Pharmacology Flashcards
What is the mechanism of action for ASA
Anti platelet - cyclooxygenase inhibitor, prevents synthesis of TXA2 to inhibit platelet aggregation
What are the primary indications for ASA
prevention of thrombosis, MI, thrombotic stroke
What monitoring is required for ASA
none
Does ASA have an antidote? If so what?
no - effect is irreversible for life of platelet (7-10days)
What is the mechanism of action for unfragmented Heparin
Antithrombin activator - QUICKLY helps antithrombin inactivate clotting factors thrombin & Xa to prevent formation of fibrin
What route can Heparin be administered
Sub q or IV
What are the major AEs associated with Heparin
Hemorrhage, Heparin-induced thrombocytopenia
Which anticoagulant is safe in pregnancy?
Heparin
What monitoring is required for patients on Heparin
platelet counts, aPTT, anti-Xa
What is the antidote for Heparin?
Protamine sulfate - 1mg for every 100mg of heparin in the last 2hrs
What is the mechanism of action for fragmented Heparin (LMW Heparin)
antithrombin activator - helps antithrombin inactivate Xa (segments too small to also inactivate thrombin)
What route can LMW Heparin be administered
ONLY sub q
What the the common AEs associated with LMW Heparin?
Bleeding, immune-mediated thrombocytopenia
What are the common indications for use of LMW Heparin
prevention of DVT, prevention of ischemic complications due to unstable angina
When should a provider adjust the standard dose of LMW Heparin
Dose should be adjusted in pts with Cr clearance of <30ml/min
What monitoring is required for LMW Heparin
None required, may do anti-Xa
What is the antidote for LMW Heparin
Protamine sulfate - not fast reversal because cannot reverse antiXa activity & half life of LMW Hep is 3-6hrs
What is the mechanism of action for Warfarin
Anticoagulation via inhibition of the enzyme that activates Vitamin K (VKORC1). This in turn decreases production of Vit K dependent clotting factors (VII, IX, X & prothrombin)
What the the common AEs associated with Warfarin
hemorrhage, fetal hemorrhage & teratogenesis/death
What is the indication for Warfarin (Coumadin)
long term prevention of thrombus
What tests are required for pts on Warfarin
INR 2-3 (2.5-3.5 if artificial valve), PT (11-13s)
What is the antidote for warfarin
Vit K (if doesn’t work may give blood/blood concentrate transfusion)
What is the mechanism of action for Apixaban
Direct inhibition of factor Xa
What are common AEs associated with Apixaban
bleeding, spinal/epidural hematoma
what are the common indications for apixaban
atrial fibrillation, knee/hip replacement
When are dose adjustments needed for Apixaban
Reduce in mild/mod renal impairment. Stop in use of severe renal or any hepatic impairment.
What monitoring is required for Apixaban
none
What is the antidote for Apixaban
Andexnet alfa
What is the mechanism of action for Dabigatran
Direct, reversible inhibition of thrombin (prevents conversion of fibrinogen into fibrin & factor XIII activation which prevents soluble fibrin converting to insoluble fibrin
What are the common AEs related to Dabigatran
Bleeding, GI distrubance (dispepsia gastritis)
What are indications for use of Dabigatran
atrial fibrillation, knee/hip replacement, treat/prevent DVTs&PEs
When is dabigatran contraindicated
Renal failure, Cr. clearance <30ml/min
What monitoring is required for Dabigatran
none
What is the antidote for Dabigatran
Idarucuzumab
What factors require vit K for synthesis
10, 9, 7 &2
