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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?

A

INR

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?

A

Warfarin

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
Q

What is the reversal agent of Warfarin if immediate effects are needed due to excessive bleed?

A

Fresh frozen plasma

26
Q

What is the reversal agent of Warfarin that will require a few days to take effect?

A

Vitamin K

27
Q

What are contraindications/precautions of Warfarin?

A

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
Q

What is the DOC for coagulation in pregnancy?

A

Lovenox (LMWH)

29
Q

What is the MOA of t-PA (Fibrinolytic Agent)?

A
  • Converts plasminogen to plasmin

- Plasmin will then degrade fibrin threads of the clot into soluble degradation products and removes the clot

30
Q

What are the uses of t-PA?

A
  • Lysis of clots –> re-establish tissue perfusion such as in MI
  • Severe PE, DVT
31
Q

If there is severe bleeding secondary to t-PA, how can it be treated?

A

Aminocaproic acid

32
Q

What is the MOA of Aminocaproic acid and Transexamic acid (Anti-fibrinolytics)?

A

Completely inhibits plasminogen activation

33
Q

What are the uses of Aminocaproic acid and Transexamic acid (Anti-fibrinolytics)?

A

Used for bleeding disorders:

  • Adjunct in hemophilia
  • Reversal of fibrinolytic therapy (t-PA)
34
Q

When are Aminocaproic acid and Transexamic acid (Anti-fibrinolytics) contraindicated?

A

In patients with DIC or GU bleeding of the upper tract due to potential for excessive clotting

35
Q

What is the MOA of Aspirin?

A

Irreversible inhibition of the COX enzyme leading to decreased TXA2 and platelet aggregation

36
Q

What are uses for Aspirin?

A

Patient at risk for embolisms:

- Secondary prevention of cardiovascular events in most patients with established cardiovascular disease

37
Q

What is the MOA of Clopidogrel (Plavix) and Ticagrelor (Brilinta)?

A

Irreversibly blocks the ADP receptor on platelets leading to decreased platelet aggregation

38
Q

What are uses for Clopidogrel (Plavix) and Ticagrelor (Brilinta)?

A
  • 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
Q

What is the DOC to prevent thrombosis in patients with coronary stents?

A

Clopidogrel (Plavix) and Ticagrelor (Brilinta)

40
Q

What are precautions with using Clopidogrel (Plavix)?

A

Caution when using drugs that impair CYP2C19 function (omeprazole) as clopidogrel is metabolized into its active form by CYP2C19

41
Q

What drug should you advise your patient against using if they are taking Clopidogrel (Plavix)?

A

Advise that they do not take omeprazole as it inhibits CYP2C19 and will not allow Plavix to become its active form

42
Q

What is the MOA of Abciximab?

A
  • Antibody to GP IIb/IIIa receptor

- Decreases platelet aggregation by inhibiting GP IIb/IIIa receptors from binding fibrinogen

43
Q

What are uses for IV Abciximab?

A

Combined with heparin during percutaneous coronary intervention (angioplasty, atherectomy, stent placement)

44
Q

What is the reversal agent of Heparin?

A

Protamine sulfate

45
Q

What is used to monitor heparin therapy?

A

PTT

Pharm II (10 decks)

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