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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
Q

Examples of vitamin K rich foods:

A
  • Mayonnaise
  • Green leafy vegetables (spinach, kale)
  • Soybean oil
26
Q

reversal of warfarin effects

A
  • Vitamin K (phytonadione)

- Must also administer fresh frozen plasma (FFP) in life-threatening bleeds

27
Q

Direct Thrombin Inhibitors (DTI)

A

Dabigatran (PO)
Bivalirudin (IV)
Argatroban (IV)

28
Q

Direct Thrombin Inhibitors (DTI) mechanism of action

A

Bind to and inhibit factor IIa (thrombin)

  • NO need for laboratory monitoring with oral medications
29
Q

adverse effect of Dabigatran

A

Dyspepsia

30
Q

monitoring/counseling points of dabigatran

A
  • No laboratory monitoring
  • Educate on signs/symptoms of bleeding
  • Reversal: Idarucizumab (Praxbind)
31
Q

Factor Xa Inhibitors

A
  • Rivaroxaban

- Apixaban

32
Q

monitoring points for Factor Xa Inhibitors

A

No laboratory monitoring required

33
Q

Rivaroxaban monitoring points

A

Take with food

34
Q

reversal of rivaroxaban and apixaban

A

Adexanet-alfa

35
Q

three main groups of Antiplatelet Drugs

A
  • Aspirin
  • P2Y12 ADP inhibitors
  • GIIb/IIIa inhibitors
36
Q

aspirin mechanism of action

A
  • Irreversible inhibitor of COX-1 and COX-2
  • Prevents production of thromboxane A2 (TXA2)
  • TXA2 can promote platelet aggregation
37
Q

adverse effects of aspirin

A

GI bleeding and ulcers

38
Q

indication of aspirin

A
  • Transient ischemic attack (TIA)
  • Ischemic stroke
  • Acute coronary syndrome
39
Q

drugs of P2Y12 Adenosine Diphosphate Receptor Antagonists

A
  • Clopidogrel (irreversible inhibitor)
  • Prasugrel (irreversible inhibitor)
  • Ticagrelor (reversible inhibitor)

ALL ORAL

40
Q

Clopidogrel monitoring/counseling points

A
  • clopidogrel is a prodrug

- Possible DDI with omeprazole because omeprazole inhibits CYP2C19

41
Q

Ticagrelor

adverse effects

A

dyspnea

42
Q

Glycoprotein IIb/IIIa Receptor Antagonists drugs

A
  • Tirofiban
  • Eptifibatide
  • Abciximab
43
Q

Mechanism of action Glycoprotein IIb/IIIa Receptor Antagonists

A

Reversible blockade of GIIb/IIIa receptors

44
Q

Glycoprotein IIb/IIIa Receptor Antagonists indications

A
  • acute coronary syndromes (ACS) and undergoing PCI

- Typically only used in the cath lab

45
Q

Glycoprotein IIb/IIIa Receptor Antagonists are used in combination with?

A

they are used in combination with heparin during PCI

46
Q

Thrombolytic (Fibrinolytic) Drugs

A
  • Alteplase (MOST COMMON)

- Tenecteplase

47
Q

adverse effects of Thrombolytic (Fibrinolytic) Drugs

A

high risk of bleeding

48
Q

‘Clot-busting’ drugs

A

Thrombolytic (Fibrinolytic) Drugs

  • Alteplase
  • Tenecteplase
49
Q

when are Thrombolytic (Fibrinolytic) Drugs used

A

Only used acutely for severe thrombus:

  • Ischemic stroke
  • Myocardial infarction
  • Pulmonary embolism
50
Q

another name for altepase

A
  • tissue plasminogen activator (tPA)
51
Q

indications of Alteplase

A
  • Acute ischemic stroke
  • Acute myocardial infarction
  • Acute pulmonary embolism
52
Q

Time is issue with alteplase

A

give these medications as quickly as possible!

53
Q

adverse effects of alteplase

A
  • Bleeding

- Angioedema

54
Q

Methods to lower bleeding risk for alteplase

A
  • 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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