L20: Anticoags

Question 1

Adverse effect of warfarin

Answer 1

Quickly reduces levels of Protein C —> cutaneous necrosis/infarction (warfarin-induced thrombosis)

Question 2

LMWH

Answer 2

Enoxaparin

Fondaparinux (synthetic)

Question 3

Used in angioplasty, atherectomy, and stent placement

Answer 3

Abciximab
Eptifibatide
Tirofiban

(GPIIb/IIIa inhibitors)

Question 4

HIT=

Answer 4

Heparin induced thrombocytopenia

Question 5

Used in patients who are allergic to aspirin

Answer 5

ADP inhibitors:
Clopidigrel
Ticlopidine
Prasugrel

Question 6

LMWH reversal

Answer 6

Protamine sulfate doesn’t completely reverse enoxaparin.

Doesn’t work at all on fondaparinux

Question 7

metronidazole

Answer 7

Inhibit liver enzymes

affecting warfarin

Question 8

Who can’t take warfarin

Answer 8

pregnant ppl

Question 9

Drugs that displace warfarin from albumin

Answer 9

Increase its effects
Penylbutazone
ethacrynic acid

Question 10

Imipramine

Answer 10

Inhibit liver enzymes

affecting warfarin

Question 11

Factor Xa inhibitors end with

Answer 11

XABAN

Question 12

Warfarin reversal

Answer 12

Vitamin K takes time

Immediate: fresh frozen plasma

Question 13

Inhibitors of the GPIIb/IIIa receptor names

Answer 13

Abciximab
Eptifibatide
Tirofiban

Question 14

Warfarin messes with the synthesis of

Answer 14

2 (II)
7 (VII)
9 (IX)
10 (X)
Protein C
Protein S

Question 15

What’s the benefit of LMWH over UFH?

Answer 15

Can be injected subcutaneously

Can be used in pregnancy

Lower incidence of HIT

Question 16

Which anticoagulant comes from leeches?

Answer 16

Bivalirudin

Question 17

Fibrinolytics

Answer 17

not-clot specific: any plasminogen

Urokinase

Question 18

Cimetidine

Answer 18

Inhibit liver enzymes

affecting warfarin

Question 19

Drug which decreases the effects of oral contraceptives/estrogen

Answer 19

Warfarin

Question 20

Chloramphenicol

Answer 20

Inhibit liver enzymes

affecting warfarin

Question 21

Antibiotics+warfarin

Answer 21

antibiotics inhibit vitamin K synthesis in intestinal flora, altering the effects of warfarin

Question 22

How to start warfarin tx

Answer 22

Takes time to take effect but lasts 4-5 days after d/c

—> start in combo with heparin for first 5 days

Question 23

Aspirin MOa

Answer 23

Irreversible inhibition of the COX enzyme —> reduced production of TXA2

No prostaglandin synthesis —> decreased platelet aggregation

Lasts the life of the platelet (7-10 days)

Question 24

Thrombolytics

Answer 24

clot specific: fibrin bound plasminogen

Alteplase
Tenecteplase

Question 25

Do you have to monitor anticoagulation with Dabigatran?

Answer 25

No - predictable anticoagulant effects, not monitored by PTT (true of all new anticoagulants)

Question 26

Warfarin

Answer 26

Inhibits reduction of vitamin K —> interferes with synthesis of II, VII, IX, and X, Protein C and S

Question 27

Barbiturates

Answer 27

Induces liver enzymes

affecting warfarin

Question 28

MOA for Clopidigrel, Ticlopidine, and Prasugrel

Answer 28

Irreversibly blocks the ADP receptor on platelets —> decreased platelet aggregation

Question 29

DOC to prevent thrombosis in patients undergoing placement of coronary stents

Answer 29

ADP inhibitors:
Clopidigrel
Ticlopidine
Prasugrel

Question 30

MOA for Fibrinolytic Agents

Answer 30

Convert plasminogen to plasminogen —> lyses thrombus from within

Question 31

DOC for secondary prevention of CV events in a patient with established CVD

Answer 31

Aspirin

Question 32

Aspirin+warfarin

Answer 32

Contraindicated
Aspirin inhibits platelet aggregation
Together cause serious bleeding

Question 33

Factor Xa inhbitors antidote

Answer 33

Andexxa

Question 34

Where do the intrinsic and extrinsic pathways meet in the coagulation cascade?

Answer 34

Factor Xa

Question 35

How is unfractionated heparin administered?

Answer 35

IV

onset of action immediate