Drugs used in Coagulation Disorders

Question 1

Drugs used in clotting disorders

Answer 1

Anticlotting (anticoagulant, thrombolytics & antiplatelet)
Drugs that facilitate clotting

Question 2

Anticoagulant moa

Answer 2

Inhibits the formation of fibrin clots

Question 3

Types of anticoagulant

Answer 3

Heparin
Direct thrombin inhibitors
Direct factor Xa inhibitors
Warfarin

Question 4

Heparin and LMW heparin molecular weight

Answer 4

Heparin - 15,000-20,000
LMW heparin - 2000-6000

Question 5

Heparin route of administration

Answer 5

IV or subcutaneously to avoid the risk of hematoma associated with intramuscular injection

Question 6

LMW heparins

Answer 6

Enoxaparin
Dalteparin
Tinzaparin

Question 7

Heparin mechanism

Answer 7

Binds to antithrombin III (ATIII) to inactivate thrombin and factor Xa

Question 8

Action of heparin is monitored with

Answer 8

Activated partial thromboplastin time (aPTT)

Question 9

Heparin onset of action

Answer 9

Rapid (within mins)

Question 10

Antidote for unfractionated heparin

Answer 10

Protamine
(Only partially reverses the effects of LMW heparins and does not effect the action of fondaparinux)

Question 11

Heparin use in pregnancy

Answer 11

Yes

Question 12

Heparin clinical use

Answer 12

When anticoagulation is needed immediately
DVT
Pulmonary embolism
Acute MI

Question 13

Combination use of heparin

Answer 13

Combination with thrombolytics for revascularization
Combination with glycoprotein IIb/IIIa inhibitors during angioplasty and placement of coronary stents

Question 14

Heparin toxicity

Answer 14

Increased bleeding (hemorrhagic stroke)
Thrombocytopenia (HIT)
Osteoporosis (prolonged use of unfractionated heparin)

Question 15

Direct thrombin inhibitors are based on proteins made by

Answer 15

Hirudo medicinalis, the medicinal leech

Question 16

Direct thrombin inhibitors forms

Answer 16

Lepirudin (recombinant)
Desirudin
Bivalirudin
Argatroban
Dabigatran (oral)

Question 17

Direct thrombin inhibitors mechanism

Answer 17

Inhibit both soluble thrombin and the thrombin enmeshed within developing clots

Question 18

Direct thrombin inhibitors clinical

Answer 18

Alternative to heparin
Bivalirudin + asprin for percutaneous coronary angioplasty
Dabigatran for prevention of stroke and systemic embolism in nonvalvular atrial fibrillation

Question 19

Direct thrombin inhibitors monitoring test

Answer 19

aPTT

Question 20

Direct thrombin inhibitors toxicity

Answer 20

Bleeding

Question 21

Direct factor Xa inhibitors

Answer 21

Rivaroxaban
Apixaban
Edoxaban

Question 22

Direct factor Xa inhibitors monitoring

Answer 22

Drugs have fixed oral doses and do not require monitoring

Question 23

Direct factor Xa inhibitors mechanism

Answer 23

Directly bind to and inhibit both free factor Xa and factor Xa bound in the clotting complex

Question 24

Direct factor Xa inhibitors clinical

Answer 24

Rivaroxaban- prevention and treatment of venous thromboembolism following hip or knee surgery and for prevention of stroke in patients with atrial fibrillation, without valvular heart disease
Apixaban- prevention of embolic stroke in patients with nonvalvular atrial fibrillation

Question 25

Factor Xa inhibitors toxicity

Answer 25

Bleeding

Question 26

Warfarin mechanism

Answer 26

Inhibits vitamin K epoxide reductase which converts vitamin K epoxide to reduced vitamin K

Question 27

Vitamin K dependent factors

Answer 27

Thrombin, factors VII, IX & X

Question 28

Warfarin antidote

Answer 28

Vitamin K

Question 29

Effect of warfarin monitored by

Answer 29

Prothrombin time PT

Question 30

Warfarin clinical

Answer 30

Same as heparin except in preg women

Question 31

Warfarin toxicity

Answer 31

Bleeding Thrombosis early in therapy due to protein C deficiency Bone defects and haemorrhage in the developing fetus

Question 32

Which drugs reduce warfarin’s anticoagulant effect

Answer 32

Cytochrome P450-inducing drugs (carbamazepine, phenytoin, rifampin, barbiturates)

Question 33

Which drugs increase warfarin’s anticoagulant effect

Answer 33

Cytochrome P450-inhibitors (amiodarone, SSRIs, cimetidine)

Question 34

Thrombolytic agents

Answer 34

Tissue plasminogen activator (t-PA) Streptokinase

Question 35

Plasmin function

Answer 35

Degrades clots by splitting fibrin into fragments

Question 36

Thrombolytic agents mechanism

Answer 36

Converts plasminogen into plasmin

Question 37

Alteplase clinical

Answer 37

Coronary artery thrombosis Ischemic stroke Pulmonary embolism

Question 38

Alteplase toxicity

Answer 38

Bleeding Cerebral haemorrhage

Question 39

Platelet aggregation is triggered by

Answer 39

Thromboxane ADP Thrombin Fibrin

Question 40

Antiplatelet drugs classification

Answer 40

NSAIDs (asprin) Glycoprotein IIb/IIIa receptor inhibitors (abciximab,tirofiban and eptifibatide) ADP receptor antagonists (clopidogrel, prasugrel & ticlopidine) Phosphodiesterase 3 inhibitors (dipyridamole & cilostazol)

Question 41

Drugs used in bleeding disorders

Answer 41

Vitamin K Clotting factors Antiplasmin agents

Question 42

Vitamin K deficiency treatment

Answer 42

Phytonadione (vitamin K1) Oral or parenteral

Question 43

Hemophilia treatment

Answer 43

Fresh plasma Clotting factors (factor VIII for hemophilia A and factor IX for hemophilia B)

Question 44

Antiplasmin agents clinical

Answer 44

Prevention or management of acute bleeding episodes in patients with hemophilia and bleeding disorders

Question 45

Antiplasmin agents

Answer 45

Aminocaproic acid Tranexamic acid

Question 46

Antiplasmin agents toxicity

Answer 46

Thrombosis Hypotension Myopathy Diarrhoea

Question 47

Sudden cessation of short acting oral anticoagulant can lead to

Answer 47

Stroke