Medications

Question 1

Warfarin (Coumadin)

Answer 1

Not a blood thinner - anticoagulant
Anticoagulation therapy
-does not dissolve pre-existing clots but prevents then from becoming larger

Question 2

Warfarin method of action

Answer 2

-vitamin K antagonist
-interferes with synthesis of clotting factors
II (prothrombin), VII (proconvertin), IX (Christmas factor/plasma thromboplastin component) and X (Stuart-Prower factor)
-So, II, VII, IX, and X
-Warfarin must be given 4-5 days to achieve full anticoagulation effect

Question 3

Heparin

Answer 3

• anticoagulation medication
• much shorter half-life than Warfarin
• can be substituted in place of Coumadin (Warfarin) if concern about hemorrhage before dental surgery

Question 4

Heparin method of action

Answer 4

Half-life = 2 hours

• onset of action is immediate
• prevents conversion of prothrombin to thrombin and inactivates thrombin
• Xa and IIa inhibitor
• discontinue heparin 6 hours prior to surgery

Question 5

Impact of Aspirin and NSAIDs on warfarin (coumadin)

Answer 5

Aspirin and NSAIDs can increase risk of warfarin-associated bleeding by inhibiting platelet aggregation

Question 6

Cephalosporins

Answer 6

• oral antibiotics
• may decrease vitamin K production due to alteration of intestinal flora
• thus anticoagulation effect of warfarin may be enhanced (more risk of hemorrhage)

Question 7

Tranexamic acid

Answer 7

• adjunctive therapy to prevent blood loss
• antifibrinolytic agent
• inhibits activation of plasminogen and therefore helps prevent the breakdown of a fibrin clot

Question 8

Rivaroxaban (Xarelto) and Apixaban (Eliquis)

Answer 8

Oral direct Factor Xa inhibitors

• used to reduce risk of stroke and blood clots in patients with a-fib
• also used to reduce risk of deep vein thrombosis (DVT) and pulmonary embolism associated with hip and knee replacements

Question 9

Portola

Answer 9

reversal agent for Xarelto (Rivaroxaban) and Eliquis (Apixaban)

Question 10

PCC (prothrombin complex concentrate)

Answer 10

• reversal agent for Warfarin (coumadin)

- combination of blood clotting factors II, VII, IX, and X as well as protein C and S

Question 11

injectable direct thrombin (IIa) inhibitor and Factor Xa inhibitor

Answer 11

Heparin

half-life: ~ 2 hours

Question 12

injectable direct factor Xa inhibitor

Answer 12

Enoxparin (Lovenox_

half life: ~ 4-5 hours