Pharm Exam 3 (Hematologic Med) Flashcards
Warfarin MOA Clin Monitor ADR Preg DI Reversal agent
Inhibits Vitamin K Cofactors
Clin — Heparin/LMWH + Warfarin for rapid effect until therapeutic INR is achieved
Monitor —INR (2-3 Normal)
ADR — Purple Toe Syndrome
Preg —X
DI — 99& Protein bound, NO NSAIDS —> INC GI bleeding risk
Reversal Agent — Phytonadione (Mephyton(PO) - Preferred & Aquamephyton (IV))
Heparin NOT bound to Protein, (DIfferent from Warfarin) MOA Clin Preg CI ADR Monitoring
Binds to anti-thrombin III and Inhibit coagulation factors (thrombin)
SubQ or IV (NOT PO) IV - Immediate anticoagulant effect (Within mins)
Safe for pregnancy (C)
CI — Purpura (Bleeding under the skin) & Intracranial Hemorahge
ADR — Heparin Induced Thrombocytopenia (HIT) (Low platelet count < 150,000) ///Stop Heparin and administer a Direct Thrombin Inhibitor Osteroporosis & HYPERkalemia w/ high-dose and long-term use
Monitoring — aPTT, (>70sec — bleeding)
LMWH MOA Clin Monitoring Pregnancy
Agent
Binds to Anti-Thrombin III & Inactivates Factor Xa (Do NOT affect aPTT Time)
In conjunction w/ Aspirin and Warfarin
NO monitoring
Less risk of HIT
PREFERRED anticoagulant for pregnant woman
(-parin) Enoxaparin (Prophylaxis of DVT —> PE, UA, Non-Q wave MI), Dalteparin (Cancer)
Fondaparinux (Sub Q) (Indirect Thrombin Inhibitor) MOA Clin Monitoring Black box warning ADR
Selectively inhibits Factor Xa, binds to anti-thrombin III
After Hip, Knee, or Stomach surgery, Acute PVT and PE (w/ warfarin)_
NO monitoring
Spinal/Epidural Hematoma(Bruise)
Protamine Sulfate Made of Clin Admin Caution Precautions DI
formed from fish sperm
Reverse Heparin Anticoagulation
Very slow IV injection
Will NOT completely reverse LMWH Overdose
Allergy to Fish
Incompatible w/ Certain antibiotics (Cephalosporins & Penicillins)
Direct Factor Xa Inhibitors (-xaban) MOA Black Box Warning Advantage vs Warfarin Dis vs Warfarin Clin
Agent
Does NOT require a co-factor (Anti-Thrombin III), NO Direct effect on platelets
Discontinuing in pts W/O adequate continuous anticoagulation —> INC risk of STROKE
Antidote available (Recombinant Factor Xa - Andexxa)
NOT for use w/ Prosthetic valves
Stroke prevention & systemic embolism in pts w/ Non-valvular AF, DVT/PE Treatment (all)
NO Monitoring
Edoxaban — NOT recommended if CrCl < 15
Apixaban — Avoid S Liver Impairment (Pregnancy B)
Rivaroxaban — Avoid M to S Liver Impairment or liver disease
Direct Thrombin Inhibitors
For who?
Drugs (3)
Reverse Agent
Pts w/ Anti-thrombin III deficiency
BAD
Bivalirudin, Argatroban, Dabigatran
Idarucizumab(Reverse agent)
Fibrinolytics/Thrombolytics (IV)
MOA
Clin
CI
Greatest benefit if given within first 3 hrs
Administration of Aspirin & Anti-thrombotic (Heparin) is required
STEMI, Acute Ischemic Stroke, Acute PE w/ Hemodynamics instability, Severe Massive DVT
Intracranial Hemorrhage, Aortic Dissection, Head or Facial trauma within 3 months,
SBP > 180 or DBP > 110 at presentation, Major surgery within 3 wks
Anticoagulant & Reversal Agent
Warfarin
UFH
Dabigatran
Edoxaban, Apixaban, Rivaroxaban (Direct Factor Xa inhibitors)
Phytonadione (Vit K)
Protamine Sulfate
Idarucizumab
Recombinant Factor Xa (Andexxa)
Fibrinolytics (-ase)
Thrombolytic enzymes (1)
MOA
Agent
Directly converts uncomplex plasminogen to active plasmin
Degrade fibrin and clotting factors V and VII
Urokinases (IV)
Fibrinolytics (-ase)
tPA
MOA
Agent
Activate plasminogen that is BOUND to fibrin in the thrombus; Initiating fibrinolysis
Alteplase — STEMI, Massive PE, Acute Ischemic Stroke within 3 hrs
Reteplase & Tenecteplase — ONLY for Acute STEMI
ADP P2Y12 Receptor Inhibitors (4)
Clopiogrel
Prasugrel
Irreversible, Prodrug
Ticagrelor — Reversibly
BBW: DEC effectiveness w/ aspirin dose > 100mg
Dyspnea (Careful w/ asthma, bradycardia)
Cangrelor (IV) — Adjunct to PCI
GPIIb/IIIa Receptors Inhibitors (IV)
Abciximab — Adjunct to PCI for the prevention of cardiac ischemic complications in pts undergoing PCI; Renal adjustment not necessary
Epitifibatide
Trifiban
Reversible inhibit the binding of fibrin to the GP IIb-IIIa receptor,
W/ Heparin and Aspirin in ACS and PCI to reduce Thrombotic cardiac events
Special dosing for pts w/ reduced renal function
Aspirin
ADR
___________ before surgery
Pregnancy
Reye’s Syndrome in children w/ Chickenpox or Influenza (Swelling of the liver and brain)
Hypersensitivity w/ Asthma
Stop 7- 10 days before surgery
Bad for Pregnancy — Acetaminophen preferred
Dipyridamole (PO/IV)
Clin
W/ ASA to prevent ________
PO used w./ Warfarin ______________
ADR
Cerebrovascular ischemia
Post-Heart valve replacement
Worsening of ischemia in UA
