Mx of anticoag

Question 1

Basic mechanism of anticoagulants

Answer 1

reduce ability of haemostatic system to respond to activation signals

Question 2

3 reasons we would use anticoagulants

Answer 2

stroke prevention
VTE
Arterial thrombotic disease

Question 3

Basic MOA of heparin

Answer 3

antithrombin mediated inhibition- inhibits FXa and thrombin

Question 4

Basic MOA of rivaroxaban, fondaparinux and apixaban

Answer 4

Inhibit FXa

Question 5

Basic MOA of dabigatran and argatroban

Answer 5

Inhibit thrombin

Question 6

where do we source unfractionated heparin

Answer 6

derived from pig intestine or bovine lung tissue

Question 7

where is lmwh derived

Answer 7

Derived from chemical or enzymatic degradation of UFH into fragments approximately one-third the size of heparin

Question 8

is there a reversal agent for lmwh

Answer 8

no

Question 9

can lmwh be used in pregnancy

Answer 9

yes

Question 10

what is the reversal agent for unfractionated heparin

Answer 10

protamine

Question 11

which is better for unplanned surgery and why- lmwh or ufh

Answer 11

UFH- short half life, IV nd can be started and stopped quickly

Question 12

how do we monitor ufh use in the lab

Answer 12

APTT ratio

Question 13

what can prolong APTT ratio (3)

Answer 13

antiphospholipid antibodies

combined Rx with warfarin or thrombolytics

congenital factor deficiencies

Question 14

what 1 thing can shorten APTT ratio

Answer 14

high VIII

Question 15

3 side effects of heparin

Answer 15

beeding
heparin induced thrombocytopenia
osteoporosis

Question 16

MOA of warfarin

Answer 16

Warfarin acts as an anticoagulant by blocking the ability of Vitamin K to carboxylate the Vitamin K dependent clotting factors, thereby reducing their coagulant activity.

Question 17

What must be used for alongside warfarin in the initiation of warfarin in patients with thrombosis?

Answer 17

heparin

Question 18

4 things that can affect warfarin dose

Answer 18

diet (Fat and Vitamin K intake)
other drugs (+/-)
ethnicity (polymorphisms)
age

Question 19

5 examples of drugs that interact with warfarin

Answer 19

alcohol
allopurinol
amiodarone
antibiotics
oral contraceptive pill 
aspirin
simvastatin

Question 20

lab control of warfarin is by …

Answer 20

INR

Question 21

CIs for anticoagulation

Answer 21

acute bleeding
active peptic ulceration
alcohol or drug abuse
poor compliance
severe liver disease
renal impairment
dementia

Question 22

3 side effects of warfarin

Answer 22

skin necrosis
coumarin embryopathy
increased fetal loss

Question 23

how do we treat bleeding in pt on anticoagulation

Answer 23

revers anticoagulation
prothrombin complex concentration
FFP

Question 24

5 advantages of newer oral anticoagulants

Answer 24

rapid onset/offset
short half life
fewer drug/food interactions
limited drug-drug interactions
predictable anti-coag effect