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Pharmacology for Advanced Practice Nurses > Coagulation > Flashcards

Coagulation Flashcards

1
Q

Factor Xa inhibitor examples

A

Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Endoxaban (Savaysa)
Betrixaban (Bevyxxa)

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2
Q

Warfarin (Coumadin)

Inhibits synthesis

A

of vitamin K–dependent clotting factors X, IX, VII, and II (prothrombin)

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3
Q

Heparin

Binds with

A

antithrombin III

Inactivates factors IXa, Xa, XIIa, XIII

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4
Q

Low-molecular-weight heparin (LMWH)

Regular heparin is processed

A

into smaller molecules

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5
Q

examples of LMWH and action

A

Enoxaparin (Lovenox), dalteparin (Fragmin)

Inactivates factor Xa

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6
Q

Fondaparinux (Arixta)

Selective inhibitor of

A

antithrombin III and factor Xa inhibitor

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7
Q

Heparin and LMWH sometimes will be given as a bridge until

A

warfarin is effective

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8
Q

Warfarin is well absorbed when taken

A

orally

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9
Q

warfarin is metabolized by and half life

A

CYP1A2 and 2C9

Half-life of 3 to 4 days

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10
Q

Warfarin precautions and contraindications

A

Pregnancy category X
Use cautiously in patients with fall risk, dementia, or uncontrolled hypertension
Avoid in hypermetabolic state

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11
Q

Warfarin ADR

A

Bleeding
Antidote is vitamin K
Allergic reactions

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12
Q

Warfarin Drug Interactions

A

Bleeding
Antidote is vitamin K
Allergic reactions

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13
Q

Warfarin anticoagulant effect may be decreased by

A

Oral contraceptives, carbamazepine, etc.

Vitamin K–containing foods

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14
Q

Warfarin clinical use and dosing

A

Start at 5 mg per day (7.5 mg/day if weight greater than 80 kg)

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15
Q

Warfarin is the drug of choice for

A

Drug of choice for deep vein thrombosis (DVT) and pulmonary embolism (PE

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16
Q

Consider lower dose of Warfarin if

A

Older than 75 years
Multiple comorbid conditions
Elevated liver enzymes
Changing thyroid status

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17
Q

Dose of warfarin is to maintain an INR between

A

2 and 3

18
Q

Warfarin monitoring

A

INR daily until in therapeutic range for 2 consecutive days
Then two or three times weekly for 1 to 2 weeks
Then less frequently but at least every 6 weeks

19
Q

Factor Xa directly inhibits

A

Factor Xa in the clotting cascade

20
Q

Factor Xa reduction in

A

risk of stroke and systemic embolism in nonvalvular atrial fibrillation

21
Q

Factor Xa is used as prophylaxis of

A

DVT following knee replacement surgery

22
Q

Per the American college of clinical pharamcy the treatmen tfor DVT or PE after initial stabilization is

A

Factor Xa (dibigatron, rivaroxaban, apixaban or endoxaban for 3 months.)

Warfarin is second line

23
Q

Factor Xa inhibitors and interacting drugs

A

Betrixaban and P-glycoprotein (P-gp) inhibitors
Apixaban and P-gp or CYP3A4 inhibitors
Rivaroxaban and P-gp/CYP3A4 inducers
Vorapaxar and CYP3A inhibitors

24
Q

Oral Direct Thrombin Inhibitors example

A

Dabigatran (Pradaxa)

25
Q

Dabigatran is the only

A

oral direct thrombin inhibitor available for clinical use

26
Q

Dabigatran is an orally administstred

A

prodrug that is converted in the liver to dabigatran, an active direct thrombin inhibitor that inhibits clot-bound and circulating thrombin

27
Q

dabigatran half life

A

12 to 17 hours (normal renal function)

28
Q

Dabigatran use

A

prevention and management of VTE, stroke prevention in afib and ischemic heart disease

29
Q

Dabigatrain contraindications

A

prosthetic heart values or pregnancy

30
Q

dabigatrain

A

no monitoring

31
Q

dabigatrain monitoring

A

none

32
Q

dabigatran before initiation

A

platelet count, PT, aPTT – after that no routine monitoring

33
Q

dabigatran SE

A

GI

34
Q

ASA MOA and how long to efffects last

A

binding irreversibly to the enzyme cyclooxygenase in platelets, which inhibits the formation of thromboxane A2, a powerful inducer of platelet aggregation.

**Effects may persist up to a week.

35
Q

ASA indication

A

prevention of stroke & MI

36
Q

Adenosine diphosphate (ADP) receptor blockers – Examples

A

Ticlopidine & Clopidogrel (examples)

37
Q

Adenosine diphosphate (ADP) receptor blockers – MOA

A

irreversibly block the ADP receptors, altering the plasma membrane of platelets.

38
Q

Glycoprotein IIb/IIIa receptor antagonists

MOA*:

A

block the glycoprotein IIb/IIIa receptors

39
Q

Glycoprotein IIb/IIIa receptor antagonists - Indication

A

prevent thrombi in recent MI, stroke or PCI

40
Q

With warfarin monitor

A

intake of Vit K. eg. green leafy vegitables

Pharmacology for Advanced Practice Nurses (50 decks)

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