Pharmacology

Question 1

action of heparin

Answer 1

acts on antithrombin increasing its action

Question 2

preparation of heparin

Answer 2

immediate effect

given parenteral IV or SC

Question 3

two forms of heparin

Answer 3

unfractionated

LMWH

Question 4

is heparin safe in pregnancy?

Answer 4

yes

Question 5

what is used to monitor unfractionated heparin?

Answer 5

APTT

Question 6

what is used to monitor LWMH?

Answer 6

anti-Xa assay

Question 7

complications of heparin

Answer 7

bleeding
heparin-induced thrombocytopenia with thrombosis (HITT)
OP with long-term used

Question 8

what to check if heparin-induced thrombocytopenia with thrombosis is suspected

Answer 8

FBC

Question 9

how do you reverse heparin bleeding?

Answer 9

protamine sulphate

Question 10

examples of coumarin anticoagulants

Answer 10

warfarin
pheninone
acenocoumarin
phenprocoumon

Question 11

action of coumarin anticoagulants

Answer 11

inhibit vitamin K

Question 12

what is vitamin K?

Answer 12

fat soluble vitamin

Question 13

how is vitamin K absorbed?

Answer 13

upper SI with bile acids

Question 14

which are the vitamin K coagulation factors?

Answer 14

II (prothrombin)
VII
IX
X

protein C and S

Question 15

why is warfarin started with heparin to begin with?

Answer 15

avoid thrombosis due to drop in naturally occurring anticoagulants (protein C and S)

Question 16

how long is heparin started with warfarin?

Answer 16

5-7 days

Question 17

how is warfarin monitored?

Answer 17

INR as has narrow therapeutic window (PT)

Question 18

adverse of warfarin

Answer 18

haemorrhage

mild bleeding

Question 19

what increases the risk of haemorrhage on warfarin?

Answer 19

intensity
concomitant clinical disorders (elderly have fragile vessels, ulcers)
other medications (liver CYP450s)

Question 20

mild bleeding that can occur in warfarin

Answer 20

bruising
epistaxis
haematuria

Question 21

reversal of warfarin

Answer 21

omit dose(s)
administer vitamin K
if severe give FFP (clotting factors)

Question 22

two types of new anticoagulants

Answer 22

1. oral direct thrombin inhibitors

2. Xa inhibitors

Question 23

example of oral direct thrombin inhibitors

Answer 23

dabigatran

Question 24

why are oral direct thrombin inhibitors second line?

Answer 24

can cause renal impaired

Question 25

examples of Xa inhibitors

Answer 25

edoxaban
rivaroxaban
apixaban

Question 26

monitoring of new oral anticoagulants

Answer 26

not need

Question 27

action of aspirin

Answer 27

inhibits COX (cyclo-oxygenase) which is necessary for production of thromboxane A2

Question 28

adverse of aspirin

Answer 28

it is an NSAID, so:

• bleeding
• blocks prostaglandins
• GI ulceration
• bronchospasm

Question 29

action of clopidogrel, ticagresler and prasugrel?

Answer 29

ADP receptor antagonists (P2Y12)

Question 30

action of dipyridamole

Answer 30

PDE inhibitor of cAMP (second messenger in platelet activation)

Question 31

action of abciximab

Answer 31

GPIIb/IIIa inhibitor preventing platelet aggregation

Question 32

examples of antiplatelets

Answer 32

aspirin
clopidogrel, prasugel
dipyridamole
abciximab

Question 33

reversal of anticoagulants

Answer 33

platelet transfusion