Coagulation related pharm

Question 1

heparins MOA

Answer 1

• increase/augment AT-III activity by 1000x

- increased inhibition of II, IX, X, XI

Question 2

unfractioned heparin

Answer 2

• nonspecific binding to AT-III, plasma proteins, endothelial cells, RES macrophages
• low bioavailability
• renal/liver metabolism
• IV/subQ

AE

• bleeding
• osteoporosis
• allergic reaction
• HIT

Question 3

LMW heparin (enoxaparin, dalteparin)

Answer 3

• shorter chain limits binding
• Factor Xa&raquo_space;» thrombin
• renal metabolism
• dose reduced with poor renal fxn
• decreased risk of HIT
• decreased risk of osteoporosis

Protamine sulfate can reverse effects

Question 4

fondaparinux

Answer 4

• heparin derived, but pure Xa inhibitor
• oral daily dosing
• renal clearance

Question 5

lepiruidin

Answer 5

• direct thrombin inhibitor
• binds thrombin-fibrin complex to inactivate
• ATIII independent
• IV
• hepatic clearance