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Hematology/Oncology-First Aid 2017 > Pharmacology-anticoagulant therapy > Flashcards

Pharmacology-anticoagulant therapy Flashcards

1
Q

What is the mechanism of heparin?

A

Lowers activity of thrombin and factor Xa

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2
Q

Indications for heparin

A

PE, ACS, MI, DVT

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3
Q

What anticoagulation test is used to monitor heparin therapy?

A

PTT

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4
Q

Why is heparin safe to use during pregnancy?

A

Does not cross placenta

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5
Q

What is the treatment for rapid reversal of HIT?

A

Protamine sulfate

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6
Q

What do low molecular weight heparins target predominantly?

A

Factor Xa

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7
Q

Which LMWH target factor Xa predominantly?

A

Enoxaparin and Dalteparin

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8
Q

What is the only heparin drug that only targets factor Xa?

A

Fondaparinux

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9
Q

What is the advantage of LMWH over unfractioned heparin?

A

Better bioavailability and 2-4x longer 1/2 life

Can be given subq without monitoring

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10
Q

What is a disadvantage of LMWH over unfractioned heparin

A

Cannot be easily reversed

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11
Q

Development of IgG antibodies against heparin-bound platelet factor 4

A

Heparin induced thrombocytopenia (HIT)

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12
Q

What is a complication of using heparin in susceptible individuals?

A

Development of HIT

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13
Q

Patient was given heparin and shortly after develops thrombosis and thrombocytopenia - what is the diagnosis?

A

HIT

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14
Q

What action does the antibody-heparin-PF4 complex have on the body?

A

Activates platelets causing thrombosis and thrombocytopenia

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15
Q

What is the only oral direct thrombin inhibitor?

A

Dabigatran

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16
Q

What is the direct thrombin inhibitor that is related to the anticoagulant used by leeches?

A

Bivalirudin

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17
Q

What is the anticoagulant used by leeches that is related to Bivalirudin, a direct thrombin inhibitor?

A

Hirudin

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18
Q

What are the direct thrombin inhibitors?

A

Bivalirudin, Argatroban, and Dabigatran

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19
Q

What is the mechanism of Bivalirudin, Argatroban, and Dabigatran?

A

Directly inhibit thrombin activity

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20
Q

Indications for Bivalirudin, Argatroban, and Dabigatran

A

Venous thromboembolism, a-fib

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21
Q

What is an advantage of direct thrombin inhibitors over heparin?

A

Safe to use in HIT

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22
Q

Complications of direct thrombin inhibitors Bivalirudin, Argatroban, and Dabigatran

A

Bleeding

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23
Q

What drug can be used to reverse Dabigatran effects?

A

Idarucizumab

24
Q

What can be used if no reversal agents are available for Dabigatran?

A

Tranexamic acid

25
Q

What coagulation pathway is affected by warfarin?

A

Extrinsic pathway

26
Q

What is the effect of warfarin on PT?

A

Increases PT

27
Q

What anticoagulation test is used to monitor warfarin therapy?

A

PT/INR

28
Q

What can be given to rapidly reverse the effects of warfarin?

A

Fresh frozen plasma or PCC

29
Q

What can be done to prevent the transient hypercoagulable state and risk of recurrent venous thromboembolism and skin/tissue necrosis caused by warfarin?

A

Give heparin bridge

30
Q

What is the cause of early transient hypercoagulability with warfarin use?

A

Shorter 1/2 lives of Protein C and S

31
Q

What is the site of action of heparin?

A

Blood

32
Q

What is the site of action of warfarin?

A

Liver

33
Q

What is the route of administration for warfarin?

A

Oral

34
Q

What is the route of administration for heparin?

A

Parenteral (IV or SC)

35
Q

What are the direct factor Xa inhibitors?

A

Apixaban and Rivaroxaban

36
Q

What is the disadvantage of direct factor Xa inhibitors?

A

Bleeding is not easily reversed

37
Q

Indications for direct factor Xa inhibitors

A

DVT, PE and stroke prophylaxis for a-fib

38
Q

What is an advantage of oral direct factor Xa inhibitors?

A

Do not require lab monitoring

39
Q

What are the thrombolytics?

A

Alteplase (tPA), Reteplase (rPA), tenecteplase (TNK-tPA) and streptokinase

40
Q

What is the effect of thrombolytics on platelet count?

A

No effect

41
Q

What is the mechanism of thrombolytics?

A

Convert plasminogen to plasmin

42
Q

What is the effect of cleaving plasminogen to plasmin using thrombolytics?

A

Cleaves thrombin and fibrin clots

43
Q

Indications for thrombolytics?

A

Early MI, ischemic stroke and severe PE

44
Q

What are the ADP receptor inhibitors?

A

Clopidogrel, Prasugrel, Ticagrelor, and Ticlopidine

45
Q

Mechanism of ADP receptor inhibitors Clopidogrel, Prasugrel, Ticagrelor, and Ticlopidine

A

Stop platelet aggregation by irreversibly binding ADP receptor

46
Q

What is the effect of binding ADP receptor with Clopidogrel, Prasugrel, Ticagrelor, and Ticlopidine

A

Prevents expression of GpIIb/IIIa on platelet surface

47
Q

Indications for ADP receptor inhibitors

A

ACS, coronary stenting, decrease thrombotic strokes

48
Q

PDE inhibitors

A

Cilostazol and dipyrdamole

49
Q

What is the effect of PDE inhibitors Cilostazol and dipyrdamole?

A

Increase cAMP in platelets stopping platelet aggregation; also vasodilate

50
Q

Indications for PDE inhibitors Cilostazol and dipyrdamole

A

Claudication, coronary vasodilation, prevent stroke or TIAs

51
Q

What drug is usually given with PDE inhibitors Cilostazol and dipyrdamole to prevent stroke or TIAs?

A

Aspirin

52
Q

What are side effects of PDE inhibitors Cilostazol and dipyrdamole?

A

Nausea, headache, facial flushing, hypotension, abdominal pain

53
Q

What are the GpIIb/IIIa inhibitors?

A

Abciximab, Eptifibatide, Tirofiban

54
Q

What is the effect of GpIIb/IIIa inhibitors Abciximab, Eptifibatide, and Tirofiban?

A

Prevent platelet aggregation

55
Q

Which GpIIb/IIIa inhibitors is made from monoclonal antibody Fab fragments?

A

Abciximab

56
Q

Indications for GpIIb/IIIa inhibitors Abciximab, Eptifibatide, and Tirofiban

A

Unstable angina and percutaneous coronary intervention

57
Q

Side effects of GpIIb/IIIa inhibitors Abciximab, Eptifibatide, and Tirofiban

A

Bleeding and thrombocytopenia

Hematology/Oncology-First Aid 2017 (5 decks)

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