CV & Renal: Coagulation

Question 1

Heparin binds what?

Answer 1

antithrombin III

Question 2

what is the antidote via competitive antogonism for heparin?

Answer 2

protamine sulfate

Question 3

heparin binding to AT III prevents what?

Answer 3

coagulation factor activation

Question 4

Antithrombin III activity is increased ____x by heparin binding

Answer 4

1000x

Question 5

What factors does heparin/antithrombin III act upon?

Answer 5

Xa and thrombin

Question 6

What are three indications for heparin?

Answer 6

anticoagulation in operations

bridging anticoagulation

DVT/PE prophylaxis

Question 7

What are 4 adverse effects of heparin?

Answer 7

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

Question 8

The following are contraindications for which drug?

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

Answer 8

Heparin

Question 9

Heparin administration has a goal of a PTT of…

Answer 9

2-2.5x normal

Question 10

Enoxaprin and fondaparinux are both what type of drug?

Answer 10

LMWH

Question 11

This drug is a heterogenous mix of sulfated mucopolysaccharides

Action is from unique pentasaccharide

Answer 11

heparin

Question 12

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

Answer 12

inhibits Xa

↑ bioavailability w/ SC admin

Lower HIT incidence

Protamine Sulfate less effective in reversal

Question 13

Which drug is a direct thrombin inhibitor?

Answer 13

Dabigatran (pradaxa_

Question 14

What are is an indication for dabigatran (pradaxa)?

Answer 14

stroke prophylaxis w/ non-valvular a fib

Question 15

Does dabigatran require PTT monitoring?

Answer 15

no

Question 16

Describe the two adverse effects of dabigatran…

Answer 16

C/I in pts. w/ mechanical heart valve

Avoid abrupt discontinuation

Question 17

which 2 drugs are direct Xa inhibitors?

Answer 17

rivaroxaban (xarelto)

apixaban (eliquis)

Question 18

What are three indications for Xarelto and Eliquis?

Answer 18

DVT, PE, Clot prophylaxis

Question 19

What is a precaution for xarelto and eliquis?

Answer 19

avoid with liver/renal disease

Question 20

What is the antidote for dabigatran?

Answer 20

praxbind

Question 21

What is the antidote for xarelto and eliquis?

Answer 21

andexxa

Question 22

How are xarelto and eliquis metabolized?

Answer 22

CYP3A4

Question 23

describe the onset of action for xarelto and eliquis?

Answer 23

rapid acting

Question 24

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

Answer 24

Warfarin

Question 25

This drug is used chronically for DVT, thromboembolism prophylaxis

Answer 25

Warfarin

Question 26

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

Answer 26

warfarin induced thrombosis

Question 27

What can mitigate warfarin induced thrombosis?

Answer 27

co-administration w/ heparin for 5 days

Question 28

Can warfarin be used in pregnancy?

Answer 28

no

Question 29

The following are drug interactions with what drug? Vitamin K Clotting Factors/oral contraceptives Platelet aggregation/ASA Inhibit/Induce LFTs

Answer 29

warfarin

Question 30

When does warfarin reach its peak effect?

Answer 30

48 hours

Question 31

What is the INR goal with warfarin?

Answer 31

2-3

Question 32

tPA has what mechanism?

Answer 32

converts plasminogen to plasmin high affinity for bound plasminogen

Question 33

This drug has the following indications: Lysis of Clot → reestablish tissue perfusion Severe PE, DVT, Arterial Thrombosis

Answer 33

tPA

Question 34

What can tPA induced hemorrhage be treated with?

Answer 34

aminocaproic acid +/- whole blood

Question 35

Which two drugs offer complete inhibition of plasminogen activation?

Answer 35

aminocaproic acid, tranexamic acid

Question 36

This drug is an adjunct for hemophilia

Answer 36

aminocaproic acid, tranexamic acid

Question 37

The following are adverse effects of... C/I in: DIC or Upper GU Tract Bleed Can cause intravascular thrombosis

Answer 37

aminocaproic acid, tranexamic acid

Question 38

What 4 drugs are antiplatelet drugs?

Answer 38

ASA, Plavix, Brilinta, ReoPro

Question 39

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

Answer 39

ASA

Question 40

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

Answer 40

ASA

Question 41

This drug has the following mechanism: Irreversible block of platelet ADP receptor → ↓ Platelet aggregation

Answer 41

plavix & brilinta

Question 42

Which two drugs? Used w/ ASA allergy DOC to prevent thrombosis after coronary stent placement

Answer 42

Plavix and brilinta

Question 43

What is becoming the DOC antiplatelet? Why?

Answer 43

brilinta, decreased mortality

Question 44

Plavix is a prodrug that must be metabolized by...

Answer 44

CYP2C19

Question 45

Which drug should be avoided with plavix?

Answer 45

omeprazole

Question 46

This drug has the following mechanism: Ab to GPIIb/IIIa → GPIIb/IIIa inhibition → ↓ platelet aggregation

Answer 46

ReoPro

Question 47

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

Answer 47

ReoPro

Question 48

What are two adverse effects of ReoPro?

Answer 48

Bleeding | Thrombocytopenia