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Phamacology Summer > Coagulation Modifying Agents Part 1: Antiplatelets and Anticoagulants > Flashcards

Coagulation Modifying Agents Part 1: Antiplatelets and Anticoagulants Flashcards

1
Q 
PARENTERAL
• Heparin Type Products
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

a. Heparin, Enoxaparin

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2
Q 
PARENTERAL
• Non-Heparin Products
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

b. Argatroban, Fondaparinux

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3
Q 
ORAL
• Vitamin K Antagonists
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

c. Warfarin

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4
Q 
ORAL
• NOAC/DOACs 
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

d. Apixaban, Rivaroxaban, Dabigatran

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5
Q

◦ Can be used in Pregnant Patients

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

Heparin

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6
Q 
USED TO 
DVT prophylaxis
◦ DVT/PE treatment (therapeutic)
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

Heparin

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7
Q

The Steps for Heparin SQ
•For subcutaneous injections, use a 20- to 22-gauge needle to withdraw medication from the vial.
Then, change the needle to a smaller needle (25- or 26-gauge, ½ to ⅝ inches long).
•Administer deep subcutaneous injections in the abdomen, ensuring a distance of at least 2
inches from the umbilicus
•Do not aspirate
•Apply gentle pressure for 1 to 2 min after the injection.
•Rotate and record injection sites

A

dddd

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8
Q 
◦ Body-
◦ Petechiae, bruising, hematoma
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

a. Heparin, Enoxaparin

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9
Q 
OTHER ADVERSE EFFECTS
◦ Osteoporosis – LONG TERM
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

a. Heparin, Enoxaparin

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10
Q 
OTHER ADVERSE EFFECTS
◦ Osteoporosis – LONG TERM
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

a. Heparin, Enoxaparin

b. Argatroban, Fondaparinux

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11
Q 
•REVERSAL AGENT/ANTIDOTE
• Protamine Sulfate
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

a. Heparin, Enoxaparin

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12
Q 
•CONTRA-INDICATIONS
◦ AVOID in epidurals + neurosurgery
◦ Hematoma in the spine can cause swelling which can lead to paralysis
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

a. Heparin, Enoxaparin

b. Argatroban, Fondaparinux

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13
Q 
• Pork allergy- from intestinal mucosa from pigs, Pork- religious
• Recommend consulting professional
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

a. Heparin, Enoxaparin

b. Argatroban, Fondaparinux

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14
Q

Check aPTT for appropriate range, review CBC (H/H,Plts)

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

a. Heparin, Enoxaparin

b. Argatroban, Fondaparinux

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15
Q

S/s of bleeding, Monitor Hgb/hct/plts

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

a. Heparin, Enoxaparin

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16
Q

S/s of bleeding, Monitor Hgb/hct/plts

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

a. Heparin, Enoxaparin

b. Argatroban, Fondaparinux

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17
Q

Weight based dosing, 80 kg patient
◦ 80 mg SC every 12 hours

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

Enoxaparin

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18
Q

◦ General adult dose is 5,000 units SC every 8 or 12 hours

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

Heparin

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19
Q

◦ General adult dose is 5,000 units SC every 8 or 12 hours

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

Heparin

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20
Q 
•USED TO TREAT (Continuous IV drip)
• patients who have developed HIT
• Hx of HIT with active PE/DVT
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

Argatroban

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21
Q 
USED TO TREAT 
• Continuous IV drip- patients who have developed HIT 
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

Argatroban

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22
Q 
USED TO TREAT (Subcutaneous injection)
• patients who have developed HIT
• Hx of HIT with active PE/DVT
• DVT/PE prophylaxis or treatment
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

Fondaparinux

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23
Q

Wich cause HIT- Heparin induced thrombocytopenia causes

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

a. Heparin, Enoxaparin

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24
Q 
USED TO TREAT
◦ Mechanical Heart valves (prevent stroke/clot formation)
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

c. Warfarin

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25
Q 
PT
INR
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

c. Warfarin

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26
Q 
ADVERSE EFFECTS
◦ Bleeding (review H/H/Plts)- BOXED WARNING FROM THE FDA
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

c. Warfarin

27
Q 
ADVERSE EFFECTS
◦ Skin Necrosis (<1%)
◦ Protein C
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

c. Warfarin

28
Q

◦ Protein C

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

c. Warfarin

29
Q 
ADVERSE EFFECTS
◦ Purple Toe Syndrome
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

c. Warfarin

30
Q 
•CONTRA-INDICATIONS
◦ AVOID in epidurals + neurosurgery
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin

31
Q 
• PREGNANCY CATEGORY X
• Heparin is safe to use as an alternative
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

c. Warfarin

32
Q 
•REVERSAL AGENTS
• Vitamin K/ Phytonadione (Aquamephyton®)
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

c. Warfarin

33
Q 
•REVERSAL AGENTS
• KCentra®- Human Clotting Factors II,VII, IX
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

c. Warfarin

34
Q 
•DRUG INTERACTIONS
• SSRI’s- Bleed risk
• NSAIDS- Bleed risk
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

c. Warfarin

35
Q

• NSAIDS- Bleed risk (recommend acetaminophen instead!)

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

c. Warfarin

36
Q

St. Johns Wort (decreases ? levels)

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

c. Warfarin

37
Q

Limit Vitamin K in Diet

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

c. Warfarin

38
Q

Start on heparin IV drip and warfarin while in the hospital. Wait until INR is therapeutic
◦ (5 days of overlap warfarin/heparin) before discharge
T or F

39
Q 
PATIENT EDUCATION CONTINUED:
▪Instruct patients to do things like use electric shaver, soft bristle toothbrush to
reduce risk for a bleed
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

c. Warfarin

40
Q

Factor Xa Inhibitors

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

Apixaban, Rivaroxaban

41
Q

•2)Direct Thrombin Inhibitor –

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

Dabigatran

42
Q 
• REVERSAL AGENT
• Andexanet Alfa (Andexxa®)
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

Apixaban, Rivaroxaban,

43
Q

? must be given with food

d. Apixaban, Rivaroxaban, Dabigatran

A

Rivaroxaban

44
Q 
USED TO TREAT:
• Atrial fibrillation (non-valvular)
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

Dabigatran

45
Q 
REVERSAL AGENT
 Praxbind® (Idarucizumab)
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
A

Dabigatran

46
Q 
CONTRA-INDICATIONS
– Same as other anticoagulants
– Active Bleeding
– Peptic Ulcer Disease
– Neurosurgery/epidural
a. Heparin,  Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban,  Dabigatran
47
Q

Must be given with full glass of water. If GI upset occurs even with full glass of water, can give with meals

a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran

A

Dabigatran

48
Q

P2Y12 ADP Receptor
Antagonists
a. Aspirin
b. Clopidogrel, Ticagrelor

A

b. Clopidogrel, Ticagrelor

49
Q 
Primary: (Heart + Brain)
• Coronary Stenting
• Acute MI/ Angina
• Stroke (Atrial fibrillation)
• TIA’s
a. Aspirin
b. Clopidogrel, Ticagrelor
A

a. Aspirin

50
Q

• Pediatrics- Kawasaki (NEVER GIVE TO CHILDREN- outside of this disease)

a. Aspirin
b. Clopidogrel, Ticagrelor

A

a. Aspirin

51
Q

-A sthma
-S alicylism (N/V/D, rapid breathing- hyperventilation)
-P remature closing of PDA/Platelet disaggregation/ Peptic Ulcer
Disease
-I ntestinal bleeding
-R eye’s Syndrome/Ringing in the ears/Renal Impairment/Rapid
Breathing/RESPIRATORY ALKALOSIS
-I diosyncratic Reaction
-N oise (Tinnitus)/Nephropathy
a. Aspirin
b. Clopidogrel, Ticagrelor

A

a. Aspirin

52
Q

Avoid with Reye Syndrome

a. Aspirin
b. Clopidogrel, Ticagrelor

A

a. Aspirin

53
Q 
CONTRA-INDICATIONS
– Active Bleeding
– Peptic Ulcer Disease
– Children (especially if infected with a virus)
a. Aspirin
b. Clopidogrel, Ticagrelor
A

a. Aspirin

54
Q

– Peptic Ulcer Disease

a. Aspirin
b. Clopidogrel, Ticagrelor

A

a. Aspirin

55
Q

• Percutaneous Coronary Intervention (STENT placement)

a. Aspirin
b. Clopidogrel, Ticagrelor

A

b. Clopidogrel, Ticagrelor

56
Q

•Thrombotic Thrombocytic Purpura (TTP)

a. Aspirin
b. Clopidogrel, Ticagrelor

A

b. Clopidogrel, Ticagrelor

57
Q 
CONTRA-INDICATIONS
– Active Bleeding
– Peptic Ulcer Disease
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”
A

b. Clopidogrel, Ticagrelor

58
Q 
USED TO TREAT
–Ischemic Stroke
–Massive Pulmonary Embolism
–Massive Myocardial Infarction
–Central venous catheter clearance (tiny dose
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”
A

c. alteplase “plase”

59
Q

Tissue Plasminogen Activator (TPA) Clot bluster

a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”

A

c. alteplase “plase”

60
Q 
Most STROKE guidelines allow within 3 to 4.5 hours of symptom
ONSET
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”
A

c. alteplase “plase”

61
Q

c. alteplase “plase” Most STROKE guidelines allow within ? to ? hours of symptom
ONSET

A

3 to 4.5 hours

62
Q 
CONTRA-INDICATIONS
◦ Active Bleeding
◦ GI Bleed/ Peptic Ulcer Disease
◦ On active anticoagulants
◦ Hemorrhagic Stroke
◦ Clotting Disorders, etc.
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”
A

c. alteplase “plase”

63
Q

POST ADMINISTRATION:
Minimize bruising or bleeding by limiting venipunctures and
subcutaneous/IM injections. Hold direct pressure to injection
site or ABG site for up to 30 min until oozing stops
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”

A

c. alteplase “plase”

64
Q

Bracelet: Some facilities give patients bracelet to wear that
says “No Anticoagulants, No Antiplatelets 24 hours after
Alteplase Administration” because bleed risk is so high
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”

A

c. alteplase “plase”

Phamacology Summer (48 decks)

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