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Pharm Fall 2019 > Ex3 Anticoagulants > Flashcards

Ex3 Anticoagulants Flashcards

1
Q

Big offender in bleeding disorders

A

herbals: garlic, fish oil, ginko

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2
Q

Disorders of Hemostasis: definition

A

increased risk of bleeding

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3
Q

Prothrombotic states: definition

A

increased risk for clotting

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4
Q

HIT

A

prothrombotic state

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5
Q

antiphospholipid antibody syndrome

A

prothrombotic state

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6
Q

DIC

A

prothrombotic state AND disorder of hemostasis

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7
Q

Liver disease

A

prothrombotic state AND

disorder of hemostasis

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8
Q

Hemophilias

A

disorder of hemostasis

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9
Q

Von Wilibrand disease

A

disorder of hemostasis

Factor 8 low

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10
Q

Vitamin K dependent clotting factors

A

Factors 2, 7, 9, 10

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11
Q

Vitamin K deficiency

A

disorder of hemostasis

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12
Q

Heparin MOA

A

Binds to antithrombin III

–>inhibits fxn factors

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13
Q

LMWH differs from UFH

A

More specific for inhibition of Xa

Renal excretion

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14
Q

UFH differs from LMWH

A

quick on, quick off, metabolized via endothelium

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15
Q

T/F: heparins & warfarin are dialyzable

A

False

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16
Q

UFH advantages

A

short half life, renal dysfxn does not impact clearance, antidote available

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17
Q

UFH disadvantages

A

frequent lab monitoring, HIT

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18
Q

LMWH advantages

A

no lab monitoring needed

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19
Q

LMWH disadvantages

A

Cannot be fully reversed

Renal elimination

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20
Q

Tx for HIT

A

direct thrombin inhibitors

Bivalrudin/Argatroban

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21
Q

aPTT is effected by

A

UFH

not affected by LMWH

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22
Q

Lab monitoring used in CABG

A

ACT

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23
Q

Anti-factor Xa Lab Test

A
  • both LMWH/UFH
  • most often for LMWH
  • UFH: used for heparin resistance
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24
Q

DOC: UFH reversal

A

protamine

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25
Q

Protamine contraindications

A

-fish allergy

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26
Q

Protamine adverse effects

A
  • Anaphylaxis (fish allergy, vasectomy, pt on NPH)
  • acute pulm vasoconstriction, hypotension, bradycardia
  • slow infusion
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27
Q

Protamine dose

A

1 mg protamine reverses 100 units UFH IV

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28
Q

Protamine dose based on

A

UFH over past 2-3 hours

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29
Q

Max protamine

A

50 mg in 10 minutes

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30
Q

Reversal agent LMWH

A

None specific to LMWH

-protamine partially effective

31
Q

Dosage for LMWH reversal

A
  • 1mg protamine per 1 mg enoxaparin given w/in last 8h

- Max dose 50mg

32
Q

After max dose protamine

A

0.5 mg for every 1mg (LMWH) and 100 units (UFH) if bleeding continues

33
Q

reason Recombinant factor VIIa not used often

A

high risk for thrombosis

34
Q

4F-PCC contraindicated

A
  • HIT
  • Heparin allergy
    (only factor product +heparin)
35
Q

Vitamin K antagonist

A

Warfarin

36
Q

Warfarin MOA

A

Inhibits activation of Vit.K dependent clotting factors (Factors 2, 7, 9, 10, Protein C+S)

37
Q

Onset Warfarin

A

Full anticoagulation effect not achieved until 4 days

38
Q

What is needed during initiation of warfarin?

A

LMWH/UFH d/t hyper-coagulable state

39
Q

reversal of warfarin

elective/nonurgent surgery

A

oral/iv vitaminK

40
Q

reversal of warfarin

urgent surgery

A

4 factor PCC + IV vitamin K

41
Q

reversal of warfarin

minor bleeding

A

iv vitamin k

42
Q

reversal of warfarin

major bleeding

A

4 factor PCC + IV vitamin k

43
Q

risk of PCC

A

increased risk of thromboembolic event

44
Q

unique aspect of dabigatran

A

dialyzable (57% over 4h)

45
Q

Bivalrudin/argatroban reversal

A

Supportive care/time

46
Q

Dabigatran reversal

A
  • activated charcoal if w/in 2 hours

- Idarucizumab direct reversal

47
Q

no role for reversal if presentation ________ after cessation of therapy

A

3-5 half lives

48
Q

No role for ______ to reverse DTIs

A

plasma

49
Q

advantages of NOACs

A

no lab monitoring

50
Q

disadvantages of NOACs

A

not indicated for mechanical valve

51
Q

Direct factor Xa inhibitors - which are dialyzable?

A

Apixaban (minimal)

No - Rivaroxaban, Edoxaban

52
Q

Standard monitoring for NOACs

A

-thrombin time
-CBC w/ differential
-renal/hepatic function
(dabi - only renal fxn)

53
Q

S/S OD dabigatran

A

aPTT > 2.5x control

54
Q

Reversal of rivaroxaban, apixaban

A

Andexxa

  • w/in 2h: active charcoal
  • bolus then infusion
55
Q

injectable Xa inhibitor

A

Fondaparinux

-no direct reverse (only activated PCC)

56
Q

What should you do prior to neuraxial anesthesia?

A

Check Azra guidelines

57
Q

avoid neuraxial anesthesia in patients taking

A

fibrinolytics/thrombolytics

58
Q

length of time to d/c heparin prior to neuraxial anesthesia

A

4-6h

59
Q

ideal situation if pt on anticoagulants & needs to go to OR

A

bridge with short acting parenteral therapy (UFH/LMWH)

60
Q

Warfarin should be held _____ prior to OR

A

5 days

61
Q

LMWH should be held _____ prior to OR

A

24h

62
Q

UFH should be held _____ prior to OR

A

4h

63
Q

antiplatelet agents

A
  • clopidogrel, prasugrel, ticagrelor, cangrelor
  • aspirin, NSAIDs
  • dipyridamole
64
Q

Prodrugs

A

Clopidogrel

Prasugrel

65
Q

inhibitors (antifungal/sedatives/antiepileptics) with clopidogrel

A

prevents breakdown of drug to active form

*same w/ prasugrel

66
Q

Percent platelet inhibition

A

aspirin - 20
clopidogrel - 40
prasugrel - 70
ticagrelor - 95

67
Q

Reversible platelet binding

A

Ticagrelor

68
Q

IV antiplatelet agent

A

cangrelor

continuous infusion

69
Q

metabolism of cangrelor

A

metabolized by dephosphorylation - restores platelets QUICKLY

  • independent of organ dysfunction
  • not dialyzable
70
Q

AE desmopressin

A

tachyphylaxis

71
Q

Antiplatelet agents in high risk pts before surgery

A

Cangrelor or glycoprotein IIb/IIIa inhibitors

72
Q

Glycoprotein IIb/IIIa inhibitors

A

tirofiban

eptifibatide

73
Q

antifibrinolytic agents

A

aminocaproic acid

tranexamic acid

74
Q

risk of tranexamic acid

A

seizures d/t possible block of GABA receptors

Pharm Fall 2019 (33 decks)

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