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Coagulation Drugs Flashcards

1
Q

What drug activity is dependent on Antithrombin II?

A

Heparin

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2
Q

Heparin mainly affect w/ steps of the coagulation cascade?

A

Xa & Thrombin

Also effects: IXa, XIa, XIIa (aPTT pathway)

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3
Q

What drug accelerates the activity of ATII x 1000?

A

Heparin

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4
Q

What anti-coagulant is used before surgery, during operations, in IV catheters, for in-patient anticoagulation bridging?

A

Heparin

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5
Q

What form of heparin is used in IV?

A

High Molecular weight

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6
Q

What form of Heparin in used in subQ injections?

A

Low Molecular weight

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7
Q

Are the effects of Heparin immediate or delayed?

A

Immediate

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8
Q

Is the PTT or PT pathway the therapeutic target of Heparin?

A

PTT

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9
Q

What drug can you give to stop Heparin induced hemorrhage?

A

Protamine sulfate

heParin –> Protamine, share a P

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10
Q

What autoimmune reaction can occur as a result of Heparin use?

A

Heparin induced Thrombocytopenia (HIT)

Pt is never able to be on Heparin again

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11
Q

Caution with Heparin use in pts w/ what dysfunction (2)

A

Renal

Hepatic

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12
Q

Heparin is contraindicated in what pts? (4)

A
  1. Actively bleeding
  2. Hemophilia/other blood clotting disorders
  3. Hypersensitivity (previous HIT)
  4. During/after surgery on the brain, spinal cord, eye
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13
Q

Enoxaprin HMW or LMW heparin?

A

LMW

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14
Q

What synthetic pentasaccharide acts on factor Xa?

A

Fondaparinux

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15
Q

Do Enoxaprin and Fondaparinux have any effect on Thrombin?

A

No, only inhibitory action is on factor Xa

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16
Q

What is the DOC for subQ anti-coagulation therapy?

A

LMW drugs: Enoxaprin and Fondaparinux

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17
Q

Is HMW or LMW Heparin safe in pregnanct, outpatient bridging, once/day dosing?

A

LMW drugs: Enoxaprin and Fondaparinux

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18
Q

Will LMW Heparin (Enoxaprin and Fondaparinux) increase or lower the incidence of HIT?

A

Lower

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19
Q

Will protamine also work as a reversal agent on Enoxaprin and Fondaparinux?

A

Won’t completely reverse Enoxaprin

No effect on Fondaparinux

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20
Q

Dabigatran (Pradaxa) is from what class of anticoagulants?

A

Direct Oral thrombin inhibitors

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21
Q

Do you monitor Dabigatran with PTT?

A

No b/c predictable anticoagulant effects

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22
Q

Dabigatran is contraindicated in pts w/ what?

A

mechanical heart valves

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23
Q

What is the antidote for Dabigatran?

A

Idarucizumab (PRAXbind)

24
Q

Black box warning for Dabigatran?

A

Avoid abrupt discontinuation w/o alternative anticoagulation?

25
Q

What class of meds are: RivaroXABAN (Xarelto) and ApiXABAN?

A

Direct Oral Inhibitors of factor Xa

-XABAN

26
Q

What drug is given in the prevention of stroke pts w/ non-valvular A-fib?

A

Dabigatran

27
Q

What drug is used for DVT, PE, and future clot prophylaxis?

A

Rivaroxaban & Apixaban

28
Q

Direct Oral Factor Xa inhibitors are contraindicated in pts w/ what?

A

Liver disease, renal failure

Cleared by Kidney and Liver (CYP34A)

29
Q

What is the antidote for Direct Factor Xa Inhibitors?

A

Factor Xa decoy (AndexXA)

30
Q

Inhibition of the reduction of Vit. K is the MOA for what drug?

31
Q

What clotting factors does Warfarin block?

A

II, VII, IX, X, Protein C & S

32
Q

Are the effects of Warfarin immediate or delayed?

A

Delayed, peak effect after 48 hours

33
Q

What lab is used to monitor Warfarin therapy?

34
Q

How long will Warfarin stay in your system after discontinuing?

A

4-5 days (t1/2 = 36 hrs)

35
Q

Is Warfarin given to prevent emboli or target already formed thrombi?

A

Prevent emboli, DVT, thrombi (so given chronically).

No effect on already formed thrombi

36
Q

What drug is co-administered w/ Warfarin during initiation of therapy? Why?

A

Heparin

Warfarin quickly reduces levels of protein C during therapy initiation –> Warfarin induced thrombosis –> cutaneous necrosis and infarct

37
Q

Vit. K and fresh frozen plasma are reversal agents for what anti-coagulant?

A

Warfarin
Vit K = slower reversal
FFP = fast reversal

38
Q

Bowel hemorrhage is an adverse of what anti-coagulant?

39
Q

Is Warfarin safe in pregnancy?

A

No (can cross placenta)

40
Q

T or F: Warfarin interacts w/ a high # of drugs?

A

TRUE

Drugs that affect: Vit. K, Clotting factors - estrogen (oral contraceptives), platelet aggregation/function (aspirin), inhibit/induce liver microsomal enzymes

41
Q

What class of drug is Alteplase/Tissue plasminogen activator (tPA)?

A

Fibronlytic agent

42
Q

What drug converts plasminogen to plasmin?

A

Alterplase/tPA

43
Q

What drug lysis clots?

A

Alterplase/tPA

44
Q

Antidote for Alterplase/tPA?

A

Aminocaproic acid and whole blood if necessary

45
Q

Aminocaproic acid and Tranexamic acid are what class of drugs?

A

Antifibrinolytics - given as reversal for fibrinolytic therapy

46
Q

Aminocaproic acid and Tranexamic acid are contraindicated in what pts?

A

Pt w/ DIC, upper GU bleed (can lead to excessive clotting)

47
Q

What 3 drugs are inhibitors of Thrombogenesis (increase bleeding time)?

A

Clopidogrel
Aspirin
Abciximab

48
Q

What drug irreversible inhibits COX enzyme?

49
Q

What drug is used as secondary prevention of CV events in pts w/ established CVD?

50
Q

What two oral drugs irreversibly block ADP receptor on platelets?

A

Clopidogrel and Ticagrelor

51
Q

When would you use Clopidogrel and Ticagrelor OVER Aspirin?

A

If pt has aspirin allergy

52
Q

What 2 meds are DOC for pts w/ coronary stents?

A

Ticagrelor (lower # death/CV endpoints) > Clopidogrel

53
Q

Clopidigrel interacts with what drugs?

A

CYP2C19. Ex: Omperazole

54
Q

What IV med is an Ab to GP IIb/IIIa receptor?

55
Q

How does Abciximab decrease platelet aggregation?

A

Inhibits GP IIb/IIIa receptors from binding to fibrinogen

56
Q

When is Abciximab used?

A

Due cardiac procedures

57
Q

Adverse effects of Abciximab?

A

Bleeding and thrombocytopenia

Pharm II (13 decks)

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