Pharmacology-anticoagulant therapy

Question 1

What is the mechanism of heparin?

Answer 1

Lowers activity of thrombin and factor Xa

Question 2

Indications for heparin

Answer 2

PE, ACS, MI, DVT

Question 3

What anticoagulation test is used to monitor heparin therapy?

Answer 3

PTT

Question 4

Why is heparin safe to use during pregnancy?

Answer 4

Does not cross placenta

Question 5

What is the treatment for rapid reversal of HIT?

Answer 5

Protamine sulfate

Question 6

What do low molecular weight heparins target predominantly?

Answer 6

Factor Xa

Question 7

Which LMWH target factor Xa predominantly?

Answer 7

Enoxaparin and Dalteparin

Question 8

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

Answer 8

Fondaparinux

Question 9

What is the advantage of LMWH over unfractioned heparin?

Answer 9

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

Can be given subq without monitoring

Question 10

What is a disadvantage of LMWH over unfractioned heparin

Answer 10

Cannot be easily reversed

Question 11

Development of IgG antibodies against heparin-bound platelet factor 4

Answer 11

Heparin induced thrombocytopenia (HIT)

Question 12

What is a complication of using heparin in susceptible individuals?

Answer 12

Development of HIT

Question 13

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

Answer 13

HIT

Question 14

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

Answer 14

Activates platelets causing thrombosis and thrombocytopenia

Question 15

What is the only oral direct thrombin inhibitor?

Answer 15

Dabigatran

Question 16

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

Answer 16

Bivalirudin

Question 17

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

Answer 17

Hirudin

Question 18

What are the direct thrombin inhibitors?

Answer 18

Bivalirudin, Argatroban, and Dabigatran

Question 19

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

Answer 19

Directly inhibit thrombin activity

Question 20

Indications for Bivalirudin, Argatroban, and Dabigatran

Answer 20

Venous thromboembolism, a-fib

Question 21

What is an advantage of direct thrombin inhibitors over heparin?

Answer 21

Safe to use in HIT

Question 22

Complications of direct thrombin inhibitors Bivalirudin, Argatroban, and Dabigatran

Answer 22

Bleeding

Question 23

What drug can be used to reverse Dabigatran effects?

Answer 23

Idarucizumab

Question 24

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

Answer 24

Tranexamic acid

Question 25

What coagulation pathway is affected by warfarin?

Answer 25

Extrinsic pathway

Question 26

What is the effect of warfarin on PT?

Answer 26

Increases PT

Question 27

What anticoagulation test is used to monitor warfarin therapy?

Answer 27

PT/INR

Question 28

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

Answer 28

Fresh frozen plasma or PCC

Question 29

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

Answer 29

Give heparin bridge

Question 30

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

Answer 30

Shorter 1/2 lives of Protein C and S

Question 31

What is the site of action of heparin?

Answer 31

Blood

Question 32

What is the site of action of warfarin?

Answer 32

Liver

Question 33

What is the route of administration for warfarin?

Answer 33

Oral

Question 34

What is the route of administration for heparin?

Answer 34

Parenteral (IV or SC)

Question 35

What are the direct factor Xa inhibitors?

Answer 35

Apixaban and Rivaroxaban

Question 36

What is the disadvantage of direct factor Xa inhibitors?

Answer 36

Bleeding is not easily reversed

Question 37

Indications for direct factor Xa inhibitors

Answer 37

DVT, PE and stroke prophylaxis for a-fib

Question 38

What is an advantage of oral direct factor Xa inhibitors?

Answer 38

Do not require lab monitoring

Question 39

What are the thrombolytics?

Answer 39

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

Question 40

What is the effect of thrombolytics on platelet count?

Answer 40

No effect

Question 41

What is the mechanism of thrombolytics?

Answer 41

Convert plasminogen to plasmin

Question 42

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

Answer 42

Cleaves thrombin and fibrin clots

Question 43

Indications for thrombolytics?

Answer 43

Early MI, ischemic stroke and severe PE

Question 44

What are the ADP receptor inhibitors?

Answer 44

Clopidogrel, Prasugrel, Ticagrelor, and Ticlopidine

Question 45

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

Answer 45

Stop platelet aggregation by irreversibly binding ADP receptor

Question 46

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

Answer 46

Prevents expression of GpIIb/IIIa on platelet surface

Question 47

Indications for ADP receptor inhibitors

Answer 47

ACS, coronary stenting, decrease thrombotic strokes

Question 48

PDE inhibitors

Answer 48

Cilostazol and dipyrdamole

Question 49

What is the effect of PDE inhibitors Cilostazol and dipyrdamole?

Answer 49

Increase cAMP in platelets stopping platelet aggregation; also vasodilate

Question 50

Indications for PDE inhibitors Cilostazol and dipyrdamole

Answer 50

Claudication, coronary vasodilation, prevent stroke or TIAs

Question 51

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

Answer 51

Aspirin

Question 52

What are side effects of PDE inhibitors Cilostazol and dipyrdamole?

Answer 52

Nausea, headache, facial flushing, hypotension, abdominal pain

Question 53

What are the GpIIb/IIIa inhibitors?

Answer 53

Abciximab, Eptifibatide, Tirofiban

Question 54

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

Answer 54

Prevent platelet aggregation

Question 55

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

Answer 55

Abciximab

Question 56

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

Answer 56

Unstable angina and percutaneous coronary intervention

Question 57

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

Answer 57

Bleeding and thrombocytopenia