Pharm 6 Thrombi pt1

Question 1

Example of Anticoagulant Drugs

Route of admin?

Answer 1

Heparin (IV)

Question 2

What does Heparin do?

What doesn’t it do?

Answer 2

Reduces the likelihood of the formation of new thrombi.

Doesn’t involve the synthesis of clotting factors and cannot dissolve existing clots

Question 3

Heparin’s IV dosing requires ____. Why?

Answer 3

IV dosing requires regular monitoring of PT/PTT/INRs, frequent adjustment of dosing
B/c of many factors ppl respond differently to it.
how it’s metabolized, endothelial linings unique to your blood vessels, weight, gender, renal function, other drugs you’re on, and foods you eat.

Question 4

Heparin’s FDA indications (5)

Answer 4

Prevention or treatment of DVTs
Prevention or treatment of pulmonary emboli
Treatment of disseminated intravascular coagulation resulting in dysfunction of the clotting cascade
Treating arterial clotting and prevention of embolus formation in patients with atrial fibrillation
Preventing thrombus formation and promoting cardiac circulation in acute coronary syndromes by preventing clot propagation of existing clots

Question 5

What is the better way to dose Heparin?

Answer 5

dosed using weight-based regimen

Question 6

Heparin Clinical Pearls

Answer 6

Can be used to prevent clotting when blood circulates through mechanical tubing outside the body (i.e., during surgery involving cardiac bypass and hemodialysis treatments)
Useful to prophylax against clotting during surgeries that involve high risk of thrombus formation (i.e., orthopaedic surgery and recovery)

Question 7

How to reverse Heparin’s risk of bleeding with overuse/misuse.

Answer 7

*Adding protamine sulfate (mix an acid and a base) makes water and salt. No more anticoagulant in the bloodstream.

Question 8

What’s the big difference between LMWH and Heparin?

Answer 8

Reacts the same for everybody, unlike Heparin.

Question 9

LMWH
Example, Route of Admin
FDA approved for (3)

Answer 9

Enoxaparin (SQ)
DVT prophylaxis in orthopedic surgeries, abdominal surgery or immobilized patient at risk for DVT
Treatment of DVT with or without PE
To prevent ischemic complications of ACS, unstable angina and non-Q-wave AMI

Question 10

How many hours to become therapeutic with Heparin? How about Enoxaparin?

Answer 10

72 hours with Heparin

11 hours with Enoxaparin

Question 11

The plan to treat DVT patient with Enoxaparin

Answer 11

Give them 1 shot of Enoxaparin, wait 11 hours for them to be therapeutic & watch them, then send ‘em home. It’s also good to have them in their own home, walking around b/c the DVT occurred while you were being immobile on an airplane, or something. A send-home nurse can give follow up

Question 12

Where is Warfarin absorbed?

What is it derived from?

Answer 12

Absorbed rapidly through GI tract

Derived from clovers

Question 13

8 FDA approved indications for Warfarin

Answer 13

Thromboembolic disorders
DVT prophylaxis
PE prophylaxis
Atrial fibrillation
Prior ischemic CVA
Recurrent ACS and AMI
Post-AMI
Bio-prosthetic heart valves

Question 14

How does Warfarin work?

How immediately does it work, why?

Answer 14

Alters the liver’s ability to synthe`size vitamin-K dependent clotting factors
Clotting factors already in the bloodstream continue to coagulate normally until they become depleted (~5 days) so anticoagulation does not begin immediately

Question 15

What test sees if the benefit of Warfarin outweighs the risk?

Answer 15

CHAD-2 scores

Question 16

What may REDUCE effectiveness of Warfarin?

Answer 16

Diets high in vitamin K (green, leafy vegetables, esp. spinach)

Question 17

Dabigatran
Route of admin?
What is it approved for? (1)
What’s good & bad about it?

Answer 17

Dabigatran PO
Approved for A Fib without valvular disease
don’t need to have monthly blood drawn. But: It chews up your platelets as long as it’s in blood. Even if you give more plasma/platelets, it chews it up still. For 5 days. If there’s a bad accident (motorcycle accident)/anything that puts you at risk for bleeding, you won’t be able to stop the bleeding, especially bad for an intracranial hemorrhage.

Question 18

Risks & Benefits of Apixaban (2)

Answer 18

Prevents ~ 3 more strokes than Warfarin

Leads to 10 fewer bleeds and 4 fewer deaths

Question 19

Risks & Benefits of Dabigatran (3)

Answer 19

Prevents ~ 5 more strokes than Warfarin
Similar bleeding risk to Warfarin
Only new agent proven to reduce both ischemic and hemorrhagic CVAs

Question 20

Risks & Benefits of Rivaroxaban (3)

Answer 20

Prevents fewer strokes than Warfarin
has similar bleeding risk
(less blood drawn)

Question 21

Name the 3 newer Oral Anticoagulants

Do NOT use newer agents for patients with:

Answer 21

Apixaban
Dabigatran
Rivaroxaban

Do NOT use with patients with Mechanical Heart Valves

Question 22

4 reasons you should not feel compelled to switch patients off Warfarin.

Answer 22

1. If INR’s are stable while on Warfarin
2. B/c Warfarin has an antidote, other agents do not
3. Warfarin costs less per month, and has once monthly INR monitoring
4. Warfarin is once daily dosing

Question 23

If you have a reason to go away from Warfarin (can be allergic to Warfarin), Lean to ___ and ___.
Why?

Answer 23

dabigatran or apixaban because they prevent more strokes

Apixaban for patients who need once daily dosing

Question 24

Use of Antiplatelet drugs

In patients at risk for what? (4)

Answer 24

Used to prevent arterial thromboembolism, particularly in patients at risk for AMI, ACS, CVA, atherosclerosis

Question 25

Key Antiplatelet drug

Answer 25

aspirin