Coagulation And Hyperlipidemia Drugs

Question 1

Vitamin K antagonist - anticoagulant/anti-platelet, example and MOA

Answer 1

Anticoagulant

Ex. Warfarin (Coumadin)

Inhibits vitamin K dependent clotting factors

Question 2

Vitamin K antagonist - clinical utility, SE

Answer 2

Clinical: a-fib, DVT/PE prevention and tx, valve replacement

SE: bleeding, skin necrosis (rare), teratogenic

Question 3

Direct thrombin inhibitors - anticoagulant/anti-platelet, example, MOA

Answer 3

Anticoagulant

Dabigatran (Pradaxa)

MOA: inhibits thrombin directly

Question 4

Dabigatran - clinical utility, SE

Answer 4

Clinical: a-fib, DVT/PE tx

SE: bleeding, GI symptoms

Question 5

Apixaban MOA

Answer 5

inhibit factor Xa, preventing prothrombin conversion to thrombin

Question 6

Apixaban SE

Answer 6

SE: bleeding, elevated liver enzymes

Question 7

Heparin MOA

Answer 7

Enhance activity of antithrombin, inhibiting thrombin and Factor Xa

Question 8

Heparin SE

Answer 8

Bleeding, heparin-induced thrombocytopenia (HIT)

Question 9

Aspirin MOA

Answer 9

Irreversibly inhibit COX-1, reducing thromboxane A2 production leading to decreased platelet aggregation

Question 10

Aspirin SE

Answer 10

bleeding, gastric ulceration, tinnitus

Question 11

Clopidogrel MOA

Answer 11

Inhibits platelet P2Y12 ADP receptor reducing platelet activation and aggregation

Question 12

Clopidogrel SE

Answer 12

bleeding, dyspnea (ticagrelor)

Question 13

Alteplase MOA

Answer 13

Activate plasminogen to plasmin, which digests fibrin and dissolves clots

Question 14

Alteplase SE

Answer 14

bleeding (including intracranial hemorrhage), allergic reactions (streptokinase)

Question 15

4 main indications for anticoagulation therapy
Main adverse effect

Answer 15

Indications: DVT, PE, atrial fibrillation, MI

AE: bleeding

Question 16

Statins SE

Answer 16

myalgia, increased liver enzymes, rhabdomyolysis (rare)

Question 17

Statins (HMG-CoA reductase inhibitors) MOA

Answer 17

inhibit HMG-CoA reductase enzyme which plays a role in cholesterol production

Question 18

Bile acid sequestrants - examples, MOA

Answer 18

Cholestyramine, colestipol, colesevelam

Bind bile acids in the intestines, promoting their excretion and reducing circulating cholesterol

Question 19

Bile acid sequestrants - clinical indications, SE

Answer 19

Hypercholesterolemia

SE: constipation, bloating, indigestion

Question 20

Ezetimibe MOA

Answer 20

Inhibits cholesterol, absorption in small intestine

Question 21

Ezetimibe SE

Answer 21

diarrhea, joint pain, sinusitis, fatigue

Question 22

PCSK9 inhibitors - examples, MOA (not on study guide)

Answer 22

Evolocumab, alirocumab

MOA: monoclonal antibodies that inhibit PCSK9, increasing LDL receptor availability and reducing LDL cholesterol

Question 23

PCSK9 inhibitors - clinical indications, SE (not on study guide)

Answer 23

HeFH, ASCVD requiring additional LDL-C lowering

SE: nasopharyngitis, injection site reactions

Question 24

Fenofibrate MOA

Answer 24

activate PPAR alpha, reducing triglyceride synthesis and enhancing triglyceride clearance

Question 25

Fenofibrate SE

Answer 25

dyspepsia, gallstones, myopathy (when combined with statins)

Question 26

Omega-3 fatty acids - examples, MOA (not on study guide)

Answer 26

Fish oil, icosapent ethyl MOA: reduce hepatic triglyceride production and increase triglyceride clearance

Question 27

Omega-3 fatty acids - clinical indications, SE (not on study guide)

Answer 27

Hypertriglyceridemia SE: fishy aftertaste, diarrhea, nausea

Question 28

Niacin - examples, MOA (not on study guide)

Answer 28

Nicotinic acid Reduces free fatty acid release, decreases VLDL and LDL synthesis, raises HDL levels

Question 29

Niacin - clinical indications, SE (not on study guide)

Answer 29

Hypercholesterolemia, mixed dyslipidemia SE: flushing, itching, elevated glucose levels

Question 30

Define blood clotting

Answer 30

coagulation; prevents excessive bleeding when vessel is damaged

Question 31

5 stages of blood clotting

Answer 31

1 - vasoconstriction 2 - formation of platelet plug (primary hemostasis) 3 - activation of coagulation cascade (2ndary hemostasis) 4 - clot retraction and repair 5 - fibrinolysis

Question 32

PT tx consideration for pt on warfarin

Answer 32

gentle w/ MT b/c pts bruise more easily

Question 33

What sign would a PT check for pt on antigcoags? What causes this sign?

Answer 33

bleeding; INR may be too high

Question 34

PT consideration for pts on heparin (3)

Answer 34

-gentle during MT to avoid bruising -padding during ex/act w/ fall risks to avoid internal bleeding -modalities like deep heat --> increase BF --> increase risk of bleeding

Question 35

PT edu for anticoags

Answer 35

signs of excessive bleeding (prolonged nose bleeds, bloody urine, lg bruises)

Question 36

What 4 symptoms might suggest internal bleeding

Answer 36

unusual pain, swelling, headache, dizziness

Question 37

What 3 tx techniques increase the risk of hematoma formation

Answer 37

dry needling, electroacupuncture, deep tissue mob

Question 38

3 signs of DVT

Answer 38

unilateral calf pain, swelling, warmth

Question 39

When is the most beneficial time to schedule sessions for anticoag pt?

Answer 39

when drug's effect is moderate, NOT peak or trough

Question 40

What are the 3 statin-associated mus symps (SAMS)

Answer 40

mus pain, tenderness, weakness (different from MSK pain d/t ex)

Question 41

Hyperlipidemia meds can affect what vitals

Answer 41

BP or HR

Question 42

What 3 symps of hyperlipidemia meds indicate immediate medical attention is needed

Answer 42

severe mus pain, tea colored urine, unexplained fatigue