Pharmacology-anticoagulant therapy

Question 1

Indications for heparin

Answer 1

PE, ACS, MI, DVT

Question 2

What anticoagulation test is used to monitor heparin therapy?

Answer 2

PTT

Question 3

Why is heparin safe to use during pregnancy?

Answer 3

Does not cross placenta

Question 4

What is the treatment for rapid reversal of HIT?

Answer 4

Protamine sulfate

Question 5

What do low molecular weight heparins target predominantly?

Answer 5

Factor Xa

Question 6

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

Answer 6

Fondaparinux

Question 7

What is the advantage of LMWH over unfractioned heparin?

Answer 7

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

Can be given subq without monitoring

Question 8

What is a disadvantage of LMWH over unfractioned heparin

Answer 8

Cannot be easily reversed

Question 9

Development of IgG antibodies against heparin-bound platelet factor 4

Answer 9

Heparin induced thrombocytopenia (HIT)

Question 10

What is a complication of using heparin in susceptible individuals?

Answer 10

Development of HIT

Question 11

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

Answer 11

Activates platelets causing thrombosis and thrombocytopenia

Question 12

What is the only oral direct thrombin inhibitor?

Answer 12

Dabigatran

Question 13

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

Answer 13

Bivalirudin

Question 14

What are the direct thrombin inhibitors?

Answer 14

Bivalirudin, Argatroban, and Dabigatran

Question 15

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

Answer 15

Directly inhibit thrombin activity

Question 16

What drug can be used to reverse Dabigatran effects?

Answer 16

Idarucizumab

Question 17

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

Answer 17

Tranexamic acid

Question 18

What coagulation pathway is affected by warfarin?

Answer 18

Extrinsic pathway

Question 19

What is the effect of warfarin on PT?

Answer 19

Increases PT

Question 20

What anticoagulation test is used to monitor warfarin therapy?

Answer 20

PT/INR

Question 21

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

Answer 21

Fresh frozen plasma or PCC

Question 22

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

Answer 22

Give heparin bridge

Question 23

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

Answer 23

Shorter 1/2 lives of Protein C and S

Question 24

What is the site of action of warfarin?

Answer 24

Liver

Question 25

What is the route of administration for warfarin?

Answer 25

Oral

Question 26

What is the route of administration for heparin?

Answer 26

Parenteral (IV or SC)

Question 27

What are the direct factor Xa inhibitors?

Answer 27

Apixaban and Rivaroxaban

Question 28

What is the disadvantage of direct factor Xa inhibitors?

Answer 28

Bleeding is not easily reversed

Question 29

Indications for direct factor Xa inhibitors

Answer 29

DVT, PE and stroke prophylaxis for a-fib

Question 30

What is an advantage of oral direct factor Xa inhibitors?

Answer 30

Do not require lab monitoring

Question 31

What are the thrombolytics?

Answer 31

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

Question 32

What is the effect of thrombolytics on platelet count?

Answer 32

No effect

Question 33

What is the mechanism of thrombolytics?

Answer 33

Convert plasminogen to plasmin

Question 34

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

Answer 34

Cleaves thrombin and fibrin clots

Question 35

Indications for thrombolytics?

Answer 35

Early MI, ischemic stroke and severe PE

Question 36

What are the ADP receptor inhibitors?

Answer 36

Clopidogrel, Prasugrel, Ticagrelor, and Ticlopidine

Question 37

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

Answer 37

Stop platelet aggregation by irreversibly binding ADP receptor

Question 38

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

Answer 38

Prevents expression of GpIIb/IIIa on platelet surface

Question 39

Indications for ADP receptor inhibitors

Answer 39

ACS, coronary stenting, decrease thrombotic strokes

Question 40

PDE inhibitors

Answer 40

Cilostazol and dipyrdamole

Question 41

What is the effect of PDE inhibitors Cilostazol and dipyrdamole?

Answer 41

Increase cAMP in platelets stopping platelet aggregation; also vasodilate

Question 42

Indications for PDE inhibitors Cilostazol and dipyrdamole

Answer 42

Claudication, coronary vasodilation, prevent stroke or TIAs

Question 43

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

Answer 43

Aspirin

Question 44

What are side effects of PDE inhibitors Cilostazol and dipyrdamole?

Answer 44

Nausea, headache, facial flushing, hypotension, abdominal pain

Question 45

What are the GpIIb/IIIa inhibitors?

Answer 45

Abciximab, Eptifibatide, Tirofiban

Question 46

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

Answer 46

Prevent platelet aggregation

Question 47

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

Answer 47

Abciximab

Question 48

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

Answer 48

Unstable angina and percutaneous coronary intervention

Question 49

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

Answer 49

Bleeding and thrombocytopenia