Drugs to Treat PAD and DVT

Question 1

Why can fondaparinux and low molecular weight heparins be administered at home?

Answer 1

Because of their predictable pharmacokinetics

Question 2

What is an example of drugs that can contain vasoconstrictors that can exacerbate PAD?

Answer 2

Cold remedies

Question 3

What is the function of CYP2C9?

Answer 3

Metabolizes the more potent S warfarin; numerous polymorphisms in this gene and those decreasing its activity against warfarin are more common in Caucasians, increasing Warfarin potency 3-5x

Question 4

Contraceptive use is associated with increased risk of what?

Answer 4

DVT in younger women due to increased clotting factor synthesis

Question 5

Name risk factors for PAD

Answer 5

obesity, smoking, diabetes, increased cholesterol levels

Question 6

What are white clots?

Answer 6

Abundance of platelets in arteries; reason platelet targeting drugs are chosen for problems there

Question 7

What is the first line tx for decreasing risk of PAD?

Answer 7

Statins

Question 8

What is a common cause of PAD?

Answer 8

atherosclerosis

Question 9

Kidney disease can hasten the elimination of what?

Answer 9

clotting factors

Question 10

What are red clots?

Answer 10

Blood clots in the venous circulation; consequence of large fibrin mesh that forms

Question 11

What is a potential sx of DVT?

Answer 11

pain

Question 12

What is a surgical tx option for PAD?

Answer 12

angioplasty

Question 13

What is a sign of PAD?

Answer 13

bruits

Question 14

Petechiae are a common sign of what?

Answer 14

platelet defects, uncommon with clotting factor defects

Question 15

What is often recommended to reduce risk of DVT?

Answer 15

exercise; cardiomyositis is an instance where it is not recommended

Question 16

What assay can be used to measure anticoagulation for drugs such as rivaroxaban?

Answer 16

Anti-Xa

Question 17

What was the first use for warfarin?

Answer 17

rat poison

Question 18

what is a stent?

Answer 18

Wire mesh placed in stenotic blood vessels to keep the lumen open; often drug-eluting

Question 19

What is cilostazol?

Answer 19

Type 3 phosphodiesterase inhibitor that prolongs the life of cAMP in platelets; used to surpress platelet aggregation and cause peripheral vasodilation; indicated for intermittent claudication associated with PAD

Question 20

How do deficiencies of clotting factors manifest?

Answer 20

as deep tissue bleeding forming large subcutaneous and soft tissue hematomas or hemarthroses; may be delayed/oozing after procedures

Question 21

what is a frequent consequence of PAD?

Answer 21

erectile dysfunction

Question 22

Which drug can cause necrosis?

Answer 22

Warfarin; occurs when there is a rapid fall in protein C leading to a hyper coagulable state; reason why pts must be transitioned to warfarin therapy rather than abruptly started on it

Question 23

How are the legs characterized in PAD?

Answer 23

have shiny skin

Question 24

What can also contribute to DVT risk?

Answer 24

genetic variability; also seen in VKORC1 (reason why AA can be resistant to warfarin and Asians more sensitive to it)

Question 25

Liver disease can impair the synthesis of what?

Answer 25

clotting factors

Question 26

What leads to platelet activation/thrombosis and platelet removal by splenic macrophages?

Answer 26

Platelet Fc receptors bind an IgG bound to heparin and PF4 in heparin induced thrombocytopenia

Question 27

What is released by thrombin?

Answer 27

fibrin; polymerized form is a substrate for plasmin

Question 28

What is a black box contraindication for cilostazol?

Answer 28

hepatic failure

Question 29

Pedal pulses tend to be weak or absent with what?

Answer 29

PAD

Question 30

What is generated as a consequence of factor X activation?

Answer 30

thrombin; inhibited by unfractionated heparin but not LMW heparin or fonaparinux

Question 31

What is an element of treatment strategy when switching from a DOAC to warfarin, but not when switching from one DOAC to another?

Answer 31

overlap

Question 32

Carbamazepine, phenytoin, and phenobarbital all decrease the effects of what?

Answer 32

Warfarin because they induce the synthesis of its metabolic enzymes

Question 33

What is a challenge associated with both heparin and warfarin?

Answer 33

dosing; which is a reason for frequent coagulation tests are required

Question 34

What is the generic name reference to the drug class that inhibits factor Xa?

Answer 34

Xaban