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Pharmacology II > CV & Renal: Coagulation > Flashcards

CV & Renal: Coagulation Flashcards

1
Q

Heparin binds what?

A

antithrombin III

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2
Q

what is the antidote via competitive antogonism for heparin?

A

protamine sulfate

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3
Q

heparin binding to AT III prevents what?

A

coagulation factor activation

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4
Q

Antithrombin III activity is increased ____x by heparin binding

A

1000x

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5
Q

What factors does heparin/antithrombin III act upon?

A

Xa and thrombin

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6
Q

What are three indications for heparin?

A

anticoagulation in operations

bridging anticoagulation

DVT/PE prophylaxis

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7
Q

What are 4 adverse effects of heparin?

A

Heparin Induced Thrombocytopenia
Hemorrhage → administer protamine sulfate
Allergy
Mild decreased platelets

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8
Q

The following are contraindications for which drug?

Active bleeding
Hemophilia, clotting disorder
Hypersensitivity
Surg. of brain, spinal cord, eye

A

Heparin

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9
Q

Heparin administration has a goal of a PTT of…

A

2-2.5x normal

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10
Q

Enoxaprin and fondaparinux are both what type of drug?

A

LMWH

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11
Q

This drug is a heterogenous mix of sulfated mucopolysaccharides

Action is from unique pentasaccharide

A

heparin

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12
Q

What are 4 things that differentiate Enoxaprin/fondaparinux from heparin?

A

inhibits Xa

↑ bioavailability w/ SC admin

Lower HIT incidence

Protamine Sulfate less effective in reversal

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13
Q

Which drug is a direct thrombin inhibitor?

A

Dabigatran (pradaxa_

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14
Q

What are is an indication for dabigatran (pradaxa)?

A

stroke prophylaxis w/ non-valvular a fib

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15
Q

Does dabigatran require PTT monitoring?

A

no

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16
Q

Describe the two adverse effects of dabigatran…

A

C/I in pts. w/ mechanical heart valve

Avoid abrupt discontinuation

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17
Q

which 2 drugs are direct Xa inhibitors?

A

rivaroxaban (xarelto)

apixaban (eliquis)

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18
Q

What are three indications for Xarelto and Eliquis?

A

DVT, PE, Clot prophylaxis

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19
Q

What is a precaution for xarelto and eliquis?

A

avoid with liver/renal disease

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20
Q

What is the antidote for dabigatran?

A

praxbind

21
Q

What is the antidote for xarelto and eliquis?

A

andexxa

22
Q

How are xarelto and eliquis metabolized?

A

CYP3A4

23
Q

describe the onset of action for xarelto and eliquis?

A

rapid acting

24
Q

This drug reduces synthesis of factors II, VII, IV, X and protein C and protein S

A

Warfarin

25
Q

This drug is used chronically for DVT, thromboembolism prophylaxis

A

Warfarin

26
Q

What is a complication arising from fast reduction of protein C by warfarin?

A

warfarin induced thrombosis

27
Q

What can mitigate warfarin induced thrombosis?

A

co-administration w/ heparin for 5 days

28
Q

Can warfarin be used in pregnancy?

A

no

29
Q

The following are drug interactions with what drug?

Vitamin K
Clotting Factors/oral contraceptives
Platelet aggregation/ASA
Inhibit/Induce LFTs

A

warfarin

30
Q

When does warfarin reach its peak effect?

A

48 hours

31
Q

What is the INR goal with warfarin?

A

2-3

32
Q

tPA has what mechanism?

A

converts plasminogen to plasmin

high affinity for bound plasminogen

33
Q

This drug has the following indications:

Lysis of Clot → reestablish tissue perfusion

Severe PE, DVT, Arterial Thrombosis

A

tPA

34
Q

What can tPA induced hemorrhage be treated with?

A

aminocaproic acid +/- whole blood

35
Q

Which two drugs offer complete inhibition of plasminogen activation?

A

aminocaproic acid, tranexamic acid

36
Q

This drug is an adjunct for hemophilia

A

aminocaproic acid, tranexamic acid

37
Q

The following are adverse effects of…

C/I in: DIC or Upper GU Tract Bleed

Can cause intravascular thrombosis

A

aminocaproic acid, tranexamic acid

38
Q

What 4 drugs are antiplatelet drugs?

A

ASA, Plavix, Brilinta, ReoPro

39
Q

Which antiplatelet has the following therapeutic effects?

Single dose may prolong bleeding time for days

Helpful in pts. with ↑ risk of embolism

Secondary prevention of ASCVD w/ established CAD

A

ASA

40
Q

This drug reduces platelet aggregation via irreversible COX inhibition leading to decreased TXA2

A

ASA

41
Q

This drug has the following mechanism:

Irreversible block of platelet ADP receptor → ↓ Platelet aggregation

A

plavix & brilinta

42
Q

Which two drugs?

Used w/ ASA allergy

DOC to prevent thrombosis after coronary stent placement

A

Plavix and brilinta

43
Q

What is becoming the DOC antiplatelet? Why?

A

brilinta, decreased mortality

44
Q

Plavix is a prodrug that must be metabolized by…

A

CYP2C19

45
Q

Which drug should be avoided with plavix?

A

omeprazole

46
Q

This drug has the following mechanism:

Ab to GPIIb/IIIa → GPIIb/IIIa inhibition → ↓ platelet aggregation

A

ReoPro

47
Q

This drug is used in combination with heparine during antioplasty, stents, etc.

A

ReoPro

48
Q

What are two adverse effects of ReoPro?

A

Bleeding

Thrombocytopenia

Pharmacology II (23 decks)

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