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PHARMACOLOGY > chapter 52- anticoagulant, antiplatelet > Flashcards

chapter 52- anticoagulant, antiplatelet Flashcards

1
Q

Anticoagulant drugs

A

Heparin and warfarin

  • the reduce formation of fibrinogen
  • All anticoagulants interfere with some point in the coagulation cascade
  • These agents can be given parenterally or orally
  • Anticoagulants are indicated for both treatment and prophylaxis of thromboembolism
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2
Q

Unfractionated Heparin (UFH) mechanism of action

A

Antithrombin III undergoes a conformational change that enhances its binding capability

  • Heparin has a rapid onset of action. Anticoagulant effects begin as soon as heparin starts binding to antithrombin III.
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3
Q

what does Unfractionated Heparin (UFH) binds to

A

UFH binds to factor IIa (thrombin) and factor Xa

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4
Q

Unfractionated Heparin (UFH) indications

A
  • Treatment of venous thromboembolism (VTE)
  • Prophylaxis of VTE
  • Myocardial infarction
  • Atrial fibrillation
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5
Q

Unfractionated Heparin adverse effects

A
  • Hemorrhage
  • Spinal/epidural hematoma
  • Heparin-induced thrombocytopenia (HIT)
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6
Q

Unfractionated Heparin laboratory monitoring

A
  • Activated partial thromboplastin time (aPTT)

- Anti-factor Xa Assay

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7
Q

Reversal of Unfractionated Heparin

A

Protamine

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8
Q

Administration of protamine

A
  • SLOW IV push

- Rapid administration will cause hypotension

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9
Q

low molecular weigh heparins (LMWH)

A

Enoxaparin

Dalteparin

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10
Q

low molecular weigh heparins (LMWH) indications

A
  • Prevention of deep vein thrombosis (DVT)
  • Treatment of venous thromboembolism (VTE)
  • Treatment of myocardial infarction (MI)
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11
Q

pharmokinetics of low molecular weigh heparins (LMWH)

A

Renally excreted

  • Doses must be reduced in renal impairment
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12
Q

low molecular weigh heparins (LMWH) adverse effects

A
  • Hemorrhage
  • Spinal/epidural hematoma
  • Heparin-induced thrombocytopenia
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13
Q

low molecular weigh heparins (LMWH) monitoring points

A

not required

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14
Q

Fondaparinux mechanism of action

A

Pentasacchride binds to antithrombin and causes conformational change

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15
Q

what does Fondaparinux bind to

A

ONLY binds to factor Xa

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16
Q

Indications of fondaparinux

A
  • Prophylaxis of DVT

- Treatment of VTE

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17
Q

fondaparinux monitoring points

A

No laboratory monitoring required

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18
Q

adverse effects of fondaparinux

A
  • Hemorrhage
  • Spinal/epidural hematoma
  • NO risk of HIT
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19
Q

Warfarin Mechanism of Action

A

Decreases production of clotting factors Seven, Nine, Ten and Two (SNTT)

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20
Q

vitamin K antagonist

A

warfarin

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21
Q

indications of warfarin

A
  • atrial fibrillation
  • mechanical heart valves
  • VTE
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22
Q

monitoring points for warfarin

A

International Normalized Ratio (INR)

23
Q

pharmacokinetics of warfarin

A

Full effects in 3 to 5 days

24
Q

dietary interactions of warfarin

A
  • Vitamin K from diet can ↓ effectiveness of warfarin
  • Keep intake of high vitamin K foods consistent
  • If vitamin K intake ↑, then warfarin doses need to be ↑
  • If vitamin K intake ↓, then warfarin doses need to be ↓
25
Examples of vitamin K rich foods:
- Mayonnaise - Green leafy vegetables (spinach, kale) - Soybean oil
26
reversal of warfarin effects
- Vitamin K (phytonadione) | - Must also administer fresh frozen plasma (FFP) in life-threatening bleeds
27
Direct Thrombin Inhibitors (DTI)
Dabigatran (PO) Bivalirudin (IV) Argatroban (IV)
28
Direct Thrombin Inhibitors (DTI) mechanism of action
Bind to and inhibit factor IIa (thrombin) - NO need for laboratory monitoring with oral medications
29
adverse effect of Dabigatran
Dyspepsia
30
monitoring/counseling points of dabigatran
- No laboratory monitoring - Educate on signs/symptoms of bleeding - Reversal: Idarucizumab (Praxbind)
31
Factor Xa Inhibitors
- Rivaroxaban | - Apixaban
32
monitoring points for Factor Xa Inhibitors
No laboratory monitoring required
33
Rivaroxaban monitoring points
Take with food
34
reversal of rivaroxaban and apixaban
Adexanet-alfa
35
three main groups of Antiplatelet Drugs
- Aspirin - P2Y12 ADP inhibitors - GIIb/IIIa inhibitors
36
aspirin mechanism of action
- Irreversible inhibitor of COX-1 and COX-2 - Prevents production of thromboxane A2 (TXA2) - TXA2 can promote platelet aggregation
37
adverse effects of aspirin
GI bleeding and ulcers
38
indication of aspirin
- Transient ischemic attack (TIA) - Ischemic stroke - Acute coronary syndrome
39
drugs of P2Y12 Adenosine Diphosphate Receptor Antagonists
- Clopidogrel (irreversible inhibitor) - Prasugrel (irreversible inhibitor) - Ticagrelor (reversible inhibitor) ALL ORAL
40
Clopidogrel monitoring/counseling points
- clopidogrel is a prodrug | - Possible DDI with omeprazole because omeprazole inhibits CYP2C19
41
Ticagrelor | adverse effects
dyspnea
42
Glycoprotein IIb/IIIa Receptor Antagonists drugs
- Tirofiban - Eptifibatide - Abciximab
43
Mechanism of action Glycoprotein IIb/IIIa Receptor Antagonists
Reversible blockade of GIIb/IIIa receptors
44
Glycoprotein IIb/IIIa Receptor Antagonists indications
- acute coronary syndromes (ACS) and undergoing PCI | - Typically only used in the cath lab
45
Glycoprotein IIb/IIIa Receptor Antagonists are used in combination with?
they are used in combination with heparin during PCI
46
Thrombolytic (Fibrinolytic) Drugs
- Alteplase (MOST COMMON) | - Tenecteplase
47
adverse effects of Thrombolytic (Fibrinolytic) Drugs
high risk of bleeding
48
'Clot-busting’ drugs
Thrombolytic (Fibrinolytic) Drugs - Alteplase - Tenecteplase
49
when are Thrombolytic (Fibrinolytic) Drugs used
Only used acutely for severe thrombus: - Ischemic stroke - Myocardial infarction - Pulmonary embolism
50
another name for altepase
- tissue plasminogen activator (tPA)
51
indications of Alteplase
- Acute ischemic stroke - Acute myocardial infarction - Acute pulmonary embolism
52
Time is issue with alteplase
give these medications as quickly as possible!
53
adverse effects of alteplase
- Bleeding | - Angioedema
54
Methods to lower bleeding risk for alteplase
- Avoid SQ or IM injections during administration - Minimize invasive procedures - Minimize concurrent use of anticoagulants or antiplatelet drugs

PHARMACOLOGY (7 decks)

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