Coagulation and Dyslipidemia

Question 1

Antithrombotic agents

Answer 1

inhibit platelet function AND prevent thrombus formation

Question 2

Antiplatelet agents

Answer 2

inhibit platelet function

Question 3

anticoagulant agents

Answer 3

alter clotting factors and prevent thrombus formation

Question 4

thrombolytic agents

Answer 4

help breakdown thrombus once formed and restore flow

Question 5

Heparin therapeutic uses

Answer 5

• ACS
• a fib
• medical and surgical VTE prophylaxis
• prosthetic heart valves
• trauma
• venous thromboembolism

Question 6

Heparin monitering

Answer 6

• s/sx of bleeding, aPTT, H/H, platelets

Question 7

Heparin side effects

Answer 7

bleeding

thrombocytopenia

Question 8

Heparin cautions/contraindicatino

Answer 8

bleeding

thrombocytopenia

Question 9

Heparin

Answer 9

• Commonly the initial agent used
• Very fast onset and elimination
• Not orally bioavailable, can only be given IV or subcutaneously
• Derived from pork
• Be aware of pork allergies
• More monitoring required compared to LMWH
• Protamine sulfate is reversal agent

Question 10

LMWH

Answer 10

• Initial agent used sometimes
• Longer onset and elimination
• More predictable response
• Also not orally bioavailable, given SQ
• Derived from pork
• Efficacy monitoring not required if used short term
• Administered once or twice a day (usually twice a day)
• Good outpatient option for VTE
• Not an alternative if patient develops HIT
• More expensive than UFH but has been shown to be cost effective for the treatment of VTE
• Can be partially reversed by protamine sulfate

Question 11

Warfarin therapeutic uses

Answer 11

• Prophylaxis of venous thrombosis (high-risk surgery)
• Treatment of VTE
• Prevention of systemic embolism
• Acute MI
• Valvular heart disease
• Atrial Fibrillation
• Heart valves (tissue, mechanical)
• Anti-phospholipid Antibody Syndrome

Question 12

Warfarin side effects

Answer 12

bleeding

skin necrosis

Question 13

Warfarin cautions/contraindications

Answer 13

Active bleeding, pregnancy, recent or potential surgery, CVA, aneurysms-cerebral, dissecting aorta
pericarditis and pericardial effusion, inadequate laboratory facilities, unsupervised, senile, alcoholic or psychotic patients
spinal puncture and other procedures with potential for uncontrollable bleeding, major regional, lumbar block anesthesia

Question 14

Warfarin

Answer 14

• Original oral agent
• Takes a few days before anticoagulant effect is seen -> start with a parenteral agent and warfarin until INR is therapeutic
• Requires frequent close monitoring
• Patient education is key
• Highly affected by diet, other medications, and genetics

Question 15

Direct thrombin inhibitor, Oral Factor- Xa inhibitor, Factor Xa inhibitor

Answer 15

• Therapeutic Use: -Non-valvular atrial fibrillation -Treatment and secondary prevention of VTE
• Administered orally twice daily
• Monitor: s/sx bleeding, H/H, renal function
• Side effects: Bleeding, GI side effects
• No reversal agent

Question 16

thrombolytic therapeutic use

Answer 16

stroke (alteplase only)
AMI
Massive PE
catheter clearance (alteplase only)

Question 17

thrombolytics contraindications

Answer 17

• History of CVA, GI bleed, trauma or major surgery within past month
• Hypertension (<185/110)
• Intracranial neoplasm
• Suspected aortic dissection, AVM or aneurysm
• Active bleeding
• Suspected ICH

Question 18

Statins therapeutic uses

Answer 18

• dyslipidemia
• post MI
• Primary prevention of CV disease

Question 19

Statins monitering

Answer 19

• lipids
• cpk
• baseline LFTs

Question 20

statins side effects

Answer 20

Headache, GI, myalgia, rhabdomyolysis (rare but serious)

Question 21

statins contraindications

Answer 21

• liver disease

Question 22

KEY POINTS

Answer 22

• Normal hemostasis is a balance between excessive and inadequate blood clotting.
• Thrombus formation and occlusion can occur with overactive blood clotting.
• Anticoagulant drugs (heparin & warfarin) and platelet inhibitors (aspirin) are used to treat venous thrombus formation and arterial thrombogenesis, respectively.
• Conditions such as hemophilia by need vitamin K to improve clotting factors or antifibrinolyticagents to inhibit clot breakdown.
• Hyperlipidemia drugs focus on minimizing atherosclerotic plaque formation.