Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PC 707 Pharmacology > Module 4: Unit C Antithrombotic > Flashcards

Module 4: Unit C Antithrombotic Flashcards

1
Q

Can pregnant people take warfarin (Coumadin)?

A

No. Can cause “fetal warfarin syndrome”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you handle a missed dose of warfarin (Coumadin)?

A

Do not double dose to make up for missed doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Drugs that increase (more likely to bleed) Warfarin’s effect:

A

Amiodarone, Antiplatelets, NSAIDs, Macrolides, and Thyroid hormones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which populations require lower warfarin dosing?

A

elderly, heart failure, malnourished, liver disease, with certain drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What important patient education is indicated for people on warfarin (Coumadin)?

A

A consistent diet of leafy greens (Do not limit).
Do not double dose to make up for missed doses. Always tell all providers (including dentists)
Contact your provider ASAP for bleeding.
Do not take ASA or NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Example AnticoagulantVitamin K antagonist

A

Warfarin (Coumadin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indications for Anticoagulant-Vitamin K antagonist

(warfarin)?

A

Main: Long-term prevention of venous thrombosis/PE
pts. w/ prosthetic heart valves
AFIB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MOA Anticoagulant-Vitamin K antagonist

(warfarin)?

A

Inhibits enzyme needed to convert vitamin K into the active form, resulting in ↓ the production of factors VII, IX, X, and prothrombin, ultimately ↓ fibrin formation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Contraindications and considerations with prescribing Anticoagulant-Vitamin K antagonist
(warfarin)?

A 
Contraindicated in pregnancy 
uncontrolled bleeding disorders
Caution in liver disease, 
vitamin K deficiency
Significant interactions with many classes of drugs-see list
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

BBW for Anticoagulant-Vitamin K antagonist

(warfarin)?

A

It can cause major or fatal bleeding.

Monitor INR-weekly until stable then q4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dietary counseling for Anticoagulant-Vitamin K antagonist

(warfarin)?

A

There are many D2D interactions, including several herbal interactions. The “G” herbs: garlic, ginger, ginkgo, and ginseng, green tea, fish oil. Leafy green vegetables.

Consistent diet!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Monitoring required with Anticoagulant-Vitamin K antagonist

(warfarin)?

A

Monitor PT/INR, range 2-3 most common

Monitor INR-weekly until stable then q4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you treat a Anticoagulant-Vitamin K antagonist

(warfarin) OD?

A

Vitamin K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Example of Anticoagulant Unfractionated Heparin (UFH)

A

Heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Indication for Unfractionated Heparin (UFH)?

A

Prophylaxis of venous thrombus

DVT, PE, DIC, MI

Open heart surgery and renal dialysis to prevent coagulation in devices

Prevent post-op thrombus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MOA Unfractionated Heparin (UFH)?

A

↓ coagulation by enhancing antithrombin’s ability to inactivate thrombin and factor Xa, ultimately ↓ fibrin formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

BBW Unfractionated Heparin (UFH)?

A

↑ risk of spinal or epidural hematoma

caution before, during, and after spinal surgery as well as eye & brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What conditions/situations is Unfractionated Heparin (UFH) contraindicated in?

A

bleeding disorders, thrombocytopenia, lumbar puncture, epidural. Not used in primary /ambulatory care. Typically reserved for the inpatient setting.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Adverse effects of Unfractionated Heparin (UFH)?

A

3 H’s:

Hemorrhage
Hyperkalemia
Heparin-induced thrombocytopenia (HIT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Heparin and Lovenox reversal agent

A

protamine sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What anithrombotic is preffered in pregnancy?

A

Heparin. (Lovenox specifically-LMWH). The large molecule does not pass the placenta or breastmilk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What lab values do we need to monitor with heparin?

A

Potassium

aPTT and adjust dosage accordingl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Example of Low-molecular-weight heparin (LMWH)

A

Lovenox

dalteparin (Fragmin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Indication for Low Molecular Weight Heparin (LMWH)?

A

DVT
PE
STEMI,
NQWMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

MOA LMWH (lovenox)

A

inactivating factor Xa, ultimately ↓ fibrin formation

26
Q

BBW LMWH (Lovenox and Fragmin)?

A

↑ risk of spinal or epidural hematoma-caution before, during, and after spinal surgery as well as eye & brain

27
Q

LMWH (Lovenox and Fragmin) are contracindicated in

A

uncontrolled bleeding disorders, severe thrombocytopenia

28
Q

Adverse effects of LMWH (Lovenox)?

A

↑ risk hemorrhage

Can cause immune-mediated thrombocytopenia

29
Q

Does aPTT need to be monitored in LMWH (Lovenox)?

A

No

30
Q

Direct Oral Anticoagulants (DOACs) Direct thrombin inhibitor Example

A

dabigatran (Pradaxa)

31
Q

Indication for DOACs [dabigatran (pradaxa)]?

A

Prevention of stroke/embolism in AFIB,

prevention of VTE after knee or hip replacement

DVT PE

32
Q

MOA for DOACs [dabigatran (pradaxa)]?

A

Direct, reversible thrombin inhibitor which prevents:
conversion of fibrinogen into fibrin
and activation of Factor IIIa (blocks conversion of soluble fibrin into an insoluble form)

33
Q

Safety considerations for DOACs (Pradaxa)?

A

Bleeding, GI disturbances: dyspepsia, gastritis s/s

P-glycoprotein inhibitors (like ketoconazole, amiodarone, verapamil, and quinidine) can ↑ level of dabigatran with ↑bleeding risk.

34
Q

BBW for DOACs (Pradaxa)?

A

​Spinal/Epidural hematomas.

35
Q

Reversal agent for DOACs (Pradaxa)

A

idarucizumab (Praxbind)

36
Q

Anticoagulant-Direct Factor Xa inhibitors example

A

-XABANs:
rivaroxaban (Xarelto)

apixaban (Eliquis)

betrixaban (Bevyxxa)

edoxaban (Savaysa)

37
Q

indication for Direct Factor Xa inhibitors (xarleto, eliquis, bevyxxa, savaysa)

A

Prevention of:

DVT/PE (after hip/knee surgery, recurrent, random)
Stroke w/ AFIB,

38
Q

Moa for for Direct Factor Xa inhibitors (xarleto, eliquis, bevyxxa, savaysa)

A

Selective inhibition of factor Xa, which inhibits the production of thrombin, ultimately ↓ fibrin formation.

39
Q

Safety considerations for Direct Factor Xa inhibitors (xarleto, eliquis, bevyxxa, savaysa)? Who should have cuation?

A

Bleeding risk.

Levels can increase in the presence of drugs that ↓ CYP3A4 or P-glycoprotein.

Caution with renal and hepatic impairment which can ↑ level and bleeding risk (monitor renal regularly)

Unsafe in pregnancy

40
Q

BBW for Direct Factor Xa inhibitors (xarleto, eliquis, bevyxxa, savaysa)

A

​Premature discontinuation increases the risk of thrombotic events.

​Spinal/Epidural hematomas.

41
Q

Monitoring required for Direct Factor Xa inhibitors (xarleto, eliquis, bevyxxa, savaysa)

A

Kidney function

Baseline and regular monitoring of kidney function to decrease risk of bleeding if renal excretion is delayed

42
Q

Reversal agent for Direct Factor Xa inhibitors (xarleto, eliquis, bevyxxa, savaysa)

A

andexanet alfa (Andexxa)

43
Q

Example of Antiplatelet-

cyclooxygenase inhibitor

A

aspirin

44
Q

indication for cyclooxygenase inhibitor (aspirin)?

A

Many indications
Prevention of arterial thrombosis

Ischemic CVA/TIA,

acute and prior MI, 1° and 2° prevention MI, unstable angina

coronary stenting,

45
Q

MOA cyclooxygenase inhibitor (aspirin)?

A

Irreversibly inhibits cyclooxygenase for the life of platelet (7-10 days), which ↓ synthesis of TXA which suppresses TXA mediated platelet aggregation and vasoconstriction

46
Q

Safety considerations with cyclooxygenase inhibitor (aspirin)?

A

↑ risk of GI bleeding and hemorrhagic stroke, even at a low dose and with enteric coatings

47
Q

BBW cyclooxygenase inhibitor (aspirin)?

A

Do not use in poor metabolizers as those with variant CYP2C19 gene cannot reliably convert this drug to its active form. This can lead to cardiovascular events.

48
Q

Examples of Antiplatelet

P2Y12 ADP Receptor Antagonist

A

GRELS

clopidogrel (Plavix)

prasugrel (Effient)

ticagrelor (Brilinta)

49
Q

indication for P2Y12 ADP Receptor Antagonist (Plavix, Effient, Brilinta) -GRELs

A

Prevent stenosis of coronary stents.

2° prevention of MI, ischemic CVA

50
Q

MOA for P2Y12 ADP Receptor Antagonist (Plavix, Effient, Brilinta)

A

Blocks P2Y12 ADP receptors on platelets which prevent ADP-mediated platelet aggregation. Action is irreversible for the life of the platelet (7-10 days).

51
Q

BBW with P2Y12 ADP Receptor Antagonist (Plavix, Effient, Brilinta)

A

Poor metabolizers: patients with variant forms of CYP2C19 cannot predictably convert clopidogrel to an active form. Genetic testing and platelet monitoring are recommended.

52
Q

Indication of antiplatelet dipyridamole (Persantine)

A

prevent post valve thromboembolism

53
Q

MOA of dipyridamole (Persantine)

A

↓ Adenosine deaminase and phosphodiesterase which↑ adenosine, adenine nucleotides, and cyclic AMP and ↓ platelet aggregation. May cause vasodilation

54
Q

Safety with dipyridamole (Persantine)

A

bleeding,

can precipitate/exacerbate angina

HA, dizziness, GI

55
Q

What is aggrenox?

A

A combination of ASA and dipyridamole (persantine) used to prevent ischemic stroke and TIA

56
Q

indication for cilostazol (Pletal)

A

Intermittent claudication (pain in legs, usually during exercise)

57
Q

MOA of cilostazol (Pletal)

A

↓ platelet aggregation and promotes vasodilation (mostly in legs) by inhibiting PDE-3 in platelets and blood vessels

58
Q

Safety with cilostazol (Pletal)

A

HA, dizziness

↑ risk of infection

rhinitis

GI upset

Cardiac: palpitations and dysrhythmias

59
Q

What is cilostazol (Pletal) often combined with?

A

ASA or Plavix.

60
Q

What patients should not use antithrombotics?

A

Do not prescribe in situations where patients are at high risk for bleeding. This would include a recent hemorrhagic stroke, risk of active major bleeding, or recent trauma.

61
Q

What is heparin-induced thrombocytopenia?

A

an antibody-mediated coagulopathy due to heparin exposure that is associated with a risk of thromboembolic complications and death. The only treatment is to stop the heparin.

62
Q

What is the treatment for HIT?

A

Stop the heparin!

PC 707 Pharmacology (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions