Drugs used in Coagulation Disorders

Question 1

Aspirin doses

Answer 1

Low dose: <160 antiplatelet
Intermediate dose: 160-1200 mg antipyretic, analgesic
High dose: >1200mg anti-inflammatory

Question 2

How many 500 mg aspirin tablets must be ingested to produce toxicity? death?

Answer 2

Toxic: 150 mg/kg = 21 tabs
Lethal: 500 mg/kg= 70 tabs

Question 3

Triad of aspirin hypersensitivity

Answer 3

Samster triad

-asthma, aspirin sensitivity, nasal polyps

Question 4

Expected acid-base abnormality in salicylate poisoning?

Answer 4

Respiratory alkalosis with HAGMA

Question 5

What is the difference in the presentation of aspirin intoxication in children and adults?

Answer 5

ADULTS=mixed acid-base disorder (Resp alk with HAGMA)

CHILDREN=pure acid-base disorder (HAGMA)

Question 6

What is the difference between an inhibitor and an uncoupler of oxidative phosphorylation?

Answer 6

INHIBITORS: completelty halt ETC
UNCOUPLERS: dissipate proton gradient without interrupting ETC

Question 7

Class and MOA of Abciximab

Answer 7

Antiplatelet drug: GPIIa/IIIa inhibitor

inhibits platelet aggregation by interfering with GPIIa/IIIa binding to fibrinogen and other ligands

Question 8

Class and MOA of Clopidogrel

Answer 8

Antiplatelet drug: ADP inhibitor

irreversibly inhibits binding of ADP to platelet receptors, reducing platelet aggregation

Question 9

Class and MOA of Dipyrimadole

Answer 9

Antiplatelet drug:PDE inhibitor
inhibits PDE III and increases cAMP in platelets and blood vessels
inhibits platelet aggregation, causes vasodilation

Question 10

When do we use anticoagulants vs antiplatelet?

Answer 10

arterial clot: platelet rich/ white thrombi -> antiplatelet

venous clot: fibrin rich/red thrombi -> anticoagulant

Question 11

Class and MOA of Heparin

Answer 11

Anticoagulant (indirect thrombin inhibitor)

Activates antithrombin III

Question 12

DOC for anticoagulation during pregnancy

Answer 12

Heparin

Question 13

Class and MOA of Enoxaparin

Answer 13

Anticoagulant (indirect thrombin inhibitor)

binds and potentiates effects of antithrombin III on factor Xa (more selective)

Question 14

Class and MOA of Lepirudin

Answer 14

Anticoagulant (direct thrombin inhibitor)

Question 15

Class and MOA of Rivaroxaban

Answer 15

Oral direct factor Xa inhibitor

inhibits factor Xa in the final common pathway

Question 16

Monoclonal antibody used for reversal of Dabigatran toxicity

Answer 16

Idarucizumab

Question 17

Class and MOA of Warfarin

Answer 17

Anticoagulant

inhibits vit K epoxide reductase

Question 18

Antidote for warfarin

Answer 18

Slow: Vit K
Fast: FFP

Question 19

Tx for Heparin-induced thromocytopenia

Answer 19

Replace warfarin with LMWH (Fondaparinux)

Question 20

Class and MOA of protamine sulfate

Answer 20

Antidote

Chemical antagonist of Heparin

Question 21

Class and MOA of Alteplase

Answer 21

Thrombolytic

Tissue plasminogen activator

Question 22

Antidote for Alteplase

Answer 22

Aminocaproic acid

Question 23

5 CI to thrombolysis

Answer 23

1. hx of cerebrovascular hemorrhage within the past year
2. non-hemorrhagic stroke or other cerebrovascular event within the past year
3. marked HTN (>180/110)
4. suspicion of aortic dissection
5. active internal bleeding (excluding menses)

Question 24

Class and MOA of tranexamic acid

Answer 24

Antiplasmin drug

Competitively inhibits plasminogen activation by inhibiting tPA

Question 25

Vitamin K1-K3 aka

Answer 25

Vit K1: Phytonadione
Vit K2: Menaquinone
Vit K3: Menadione

Question 26

Class and MOA of Desmopressin

Answer 26

ADH agonist

V2 receptor agonist