L20: Anticoags Flashcards
Adverse effect of warfarin
Quickly reduces levels of Protein C —> cutaneous necrosis/infarction (warfarin-induced thrombosis)
LMWH
Enoxaparin
Fondaparinux (synthetic)
Used in angioplasty, atherectomy, and stent placement
Abciximab
Eptifibatide
Tirofiban
(GPIIb/IIIa inhibitors)
HIT=
Heparin induced thrombocytopenia
Used in patients who are allergic to aspirin
ADP inhibitors:
Clopidigrel
Ticlopidine
Prasugrel
LMWH reversal
Protamine sulfate doesn’t completely reverse enoxaparin.
Doesn’t work at all on fondaparinux
metronidazole
Inhibit liver enzymes
affecting warfarin
Who can’t take warfarin
pregnant ppl
Drugs that displace warfarin from albumin
Increase its effects
Penylbutazone
ethacrynic acid
Imipramine
Inhibit liver enzymes
affecting warfarin
Factor Xa inhibitors end with
XABAN
Warfarin reversal
Vitamin K takes time
Immediate: fresh frozen plasma
Inhibitors of the GPIIb/IIIa receptor names
Abciximab
Eptifibatide
Tirofiban
Warfarin messes with the synthesis of
2 (II) 7 (VII) 9 (IX) 10 (X) Protein C Protein S
What’s the benefit of LMWH over UFH?
Can be injected subcutaneously
Can be used in pregnancy
Lower incidence of HIT
Which anticoagulant comes from leeches?
Bivalirudin
Fibrinolytics
not-clot specific: any plasminogen
Urokinase
Cimetidine
Inhibit liver enzymes
affecting warfarin
Drug which decreases the effects of oral contraceptives/estrogen
Warfarin
Chloramphenicol
Inhibit liver enzymes
affecting warfarin
Antibiotics+warfarin
antibiotics inhibit vitamin K synthesis in intestinal flora, altering the effects of warfarin
How to start warfarin tx
Takes time to take effect but lasts 4-5 days after d/c
—> start in combo with heparin for first 5 days
Aspirin MOa
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)
Thrombolytics
clot specific: fibrin bound plasminogen
Alteplase
Tenecteplase
Do you have to monitor anticoagulation with Dabigatran?
No - predictable anticoagulant effects, not monitored by PTT (true of all new anticoagulants)
Warfarin
Inhibits reduction of vitamin K —> interferes with synthesis of II, VII, IX, and X, Protein C and S
Barbiturates
Induces liver enzymes
affecting warfarin
MOA for Clopidigrel, Ticlopidine, and Prasugrel
Irreversibly blocks the ADP receptor on platelets —> decreased platelet aggregation
DOC to prevent thrombosis in patients undergoing placement of coronary stents
ADP inhibitors:
Clopidigrel
Ticlopidine
Prasugrel
MOA for Fibrinolytic Agents
Convert plasminogen to plasminogen —> lyses thrombus from within
DOC for secondary prevention of CV events in a patient with established CVD
Aspirin
Aspirin+warfarin
Contraindicated
Aspirin inhibits platelet aggregation
Together cause serious bleeding
Factor Xa inhbitors antidote
Andexxa
Where do the intrinsic and extrinsic pathways meet in the coagulation cascade?
Factor Xa
How is unfractionated heparin administered?
IV
onset of action immediate
