PHARM-- antithrombotics Flashcards
irreversibly inhibits Cyclooxygenase (COX-1, COX-2) via acetylation→ decreases thromboxane A2 (TxA2) production→ inhibits platelet aggregation
aspirin MOA
Inhibits cyclic nucleotide phosphodiesterase & block adenosine uptake→ increased cAMP (platelet inhibitor)
aspirin/dipyridamole (aggrenox) MOA
selectively & irreversibly blocks the P2Y12 part of ADP receptors→ no activation of GP2b/3a receptor complex→ reduced platelet aggregation
clopidogrel MOA
Irreversibly blocks P2Y12 of ADP receptor→ inhibits platelet aggregation
prasugrel MOA
which 2 P2Y12 inhibitors are Thienopyridines
clopidogrel & prasugrel
Reversibly & noncompetitively binds P2y12 to inhibit platelet aggregation
ticagrelor MOA
which P2y12 inhibitor is a Cyclopentyl Triazolopyrimidine
ticagrelor
which P2Y12 is a Non-thienopyridine
Cangrelor
**Selectively & Reversibly **blocks P2Y12 to inhibit platelet aggregation
Cangrelor MOA
Binds to GP2b/3a receptor which inhibits platelet aggregation
Eptifibatide, Tirofiban, Abciximab
the GP2b/3a inhibitors
Binds to GP2b/3a receptor which inhibits platelet aggregation
Eptifibatide, Tirofiban, Abciximab
the GP2b/3a inhibitors
these are indications for which antiplatelet drug
- A fib
- CAD prevention
- stroke/TIA
- Peripheral artery dz
aspirin
4 C/I of aspirin
- Under 16 yo w/ viral illness (risk of reyes syn.)
- Asthma
- rhinitis
- nasal polyps
3 ADR of aspirin
- bleeding
- dose related gastric erosion
- ICH
how far in advance should you stop ASA before procedures
5-7 days
indicated for thromboembolic stoke prevention- 1 cap PO BID
Aspirin/Dipyridamole (Aggrenox)
4 indications for clopidogrel
- MI (stemi, nstemi)
- CVA
- PAD
- PCI
PGY12 used in ACS– PCI thrombosis prophylaxis
Prasugrel
which P2Y12 inhibitor has these indications
- ACS
- PCI
- primary prev. in pt w/ CAD & high CV event risk
- minor ischemic stroke & high risk TIA
ticagrelor
P2Y12 inhibitor used in PCI pts not previously loaded w/ an oral P2Y12 blocker
Cangrelor
which GP 2b/3a is used in
- PCI
- UA/NSTEMI not responsive to medical tx & planned PCI w/in 24 hrs
Abciximab
which GP 2b/3a is used in
- ACS
- PCI +/- stenting
Tirofiban
which GP 2b/3a is used in
- UA/NSTEMI
Eptifibatide
which antithrombotic is used in
Afib, VTE, mechanical heart valves
warfarin
which antithrombotic is used in
- acute VTE, DIC, PCI
- acute MI, UA
- cardiopulmonary bypass & vascular surgery
UFH
which form of heparin is ok in dialysis
UFH
which antithrombotics is used in
- VTE, PE
- UA or non-Q wave MI
- STEMI
LMWH– enoxaparin, dalteparin
2 common indications for DOACs
- DVT/PE tx & secondary prophy.
- stroke & systemic embolism prev in pt w/ nonvalvular afib
which DOAC can be used in stable CAD or PAD, VTE prophylaxis in acutely ill patient
rivaroxaban
the only DOAC that is NOT used in VTE prophylaxis s/p surgery
edoxaban
inhibits Vit K dependent clotting factor (2,7,9,10) also blocks protein C & S
warfarin MOA
interacts w/ ATIII to inactivate factor X1 & blocks thrombin formation; also IXa, XIa, XIIa
UFH
which DOAC is a direct thrombin inhibitor
dabigatran
which class of antiplatelet should not be used in patients who have urgent CABG
P2Y12 inhibitors
which P2Y12 inhibitor is C/I in ppl w/ hx of stroke/TIA & is not recommended in 75+
prasugrel
which P2Y12 inhibitors should be avoided in severe hepatic impairment, ICH, active bleeding
Ticagrelor
which antiplatelet has these C/I
- rash
- bleeding
- rare TTP
clopidogrel
which antiplatelet has these C/I
- Bleeding
- rash
- rare TTP
- HTN
- hyperlipidemia
- HA, backache
prasugrel
which antiplatelet has these C/I
- Bleeding
- HA
- increase SCR
- dyspnea
- bradyarrhythmias
Ticagrelor
which antitplatelet has these C/I
- bleeding
- dyspnea
- renal insufficiency
- hypersensitivity
cangrelor
which class of antiplatelet has these C/I
- thrombocytopenia
- bleeding
- hypotension
GP 2b/3a inhibitors
which two antiplatelet has dyspnea as an ADR
Ticagrelor & Cangrelor
which P2Y12 inhibitor is an IV
cangrelor
which two P2Y12 inhibitors are used with aspirin
prasugrel & ticagrelor
which DOAC is used in dialysis vs which is not used if CrCL > 95 (good function)
- used in dialysis: apixaban
- NOT used w/ good kidney function: Edoxaban
which class of antithrombotic is not used in epidural/spinal hematoma & spinal procedures
DOACs
3 ADR of DOACs
- Bleeding
- GI (dabigatran)
- Rash (edoxaban)
ADR of
- Bleeding, bruising
- Skin necrosis
- Purple toes syndrome
warfarin
ADR of
- bleeding, HIT
- osteoporosis
- Increased LFTs
UFH
which type of heparin is dosing based on body weight
LMWH
4 phases of hemostasis
- Platelet aggregation to form plug
- Propagation by Coagulation cascade
- Termination by Antithrombotic mechanisms
- Clot removal by Fibrinolysis
which 2 DOACs are ok in obesity
- rivaroxaban
- apixaban
which is better for ICH or hemorrhagic strokes: DOAC or warfarin?
DOAC
4 risk factors for GI bleeding
- previous GI bleed or PUD
- advanced age
- use of anticoag, steroids or NSAIDs
- H. pylori infection
