparin

A
  1. aging
  2. obesity
  3. changes in heparin binding proteins
  4. liver diseases
  5. kidney diseases
  6. heparin resistance
22
Q

***List 2 conditions that lead to prolonged activated partial thromboplastic (aPTT) without heparin

A

Lupus (autoimmune disease)
Deficiency in contact factors

23
Q

Specify the patient group at a higher risk of developing HIT

A

Post-op patients

24
Q

Define heparin-induced thrombocytopenia (HIT) type II and describe its pathophysiology

A

Type 2 HIT is an immune-mediated disorder (due to abnormal antibodies) that typically occurs 4-10 days after exposure to heparin and has life- and limb-threatening thrombotic complications

25
Q

Identify 5 complications of HIT type II

A

Complications include clots–not bleeding!

  1. DVT
  2. PE
  3. skin necrosis
  4. MI
  5. venous gangrene
26
Q

List an example of low-molecular weight heparin (LMWH)

A

enoxaparin

Sub Q administration

27
Q

Recount 3 differences between LMWH and unfractionated heparin (UFH)

A

LMWH is:

  1. broken into smaller pieces
  2. more specific to factor Xa inactivation
  3. more predictable; they can be given as a weight based dose
28
Q

What is the antidote for heparin overdosing?

A

Protamine sulfate

29
Q

Describe the mechanism of action of aspirin and list the 2 therapeutic uses of aspirin

A

Aspirin suppresses platelet aggregation by inhibiting the isoenzyme “cyclooxygenase (COX)” which leads to pain relief and the reduction of inflammation, fever, and clots.

Therapeutic uses:
1. MI and angina
2. ischemic stroke and transient ischemic attacks (TIAs)

30
Q

Describe the mechanism of action of clopidogrel and list the 2 therapeutic uses of clopidogrel

A

Clopidogrel is a prodrug –> metabolized in the liver into its’ active form –> suppresses platelet clumping by blocking P2Y12ADP receptors on the platelets

Therapeutic uses:
- keep coronary stents open
- reduce thrombotic events such as MI, stroke, or peripheral arterial disease

31
Q

Name an example of glycoprotein IIB/IIIa (GPIIB/IIIa) receptor blockers

A

Amociximab

Two things to know:
1. Most effective antiplatelet drugs
2. Must be given IV

Nice to know:
Block the last step of platelet aggregation by blocking the receptor –> prevent fibrinogen & vWf factors from binding on platelets

32
Q

State 2 indications of GPIIB/IIIa receptor blockers (Abciximab)

A
  1. Percutaneous Coronary Intervention (PCI)
  2. Acute Coronary Syndromes (unstable angina and non-STEMI)
33
Q

List precautions for GPIIB/IIIa receptor blockers

A
  1. The elderly, patients with renal disease, and women
    –> higher risk of bleeding
  2. No reversal agent
34
Q

What kind of lab work must be drawn for Abciximab administration?

A
  1. Platelet count
  2. Hb labs
35
Q

Discuss the MOA of thrombolytic therapy and name 1 drug in this class

A

Alteplase (tPA)

converts plasminogen to plasmin –> dissolve clots!

tPA is for emergency use only!

Pharmacology (20 decks)

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