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Pharm II > Exam 2 - Coagulation > Flashcards

Exam 2 - Coagulation Flashcards

1
Q

What is the MOA of Heparin?

A

Catalyst which accelerates activity of Anti-thrombin III

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2
Q

What are the uses of Heparin?

A
  • Anticoagulant for operations and IV catheters
  • Bridging anticoagulant therapy before surgery
  • Prophylaxis against DVT/PE
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3
Q

What are the pharmacokinetics of Heparin?

A
  • IV and SC

- IV onset of action is immediate

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4
Q

What are adverse effects of Heparin?

A
  • Hemorrhage

- Heparin-induced thrombocytopenia (HIT) –> autoimmune aggregation

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5
Q

What are contraindications/precautions of Heparin?

A

Renal or hepatic dysfunction

DO NOT USE in patients;

  • Actively bleeding
  • Hemophilia or other blood clotting disorders
  • Hypersensitive
  • During or after surgery of the brain, spinal cord or eye
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6
Q

What is the MOA of LMWH and similar drugs (Enoxaprin, Fondaparinux)?

A
  • Main inhibitory effect on factor Xa (not much on thrombin)
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7
Q

What are the uses of LMWH?

A

Better bioavailability when injected SC:

  • Pregnancy
  • Outpatient bridging for warfarin patients having surgery
  • Once/day dose
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8
Q

What is the MOA of Dabigatran (Pradaxa)?

A

Oral direct inhibitor of thrombin

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9
Q

What are the uses of Dabigatran (Pradaxa)?

A

Prevention of stroke in patients with non-valvular A-fib

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10
Q

What patient population should Dabigatran (Pradaxa) not be used in?

A

Patient with mechanical heart valves

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11
Q

What is the black box warning associated with Dabigatran (Pradaxa)?

A

Avoid abrupt discontinuation without adequate alternative anti-coagulation due to the acute increased risk of thrombotic events

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12
Q

What is the antidote for Dabigatran (Pradaxa)?

A

Idarucizumab (Praxbind)

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13
Q

What is the MOA of Rivaroxaban (Xarelto), Apixaban (Eliquis)?

A

Oral direct inhibitors of factor Xa

***both names end in “Xa” “Ban”

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14
Q

What are the uses of Rivaroxaban (Xarelto) and Apixaban (Eliquis)?

A
  • DVT, PE

- Future clots (prophylaxis)

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15
Q

When should you avoid using Rivaroxaban (Xarelto) and Apixaban (Eliquis)?

Why?

A

Avoid use in patients with liver disease or renal failure as these meds are cleared by the kidney and liver (CYP3A4)

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16
Q

What is the antidote for Rivaroxaban (Xarelto) and Apixaban (Eliquis)?

A

Factor Xa decoy (Andexxa)

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17
Q

What is the MOA for Warfarin?

A
  • Inhibits reduction of vitamin K (need reduced vitamin K for mature clotting factor)
  • Interferes with synthesis of II, VII, IX, X, Protein C/S
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18
Q

What is important to note about the administration of Warfarin?

A

Takes time to become effective and is initiated slowly over about a week along with co-administration of Heparin for first 5 days

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19
Q

How is Warfarin monitored?

20
Q

What are the uses of Warfarin?

A

Prevent development of emboli

No effect on already formed thrombi

21
Q

What anti-coagulant is monitored by INR levels?

22
Q

What are adverse effects of Warfarin?

A
  • Hemorrhage
  • Quickly reduces levels of protein C (increases chance of warfarin-induced thrombosis and cutaneous necrosis/infarction)
23
Q

What is the first component that is reduced/disappears with Warfarin therapy and why is this significant?

A

Protein C is the first component that is reduced. At the beginning of therapy, Warfarin actually promotes coagulation as it reduces levels of protein C which is an anticoagulant. This is why we must bridge with Heparin for first 5 days to prevent coagulation during initiation of therapy.

24
Q

What are the reversal agents for Warfarin?

A
  • Vitamin K

- Fresh frozen plasma

25
What is the reversal agent of Warfarin if immediate effects are needed due to excessive bleed?
Fresh frozen plasma
26
What is the reversal agent of Warfarin that will require a few days to take effect?
Vitamin K
27
What are contraindications/precautions of Warfarin?
Pregnancy (crosses placenta and leads to birth defects) Drug interactions/drugs that affect: - Vitamin K (abx) - Clotting factors (estrogen) - Platelet aggregation (aspirin) - Inhibit/induce liver microsomal enzymes
28
What is the DOC for coagulation in pregnancy?
Lovenox (LMWH)
29
What is the MOA of t-PA (Fibrinolytic Agent)?
- Converts plasminogen to plasmin | - Plasmin will then degrade fibrin threads of the clot into soluble degradation products and removes the clot
30
What are the uses of t-PA?
- Lysis of clots --> re-establish tissue perfusion such as in MI - Severe PE, DVT
31
If there is severe bleeding secondary to t-PA, how can it be treated?
Aminocaproic acid
32
What is the MOA of Aminocaproic acid and Transexamic acid (Anti-fibrinolytics)?
Completely inhibits plasminogen activation
33
What are the uses of Aminocaproic acid and Transexamic acid (Anti-fibrinolytics)?
Used for bleeding disorders: - Adjunct in hemophilia - Reversal of fibrinolytic therapy (t-PA)
34
When are Aminocaproic acid and Transexamic acid (Anti-fibrinolytics) contraindicated?
In patients with DIC or GU bleeding of the upper tract due to potential for excessive clotting
35
What is the MOA of Aspirin?
Irreversible inhibition of the COX enzyme leading to decreased TXA2 and platelet aggregation
36
What are uses for Aspirin?
Patient at risk for embolisms: | - Secondary prevention of cardiovascular events in most patients with established cardiovascular disease
37
What is the MOA of Clopidogrel (Plavix) and Ticagrelor (Brilinta)?
Irreversibly blocks the ADP receptor on platelets leading to decreased platelet aggregation
38
What are uses for Clopidogrel (Plavix) and Ticagrelor (Brilinta)?
- Used in patients at risk for embolisms and who are allergic to aspirin - Decrease thrombotic events following MI and stroke - Prevent thrombosis in patients with coronary stents (DOC)
39
What is the DOC to prevent thrombosis in patients with coronary stents?
Clopidogrel (Plavix) and Ticagrelor (Brilinta)
40
What are precautions with using Clopidogrel (Plavix)?
Caution when using drugs that impair CYP2C19 function (omeprazole) as clopidogrel is metabolized into its active form by CYP2C19
41
What drug should you advise your patient against using if they are taking Clopidogrel (Plavix)?
Advise that they do not take omeprazole as it inhibits CYP2C19 and will not allow Plavix to become its active form
42
What is the MOA of Abciximab?
- Antibody to GP IIb/IIIa receptor | - Decreases platelet aggregation by inhibiting GP IIb/IIIa receptors from binding fibrinogen
43
What are uses for IV Abciximab?
Combined with heparin during percutaneous coronary intervention (angioplasty, atherectomy, stent placement)
44
What is the reversal agent of Heparin?
Protamine sulfate
45
What is used to monitor heparin therapy?
PTT

Pharm II (10 decks)

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