Drugs Used For PAD and DVT

Question 1

What type of clots are seen during deep venous thrombosis?

What is it rich in?

Answer 1

1) Red clot

2) Fibrin

Question 2

What does cilostazol inhibit?

What does this cause?

Answer 2

1) Phosphodiesterase (Type 3 inhibitor)

2) Prolongs life of cAMP in platelets and cells

Question 3

What effects does cilostazol have?

Answer 3

1) Inhibits platelet aggregation

2) Vasodilation

Question 4

What is the clinical application of cilostazol?

Answer 4

Intermittent claudication

Question 5

What toxicities are notabile with cilostazol?

Answer 5

1) Headaches

2) Peripheral edema

Question 6

What is the black box warning for cilostazol?

Answer 6

Contraindicated in patients with HF

Question 7

What is a pharmacologic risk factor of DVT?

Answer 7

Oral contraceptive or hormone replacement therapy (estrogen)

Question 8

What is the active region of unfractionated heparin?

What does this region bind to?

What does this cause?

Answer 8

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

Question 9

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

Answer 9

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

Question 10

Can unfractionated heparin be used in pregnancy?

Why/why not?

Answer 10

Yes, because it doesn’t cross the placenta

Question 11

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

What happens if given IM?

Answer 11

1) It has a large molecular weight

2) Hematoma

Question 12

Unfractionated heparin is contraindicated for patients with?

Answer 12

Thrombocytopenia and uncontrollable bleeding

Question 13

What is enoxaparin?

What effect does it have?

Answer 13

1) A low molecular weight heparin

2) Selectively blocks factor Xa

Question 14

What is the clinical application of enoxaparin?

Can it be used during pregnancy?

Answer 14

1) Prevention/treatment of DVT

2) Yes

Question 15

Why is enoxaparin easier to use than unfractionated heparin?

Answer 15

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

Question 16

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

Answer 16

Enoxaparin

Question 17

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

Answer 17

Fondaparinux

Question 18

What does fondaparinux selectively inhibit without affecting thrombin?

What effect does this have?

Answer 18

1) Factor Xa

2) Prevents prothrombin to thrombin

Question 19

What is the clinical application of fondaparinux?

Answer 19

Prevent/treat DVT in conjunction with warfarin

Question 20

How does it compare to enoxaparin?

Answer 20

More effective but has higher chance of bleed

Question 21

What is the antidote for unfractionated heparin and enoxaparin?

Does it work for fondaparinux as well?

Answer 21

1) Protamine

2) No

Question 22

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?

Answer 22

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

Question 23

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?

Answer 23

1) Bivalirudin
2) Reversibly inhibits thrombin
3) With aspirin to patients undergoing coronary angioplasty

Question 24

Bivalirudin must be given via what route?

How does it compare to heparin?

Answer 24

1) IV

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

Question 25

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

Answer 25

Catalytic site of thrombin

Question 26

What is the clinical application of argatroban?

Answer 26

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

Question 27

Warfarin is an antagonist to?

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

Answer 27

1) Vitamin K

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

Question 28

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

In what setting is it not effective?

Answer 28

1) Orally active (100% bioavailability)

2) Emergencies since effects are delayed

Question 29

How is warfarin induced bleeding treated?

Answer 29

Administering vitamin K

Question 30

Can warfarin be used in pregnancy?

Why/why not?

Answer 30

No, because it crosses the placenta

Question 31

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

Answer 31

To avoid cutaneous necrosis

Question 32

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

This has what effect?

Answer 32

1) Factor Xa

2) Inhibits thrombin production

Question 33

What is the clinical application of rivaroxaban?

Answer 33

1) Prevention of DVT and PE

2) Prevention of stroke in patients with nonvalvular Afib

Question 34

How does rivaroxaban compare to warfarin?

Answer 34

Safer and has faster onset

Question 35

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

What is it indicated for?

What contraindication does it have?

Answer 35

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