Drugs Used For PAD and DVT Flashcards

1
Q

What type of clots are seen during deep venous thrombosis?

What is it rich in?

A

1) Red clot

2) Fibrin

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2
Q

What does cilostazol inhibit?

What does this cause?

A

1) Phosphodiesterase (Type 3 inhibitor)

2) Prolongs life of cAMP in platelets and cells

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3
Q

What effects does cilostazol have?

A

1) Inhibits platelet aggregation

2) Vasodilation

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4
Q

What is the clinical application of cilostazol?

A

Intermittent claudication

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5
Q

What toxicities are notable with cilostazol?

A

1) Headaches

2) Peripheral edema

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6
Q

What is the black box warning for cilostazol?

A

Contraindicated in patients with HF

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7
Q

What is a pharmacologic risk factor of DVT?

A

Oral contraceptive or hormone replacement therapy (estrogen)

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8
Q

What is the active region of unfractionated heparin?

What does this region bind to?

What does this cause?

A

1) Pentasaccharide sequence
2) Antithrombin III
3) Inhibits factor Xa and blocks the generation of thrombin

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9
Q

Unfractionated heparin is used whenever there is a need or rapid onset anticoagulation such as?

A

1) PE
2) Stroke
3) DVT
4) Acute MI

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10
Q

Can unfractionated heparin be used in pregnancy?

Why/why not?

A

Yes, because it doesn’t cross the placenta

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11
Q

Why must unfractionated heparin be given parenterally (IV or SC)?

What happens if given IM?

A

1) It has a large molecular weight

2) Hematoma

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12
Q

Unfractionated heparin is contraindicated for patients with?

A

Thrombocytopenia and uncontrollable bleeding

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13
Q

What is enoxaparin?

What effect does it have?

A

1) A low molecular weight heparin

2) Selectively blocks factor Xa

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14
Q

What is the clinical application of enoxaparin?

Can it be used during pregnancy?

A

1) Prevention/treatment of DVT

2) Yes

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15
Q

Why is enoxaparin easier to use than unfractionated heparin?

A

It doesn’t have the issue of nonselective binding that unfractionated heparin making dosing as use at home without regular monitoring safer

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16
Q

Which is the first choice for Tx/prevention of DVT?

A

Enoxaparin

17
Q

What drug is a synthetic pentasaccharide identical to the antithrombin binding structure of heparin?

A

Fondaparinux

18
Q

What does fondaparinux selectively inhibit without affecting thrombin?

What effect does this have?

A

1) Factor Xa

2) Prevents prothrombin to thrombin

19
Q

What is the clinical application of fondaparinux?

In conjunction with?

A

1) Prevent/treat DVT

2) Warfarin

20
Q

How does fondaparinux compare to enoxaparin?

A

More effective but has higher chance of bleed

21
Q

What is the antidote for unfractionated heparin and enoxaparin?

Does it work for fondaparinux as well?

A

1) Protamine

2) No

22
Q

Which injectable anticoagulant inhibits both factor Xa and thrombin?

Which just binds/activates antithrombin and is not reversed by protamine?

Which only blocks factor Xa?

A

1) Heparin
2) Fondaparinux
3) LMW heparin (enoxaparin)

23
Q

What is a synthetic 20 aa peptide similar to hirudin (anticoagulant of leeches)?

What is its effect?

It can it be given in combination with what other drug to patients undergoing coronary angioplasty?

A

1) Bivalirudin
2) Reversibly inhibits thrombin
3) Aspirin

24
Q

Bivalirudin must be given via what route?

How does it compare to heparin?

A

1) IV

2) As effective, doesn’t require antithrombin, and causes less bleeding

25
Q

Argatroban is a small molecular weight thrombin inhibitor that directly bind to?

A

Catalytic site of thrombin

26
Q

What is the clinical application of argatroban?

A

Prophylaxis and treatment of thrombin in patients with heparin-induced thrombocytopenia

27
Q

Warfarin is an antagonist to?

This leads to the decrease production of what clotting factors and regulatory factors?

A

1) Vitamin K

2) II, VII, IX, X, and proteins C and S

28
Q

Why is warfarin the most widely used long-term prophylaxis of thrombosis?

In what setting is it not effective?

A

1) Orally active (100% bioavailability)

2) Emergencies since effects are delayed

29
Q

How is warfarin induced bleeding treated?

A

Administering vitamin K

30
Q

Can warfarin be used in pregnancy?

Why/why not?

A

No, because it crosses the placenta

31
Q

Why is it important to cautiously transition a patient from heparin like anticoagulant to warfarin?

A

To avoid cutaneous necrosis

32
Q

Rivaroxaban is an oral anticoagulant that is a direct inhibitor of?

This has what effect?

A

1) Factor Xa

2) Inhibits thrombin production

33
Q

What is the clinical application of rivaroxaban?

A

1) Prevention of DVT and PE

2) Prevention of stroke in patients with nonvalvular Afib

34
Q

How does rivaroxaban compare to warfarin?

A

Safer and has faster onset

35
Q

Dabigatran is an oral anticoagulant that is a direct inhibitor of?

What is it indicated for?

What contraindication does it have?

A

1) Thrombin
2) Prevention of stroke in patients with nonvalvular Afib
3) Those with mechanical heart valves