Heme Drugs (AntiCoags)

Question 1

How does Heparin work?

What is it used for?

Answer 1

COFACTOR for ATIII…decrease Thrombin and 10a

Immediate Anticoag

Anticoag for PE
Acute Coronary Syndrome
MI
DVT
Used in preggos

Monitor th PTT

Question 2

What are the SEs of heparin?

Answer 2

Bleeding
HIT
Osteoporosis
DDI

Question 3

What HIT?

Answer 3

Heparin induced thrombocytopenia

Heparin binds to PF-4 forming a complex which is targeted by IgG

this activates platelets and causes thrombosis which uses up the platelets then causes thrombocytopenia

Question 4

Wha is the antidote for heparin?

Answer 4

Protamine Sulfate

Question 5

What are the low molecular weight heparins and what d they target?

Answer 5

Enoxaparin,Dalteparin

Factor 10a

Have longer half life and better bioavailability

No need to follow in labs, but not easily reversible

Question 6

What is Argatroban, Lepirudin and Bivalirudin?

Answer 6

Direct Thrombin inhibitors

Used for HIT patients instead of hep

Derived from hirudin

Question 7

Patients at risk for DVT have to be given what for pre-op prophylaxis? If not what are they at risk for?

Answer 7

Heparin

If not they will develop a DVT, then a pulmonary embolism

Question 8

How does coumadin (warfarin) work?

Answer 8

Blocks gamma CO2’n of 2,7,9,10,C,S by blocking epoxide reductase

Metab’d by P450

Question 9

What is coumadin used for?

Answer 9

CHRONIC Anticoag like after a STEMI, venous thromboembolism prophylaxis,
PREVENT STROKE IN AFIB

Not for preggos bc can X BBB

Question 10

SEs of coumadin

How do you reverse warfarin toxicity?

Answer 10

Bleeding, teratogenic, skin necrosis in people with Protein C deficiency

Reversal:
Vitamin K

For rapid reversal of severe OD: give FFP which replenishes all coag factors

Question 11

What are the direct 10a inhibitors?

How do they work?

Answer 11

Apixaban, Rivaroxaban

Binds to and directly blocks 10a

Question 12

What is Apixaban and Rivaroxaban used for?

SEs?

Answer 12

Direct 10a inhibitors are used for prophylaxis of DVT and PE (rivaroxaban)

Stroke prophylaxis in A-Fib patients

SEs: Bleeding and there’s no antidote

apiXaban and rivaroXaban for factor Xa

Question 13

What are the thrombolytics and how do they work?

Answer 13

Alteplase (tPA)
Retaplase (rPA)
Tenecteplase (TNK-tPA)

Converts plasminogen into plasmin which cleaves thrombin and fibrin clots

Question 14

What are the effects on PT, PTT or platelet counts with the thrombolytics?

Answer 14

Increases both PT, PTT but no effect on platelet count

Question 15

What ae the thrombolytics used for?
SEs:
What is used to reverse it

Answer 15

Early MI
Early ischemic stroke especially
Direct thrombolysis of severe PE

Bleeding, so dont give to ppl who are actively bleeding, or have Hx of bleeding, or severe HTN

Reversal: Aminocaproic acid which blocks fibrinolysis. Can also give FFP or cryoprecipitate

Question 16

What does aspirin block specifically?
What is it used for?
SEs?

Answer 16

Irreversibly inhibits COX-1 & 2 via covalent acetylation
Increases bleeding time and decreases TXA2 and PGs
NO EFFECT ON PT OR PTT

Fever, analgesic, anti-inflamm, anti platelet aggregation

Ulcers, Tinnitis (CN8). chronic use: renal failure, interstitial nephritis
Reyes in children

Question 17

What are the ADP receptor inhibitors?
MOA?
SEs?

Answer 17

Clopidogrel, Ticlopidine, Prasugrel, Ticagrelor

Irreversibly block ADP receptors
Prevents Fibrinogen from binding by blocking GpIIb/IIIa from binding to fibrinogen

Used for ACS, coronary stenting, decreases thrombotic stroke

SEs: Neutropenia (ticlopidine), TTP/HUS

Question 18

What is Cilostazol and Dipyridamole?
MOA?
Toxicity?

Answer 18

Phosphodiesterase III Inhibitors

Incr cAMP in platelets—>inhibiting platelet aggregation

For intermittent claudication
Coronary vasodilation, prevent stroke or TIA (when combined with aspirin),
Angina prophylaxis

SEs: Nausea, HA, facial flushing, HTN, abd pain

Question 19

What are the GpIIa/IIIb Inhibitors?
MOA?
SEs?

Answer 19

AbSIXimab, Eptifibatide, Tirofiban

block platelet aggregation

Abciximab made from Fab fragments

Used for UNSTABLE angina, percutaneous transluminal coronary angioplasty

SEs: Bleeding, low platelets