Exam 4 - Anticoagulants

Question 1

Anticoags

DRUG LIST

Answer 1

Heparin
Enoxaparin
Fondaparinux
Warfarin
Dabigatran
Rivaroxaban

Question 2

Antiplatelet

DRUG LIST

Answer 2

Aspirin

Clopidogrel

Question 3

Mechanism Only

DRUG LIST

Answer 3

Desirudin - complexes w/ and inhibits thrombin
Bivalrudin - complexes w/ and inhibits thrombin
Agratroban - complexes w/ and inhibits thrombin
Abciximab - blocks GPIIb/IIIa receptors

Question 4

Anticoags

Targets

Answer 4

Xa

IIa

Question 5

Anticoags

Antithrombin III Catalysts (3)

Answer 5

“Parins”
Heparin
Enoxaparin
Fondaparinux

Question 6

Anticoags

Thrombin and Xa inhibitors (2)

Answer 6

“TranBans”
Dabigatran
Rivaroxaban

Question 7

Anticoags

Clotting Factor Inhibitors

Answer 7

Warfarin

Question 8

Anticoags
Heparins
General

Answer 8

• natural polysaccharide extracted from barnyard friends
• fractionated v unfractionated
• strongly acidic

Question 9

Anticoags
Unfractionated Heparin
Mechanism

Answer 9

-Activates antithrombin III which then
binds and inactivates IIa and Xa
-Is not consumed

Question 10

Anticoags
LMW Heparins (2)

Answer 10

Enoxaparin

Fondaparinux

Question 11

Anticoags
LMW Heparins (2)
Mechanism

Answer 11

-Specific inhibition for Xa

Question 12

Anticoags
Heparins
Administration

Answer 12

• Heparin IV, LMW Heparin subcutaneous

- Routine monitoring for Heparin, not LMW

Question 13

Anticoags
Heparins
Indications

Answer 13

Heparin: DVT/PE prevention, MI/angina
LMW: Fondaparinux for Hip/Knee surgery, HIT

Question 14

Anticoags
Heparins
Toxicities

Answer 14

• Heparin-induced thrombocytopenia
• paradoxical thrombosis
• bleeding
• hypersensitivity

Question 15

Anticoags
Heparins
Contraindications

Answer 15

-Warfarin contra’d with Hep-induced Thrombocytopenia
-Use fondaparinux instead for HIT
-Hypersens, active bleed, risk of abortion,
infective endocarditis, surgery
-Protamine Sulfate (dyspnea, bradycardia, HoTN)

Question 16

Anticoags
Warfarin
Mechanism

Answer 16

• inhibits carboxylation/activation of clotting factors
• Vitamin K analog
• S enantiomer 4x more potent
• inhibits VKORC1, limiting amt of Vit K available for carboxylation

Question 17

Anticoags
Warfarin
ADME

Answer 17

• 100% bioavailable
• oral sodium salt
• excreted in urine

Question 18

Anticoags
Warfarin
Adverse

Answer 18

-bleeding, fetal hemorrhagic d/o
-inhibits Proteins C and S, leads to
acute procoagulant state
-teratogenic

Question 19

Anticoags
Warfarin
Interactions

Answer 19

• CYP2C9 inhibs/inducers and S enantiomer
• Vitamin K supplement can interfere
• MANY INTERACTIONS
• St John’s Wort

Question 20

Anticoags
IIa inhibitor
Dabigatran
Mechanism

Answer 20

• blocks active site of IIa (thrombin)

- prodrug

Question 21

Anticoags
IIa inhibitor
Dabigatran
Adverse/Interactions

Answer 21

• bleeding

- P-glycoprotein effects (ketoconazole, rifampin)

Question 22

Anticoags
Xa inhibitor
Rivaroxaban
mechanism

Answer 22

-blocks active site of Xa

Question 23

Anticoags
Xa inhibitor
Rivaroxaban
Adverse/Interactions

Answer 23

• bleeding

- P-glycoprotein effects (ketoconazole, rifampin)

Question 24

Anticoags
Random 3 Rx
Mechanism

Answer 24

Desirudin - complexes w/ and inhibits thrombin
Bivalrudin - complexes w/ and inhibits thrombin
Agratroban - complexes w/ and inhibits thrombin

Question 25

Antiplatelets
Aspirin
Mechanism

Answer 25

• Inhibits TXA2 production (via COX1, irreversibly)

- inhibits platelet aggregation

Question 26

Antiplatelets
Clopidogrel
Mechanism

Answer 26

-inhibits ADP-mediated activation of platelets

by binding irreversibly to purine receptors (P2Y 1 and 2)

Question 27

Antiplatelets
Clopidogrel
Adverse

Answer 27

-rash, diarrhea, dyspepsia

Question 28

Antiplatelets
Abciximab
Mechanism

Answer 28

blocks GPIIb/IIIa receptors