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hemostatsis and thrombosis Rx Flashcards

1
Q

vita k antag

A

warfarin (po and IV)

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2
Q

warfarin moa

genetics? only effective when?

A

Inhibits vitamin K epoxide reductase component 1
(VKORC1). Preventing the formation of vitamin K
dependent clotting factors (II, VII, IX, X, protein C, protein S).

The VKORC1 gene is polymorphic resulting in different affinities for warfarin.

Only effective in vivo

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3
Q

warfarin adrs

A

Bleeding (can be life threatening)- GI bleeding most common
Rash
Skin necrosis
Taste disturbance
“Purple toe” syndrome

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4
Q

warfarin dental

A

Bleeding- most procedures can be done without
holding medication

Antibiotic use after dental procedure may increase
risk of bleeding

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5
Q

unfractionated heparin

A

heparin (sq and IV)

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6
Q

heparin moa

works when?

A

Activation of antithrombin III, thereby inactivating Factor Xa and Thrombin (factor II).
Inhibits coagulation in vivo and in vitro

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7
Q

heparin adrs

A

Bleeding (can be life threatening)
Thrombosis- both HAT and HIT
Osteoporosis
Aldosterone inhibition-leading to hyperkalemia
Hypersensitivity reaction

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8
Q

heparin dental

A

Bleeding/bleeding gum
Although unlikely to be on heparin during dental
treatment

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9
Q

Low Molecular Weight Heparin (LMWH names

forms

A

Enoxaparin
Dalteparin
Tinzaparin
Available: SQ

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10
Q

LMWH moa

in vivo/vitro?

A

Activation of antithrombin III, thereby inactivating Factor Xa.

Smaller portion of the heparin molecule therefore not large enough to interact with thrombin (factor II).

Inhibits coagulation in vivo and in vitro.

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11
Q

LMWH adrs

A

Same as UFH
Bleeding (can be life threatening)
Thrombosis- both HAT and HIT- HIT less common with
LMWHs
Osteoporosis
Aldosterone inhibition-leading to hyperkalemia
Hypersensitivity reaction

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12
Q

LMWH dental

A

Bleeding- most procedures can be done without
holding medication

Coagulation tests (PT/aPTT) are insensitive to anticoagulant effects of LMWHs

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13
Q

Direct Thrombin Inhibitors

forms

A

Argatroban-Available: IV
Bivalirudin- Available: IV
Dabigatran- Available: PO

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14
Q

direct thrombin inhibitors moa

A

Binds to the fibrin- binding sites of thrombin preventing the conversion of fibrinogen

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15
Q

direct thrombin inhibitors adrs/ names

A

Argatroban/Bivalirudin: bleeding (life threatening)

Dabigatran: Bleeding (can be life threatening)- new reversal agent available and Dyspepsia/gastritis with dabigatran due to formulation

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16
Q

direct thrombin inhibitors dental

A

Bleeding- Although unlikely to be on argatroban or bivalirudin during dental treatment

Bleeding- most procedures can be done without holding dabigatran

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17
Q

factor Xa inhibitors

forms

A

Apixaban-Available: PO
Edoxaban- Available: PO
Fondaparinux- Available: SQ
Rivaroxaban- Available: PO

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18
Q

factor Xa inhibitors moa

A

Binds to factor Xa and
prevent the conversion
of prothrombin to
thrombin

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19
Q

factor Xa inhibitors adrs

A

bleeding

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20
Q

factor Xa inhibitors dental

A

Bleeding- most procedures
can be done without
holding medications

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21
Q

cox inhibitor

A

aspirin (PO)

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22
Q

aspirin MOA

A

Inhibits cyclo-oxygenase 1 (COX 1). Prevents formation of prostaglandin which is subsequently converted to
thromboxane A2

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23
Q

aspirin adrs

A

Bleeding (GI most common)
Dyspepsia
Rash
Angioedema
Tinnitus
Respiratory distress

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24
Q

aspirin dental

A

Bleeding- although most procedures can be completed without holding medication

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25
Q

P2Y12 inhibitors and forms

A

Cangrelor- Available: IV
Clopidogrel- Available: PO
Prasugrel- Available: PO
Ticagrelor- Available: PO

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26
Q

P2Y12 inhibitor moa

A

Inhibition of ADP binding at the P2Y12 receptor

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27
Q

P2Y12 inhibitors adrs/ names

A

Cangrelor- Bleeding (major) and Renal insufficiency

Clopidogrel/ Prasugrel/ Ticagrelor-
* Bleeding more common when combined with ASA
* Skin rash (more common with clopidogrel)
* Thrombocytopenia
* Dyspnea and elevated serum creatinine- unique to ticagrelor

28
Q

P2Y12 inhibitors dental

A

Bleeding- although it is unlikely patients will be on cangrelor during tx
Clopidogrel/ Prasugrel/ Ticagrelor: Bleeding- it is recommended to continue therapy through dental procedure.

29
Q

Glycoprotein IIb/IIIa inhibitors

forms

A

Eptifibatide
Tirofiban
Both Available: IV

30
Q

Glycoprotein IIb/IIIa inhibitors moa

A

Bind to GP IIb/IIIa receptor preventing the final
common pathway of platelet aggregation

31
Q

Glycoprotein IIb/IIIa inhibitors adrs/ names

A

Bleeding- highest incidence of all antiplatelet medications
Thrombocytopenia

Eptifibatide and Tirofiban

32
Q

Glycoprotein IIb/IIIa inhibitors dental

A

Bleeding- although it is unlikely patients will be on
these medications during procedure

33
Q

PAR-1 antagonist name

form

A

Vorapaxar
Available: PO

34
Q

vorapaxar moa

A

Antagonist of the PAR-1 inhibiting thrombin receptor agonist peptide (TRAP)- induced platelet aggregation

Does not effect the conversion of fibrinogen to fibrin by thrombin

35
Q

vorapaxar adrs

36
Q

vorapaxar dental

A

Bleeding-no recommendations made regarding whether or not to hold medication during procedure

37
Q

Fibrinolytic Therapy (Plasminogen activators)

form

A

Alteplase
Reteplase
Tenecteplase
Available: IV

38
Q

Fibrinolytic Therapy (Plasminogen activators) moa

A

Binds to tissue bound fibrin and plasminogen converting plasminogen to plasmin (fibrin specific)

39
Q

Fibrinolytic Therapy (Plasminogen activators adr

A

bleeding (mostly at infusion site)

40
Q

Fibrinolytic Therapy (Plasminogen activators dental

A

Bleeding- although it is unlikely that a patient will
be receiving these medications during procedure

41
Q

Antifibrinolytic Therapy (Hemostatic agents)

forms

A

Aminocaproic acid
Tranexamic acid
Available: PO and IV

42
Q

Antifibrinolytic Therapy (Hemostatic agents moa

A

Competitive inhibition of plasminogen activation by
binding to plasminogen
At higher concentrations non- competitive inhibition of
plasmin

43
Q

Antifibrinolytic Therapy (Hemostatic agents) adrs

IV vs PO

A

IV- hypotension and giddiness
PO- headache, abdominal pain, and nasal/sinus
symptoms

44
Q

Antifibrinolytic Therapy (Hemostatic agents) dental

A

Used as an off-label indication to prevent or treat dental bleeding

45
Q

Enoxaparin moa

A

LMWH:
Activation of antithrombin III, thereby inactivating Factor Xa. Smaller portion of the heparin molecule therefore not large enough to interact with thrombin (factor II).
Inhibits coagulation in vivo and in vitro.

46
Q

dalteparin moa

A

LMWH
Activation of antithrombin III, thereby inactivating Factor Xa. Smaller portion of the heparin molecule therefore not large enough to interact with thrombin (factor II).
Inhibits coagulation in vivo and in vitro.

47
Q

tinzaparin moa

A

Activation of antithrombin III, thereby inactivating Factor Xa. Smaller portion of the heparin molecule therefore not large enough to interact with thrombin (factor II).
Inhibits coagulation in vivo and in vitro.

48
Q

Argatroban moa

A

Binds to the fibrin-
binding sites of thrombin
preventing the
conversion of fibrinogen

49
Q

bivalirudin moa

A

Binds to the fibrin-
binding sites of thrombin
preventing the
conversion of fibrinogen

50
Q

dabigatran moa

A

Binds to the fibrin-
binding sites of thrombin
preventing the
conversion of fibrinogen

51
Q

apixaban moa

A

Binds to factor Xa and
prevent the conversion
of prothrombin to
thrombin

52
Q

edoxaban moa

A

Binds to factor Xa and
prevent the conversion
of prothrombin to
thrombin

53
Q

fondaparinux moa

A

Binds to factor Xa and
prevent the conversion
of prothrombin to
thrombin

54
Q

rivarobaxan moa

A

Binds to factor Xa and
prevent the conversion
of prothrombin to
thrombin

55
Q

Cangrelor moa

A

Inhibition of ADP binding
at the P2Y12 receptor

56
Q

clopidigrel moa

A

Inhibition of ADP binding
at the P2Y12 receptor

57
Q

prasugrel moa

A

Inhibition of ADP binding
at the P2Y12 receptor

58
Q

ticagrelor moa

A

Inhibition of ADP binding
at the P2Y12 receptor

59
Q

Eptifibatide moa

A

Bind to GP IIb/IIIa receptor
preventing the final
common pathway of
platelet aggregation

60
Q

tirofiban moa

A

Bind to GP IIb/IIIa receptor
preventing the final
common pathway of
platelet aggregation

61
Q

Alteplase moa

A

Binds to tissue bound fibrin and
plasminogen converting
plasminogen to plasmin
(fibrin specific)

62
Q

reteplase moa

A

Binds to tissue bound fibrin and
plasminogen converting
plasminogen to plasmin
(fibrin specific)

63
Q

tenecteplase moa

A

Binds to tissue bound fibrin and
plasminogen converting
plasminogen to plasmin
(fibrin specific)

64
Q

Aminocaproic acid moa

A

Competitive inhibition of plasminogen activation by
binding to plasminogen
At higher concentrations non-competitive inhibition of plasmin

65
Q

tranexaminic acid moa

A

Competitive inhibition of plasminogen activation by
binding to plasminogen
At higher concentrations non-competitive inhibition of plasmin

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