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Pharmacology > MCPHS PA Pharmacology Anticoags Practical Info EXAM 3 > Flashcards

MCPHS PA Pharmacology Anticoags Practical Info EXAM 3 Flashcards

1
Q

All Heparin and Heparin like drugs can be administered SQ, which if any can be administered by alternate route?

A

UFH can be administered via IV.

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2
Q

Which Heparin and Heparin like drugs require hospitalization?

A

UFH

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3
Q

In which Heparin and Heparin like drugs are you not concerned with Spinal / Epidural Hematoma, or HIT?

A

Fondaparinux

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4
Q

Which Heparin and Heparin like drugs are not treated with Protamine and why?

A

Fondaparinux isn’t treated with Heparin because it is to small to be properly inhibited by Protamine (not large and negatively charged enough.

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5
Q

What is the onset of Heparin and Heparin like drugs?

A

Extremely quick, within minutes for UFH, and within a couple hours for LMWH and Fondaparinux.

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6
Q

Which Heparin and Heparin like drug is used for DVT/PE treatment / Prophylaxis?

A

Fondaparinux

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7
Q

What is Warfarin’s method of action to Prevent clots?

A

Warfarin inhibits clotting factor synthesis that require Vitamin K (inhibits Vit K epoxide reductase complex 1 and vit K reductase)

-Inhibit production of: Prothrombin (FactorII), VII, IX, X, protein C and S.

2+7=9 and 1 more is 10 C&S

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8
Q

How is Warfarin administered and what is it’s onset?

A

Admin: PO or IV

Onset: Delayed, takes approx 2 days to start decreasing clotting factors.

  • Usually takes several days to achieve full therapeutic effect.
  • If drug stopped, effects linger.
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9
Q

Why does Warfarin linger even after discontinuing the medication?

A

Warfarin is extensively bound to albumin, and cannot be metabolized until it is unbound.

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10
Q

Where is Warfarin Metabolized?

A

Warfarin is metabolized in the liver by CYP2C9.

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11
Q

How is Warfarin Monitored?

A

International Normalized Ratio (INR)

Prothrombin time (PT)

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12
Q

What are Warfarin’s Goal INRs?

A

Normal INR is 1.0

Warfarin wants between 2-3 for

Acute MI, AFIB, Valvular heart disease, Pulmonary embolism, DVT, and Tissue Heart Valve.

For mechanical heart Failure we want between 2.5-3.5

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13
Q

What are the adverse effects of Warfarin?

A

Bleeding

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14
Q

What can be done to reverse uncontrolled bleeding while on Warfarin?

A

Phytonadione (Vitamine K) can be administered.

Can give Plasma or prothrombin complex concentrate (PCC) or Factor VII (Novoseven)

If you give PCC VIT K is needed as well PO preferred.

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15
Q

When reversing uncontrolled bleeding while on Warfarin how should Vit K be administered?

A

PO preferred, but IV will be used in life threatening conditions.

Takes 2-6 hours to start revesing effects, with a total effect within 24 hours.

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16
Q

What is Prothrombin Complex Concentrate(PCC)?

A

PCC - contains major clotting factors II, VII, IX, and X, all of which are low in patients treated with warfarin or other VKA anticoagulants, as well as the antithrombotic proteins C and S

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17
Q

Warfarin interactions, which drugs increase INR?

A

Bactrim

Amiodarone

Cimetidine

Acetaminophen

Metronidazole

Azol Antifungals

Warfarin is BAC up Ask Me Anything

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18
Q

Warfarin interactions, which drugs decrease INR?

A

Rifampin

Carbamazepine

Phenobarbital

Phenytoin

Down to RC the PP

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19
Q

What is Dabigatran used for?

A

A direct Thrombin inhibitor used to Treatment of DVT/PE and Prophylaxis of nonvalvular AFIB.

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20
Q

What is Argatroban used for?

A

Direct Thrombin inhibitor used to treat HIT, and for Cardiac Catheterization (PCI)

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21
Q

What is Bivalirudin used for?

A

Cardiaccatheterization (PCI) with active or remote history of HIT.

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22
Q

Are all Direct Thrombin Inhibitors Renally Eliminated?

A

No Argatroban is eliminated by the liver and requires dose adjustment for Chronic Liver disease.

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23
Q

Do you treat bleeding in the same way with all Direct Thrombin Inhibitors?

A

All are treated with Plasma, but you can also use Praxbind in response to Dabigatran or remove it entirely with Dialysis.

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24
Q

What is the onset of Direct Thrombin Inhibitors?

A

Quick Onset

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25
Q

Are all Direct Thrombin Inhibitors administered IV?

A

No Dabigatran is administered PO.

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26
Q

Are all Direct Thrombin Inhibitors Monitored via aPTT?

A

No Dabigatran is generally not monitored.

Agatroban may also artificially raise INR.

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27
Q

Are any of the Direct Thrombin inhibitors Prodrugs?

A

Dabigatran

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28
Q

Are any Direct Xa inhibitors used for anything other than DVT/PE treatment, stroke prophylaxis in non valvular AFIB, and Post-op DVT prophylaxis?

A

Edoxaban is not used for Post-op DVT prophylaxis

Betrixaban is only used for VTE prophylaxis.

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29
Q

Do Direct Xa inhibitors have any DDIs?

A

CYP3A4/PGP inhibitors/inducers

Betrixaban only DDI Strong PGP inhibitors

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30
Q

What is the treatment for bleeding while on Direct Xa inhibitors?

A

PCC & Plasma

Andexxa

Not removed by Dialysis

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31
Q

Other than adjustments for Renal insufficiency are there any other dose adjustments for DIrect Xa Inhibitors?

A

You must also dose adjust Apixaban if 2 of the following are met,

>80 Y/O

Scr>1.5

Wt<60Kg

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32
Q

Where are the effects of Antiplatlets concentrated?

A

Arterial, not used for DVT/PE

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33
Q

How long does the irreversible inhibition of TXA2 on platelets last when using low dose ASA?

A

the life of the platelet 7-10 days

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34
Q

What is the MOA of P2Y12 inhibitors?

A

Prevent platelet activation by inhibiting ADP binding to P2Y12 receptor.

35
Q

How are P2Y12 inhibitors monitored?

A

Platelet Assay Test

36
Q

Which P2Y12 inhibitors are reversible?

A

Ticagrelor

Cangrelor

37
Q

Which P2Y12 inhibitors are irreversible?

A

Clopidogrel

Prasugrel

Ticlopidine

38
Q

Are any of the P2Y12 inhibitors Prodrugs?

A

Clopidogrel - Metabolized by CYP2C19 (Genetic Variance)

Prasugrel - Metabolized by liver

39
Q

Do P2Y12 inhibitors have any DDIs?

A

Clopidogrel - CYP2C19

Ticagrelor - ASA, CYP3A4 inhibitor/inducer, Simvastatin & lovastatin (no more than 40mg a day), Digoxin.

40
Q

What is the specific use of Clopidogrel?

A

Peripheral vascular disease

Ischemic Stroke

Prevent Coronary stent thrombosis

PVD IS CST Prevention

41
Q

What is the specific use of Cangrelor?

A

Approved for use with Cardiac Catheterization (PCI)

Cangrelor Cardia Catheterization!

42
Q

What is the specific use of Prasugrel?

A

Acute Coronary Syndromes

ACS needs TP

43
Q

What is the specific use of Ticlopidine?

A

Prevention of thrombotic Stroke and reduce instent thrombosis.

Stroke “TI”lopidine

44
Q

What is the specific use of Ticagrelor?

A

Acute Coronary Syndrome?

ACS needs TP

45
Q

What is the Onset and Duratuion of Clopidogrel?

A

Onset: 2 hrs

Duratuion: 5 days

46
Q

What ADR’s does Clopidogrel have?

A

Bleeding and TTP

Can only give platelets.

CloTico - Low Penia, High Bleed

47
Q

Does Clopidogrel have any special instructions?

A

Hold for 5 days prior to Surgery / procedures.

Its not Pra”surgre”l, but no to 5

48
Q

What is the onset of Prasugrel?

A

30 minutes

49
Q

What ADRs are associated with Prasugrel?

A

Bleeding (treat with platelets)

Angioedema (rare)

Bleeding, NOT THE FACE!

50
Q

Does Prasugrel have any CIs?

A

Avoid in PTs >75 Y/O

Avoid in Hx of Stroke or TIA

SrokeTia/75 = CI

51
Q

Does Prasugrel have any dose adjustments?

A

Adjust dose if PT <60 KG

Weight drop, drug drop

52
Q

Does Prasugrel have any special instructions?

A

Hold for 5 days prior to Surgery

Stop 5 days before Pra”sugre+l

53
Q

What is the onset of Ticlopidine?

A

48 hrs

54
Q

What ADRs does Ticlopidine have?

A

Neutropenia/TTP

(Monitor every 2 weeks for 12 weeks after initiation)

Bleeding

(Give platelets)

CloTico - Low Penia, High Bleed

55
Q

What is the onset of Ticagrelor?

A

1.5 Hours

56
Q

What ADRs does Ticagrelor have?

A

Bleeding (platelets)

Dyspnea

Ventricular pauses

Ticagrelor -hard to beat breathing

57
Q

Does Ticagrelor have any special instructions?

A

Do not use if concerned about adherance.

Hold 1 day prior to Surgery.

1 day before surgery, don’t forget no Ticagrelor

58
Q

How is Cangrelor administered?

A

IV, transition to oral P2Y12 after infusion.

59
Q

How is Cangrelor Dosed?

A

30 mcg/kg bolus followed by infusion 4mcg/kg/min

No dose adjustment

60
Q

What ADRs does Cangrelor have?

A

Bleeding (platelets)

61
Q

What are the Specific uses of GP IIb/IIIa antiplatelets?

A

Acute Coronary Syndrome undergoing PCI

IIb PCI IIIaCS

62
Q

What is the MOA of GP IIb/IIIa antiplatlets?

A

Inhibit GP IIb/IIIa causing a reversable blockade

63
Q

What ADRs do GP IIb/IIIa antiplatlets have?

A

Bleeding (platelets)

64
Q

What is the administration route and onset of GP IIb/IIIa antiplatlets?

A

IV with immidiate onset

65
Q

What is the specific use of Dipyridamole?

A

Heart Valve replacement and stroke

Stroke Dipyridamole’s HVR!

66
Q

What is the MOA of Dypiridamole?

A

inhibits platelets by increasing plasma adenosine

67
Q

What ADRs does Dipyridamole have?

A

Bleeding (give platelets)

Dyspepsia (indigestion)

DD Dipyridamole Dyspepsia

68
Q

Are there any special instructions for Dipyridamole admin?

A

Always give with ASA

69
Q

What is the specific use of Cilostazol?

A

Clot Treatment

CC Cilostazol Clot

70
Q

What DDIs does Cilostazol have?

A

CYP3A4 inhibitors

71
Q

What is the MOA of Cilostazol?

A

PDE-3 inhibitor

72
Q

What are Cilostazol’s ADRs?

A

Headache

73
Q

What is the onset of Cilostazol?

A

Full onset in 12 weeks

74
Q

Does Cilostazol have any CIs?

A

Do not use in PT with Heart Failure

NO HF for Cilostazol

75
Q

What is the specific use of Pentoxyfyline?

A

Intermittent claudication

Liver disease

vasculitis

PENTOXYFYLINE

The Church of claudication and LDV

76
Q

What is the MOA of Pentoxyfyline?

A

Increase in cyclicAMP in RBC leading to increased RBC flexability and laminar flow

77
Q

What are the ADRs associated with Pentoxyfyline?

A

nausea

vomiting

leukopenia

N/V/ Leukopenia not Diarrhea

78
Q

Is there any concern of bleeding with Pentoxyfyline?

A

No

79
Q

Other than treatment of Acute MI do thrombolytics have any other specific uses?

A

Ateplase

Acute ischemic stroke

Acute massive PE

80
Q

What is the MOA of Ateplase?

A

Identical to tissue plasminogen activator, Ateplase catalyzes plasminogen to plasmin to break down fibrin

81
Q

What is the MOA of Tenecteplase and Reteplase?

A

Romes already formed thrombi

82
Q

What are the ADRs associated with Tenecteplase and Recteplase?

A

Bleeding (Treat with Plasma)

83
Q

How are Tenecteplase and Recteplase dosed?

A

Tenecteplase is a single dose with a longer halflife.

Recteplase is dosed as 2 intermittant injections with a shorter half-life.

(Complex dosing makes it less favorable than Tenecteplase or Alteplase)

Pharmacology (14 decks)

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