Pharmacology Quiz 2-Anti-Coagulants

Question 1

Hemophelia

Answer 1

The body hates clotting; factor II, VII, VIII, XI deficiency

Question 2

Hypercoagulable State

Answer 2

The body loves clotting; could be do to cancer, trauma, DVT, pulmonary embolism, prolonged immobility,

Question 3

DVT

Answer 3

Deep vein thrombosis; clot in the venous system; generally the legs due to poor flow

Question 4

PE

Answer 4

Pulmonary embolism; clot in the pulmonary veins, commonly emboli from a DVT

Question 5

Antithrombotic Agents

Answer 5

Antiplatelet OR anticoagulant agents;

Question 6

Antiplatelet agent

Answer 6

Under the antithrombotic agents; inhibits platelet function

Question 7

Anticoagulant Agents

Answer 7

Under the antithrombotic agents; alters clotting factors and prevents thrombus formation

Question 8

Thrombolytic Agents

Answer 8

Helps breakdown thrombus after it has formed to restore flow

Question 9

The Clotting Cascade

Answer 9

The “contact factor” (intrinsic) and “tissue factor” (extrinsic) are turned on due to damage to the blood vessel; this leads to a cascade of clotting factors (XII, XI, IX, X) in the intrinsic pathway and (VII, X, tissue factor) in the extrinsic factor; all lead to Xa being created; Xa converts prothrombin to thrombin, fibrinogen to fibrin, and eventually to a cross linked fibrin clot

Question 10

Unfractionated Heparin: general

Answer 10

Along with an antithrombin, the heparin binds to thrombin and factor Xa so it can’t create the clot in the cascade; acts quickly, and doesn’t last that long; only given IV or subQ; derived from pork; more monitoring than LMWH

Question 11

Heparin: therapeutic uses, monitoring, side effects

Answer 11

Used for ACS, atrial fibrillation, medical/surgical VTE (venous thromboembolism) prophylaxis, prosthetic heart valves, trauma, venous thromboembolism; monitor bleeding, anti-Xa levels, H/h, platelets; side effects include bleeding and thrombocytopenia; anticoagulant

Question 12

Heparin Induced Thrombocytopenia

Answer 12

Profound drop in platelet levels secondary to heparin use; occurs between 5-10 days after heparin exposure; high rate of thrombus formation –> amputation/death; must discontinue ALL heparin use; do not initiate another type of antithrombotic agent; a “heparin allergy”

Question 13

Low Molecular Weight Heparin: general

Answer 13

LMWH with an antithrombin bind only to factor Xa to prevent it from creating a clot; work less quickly but last longer; more predictable response; only SubQ or IV; derived from pork; not as much monitoring required; good option for VTE; more expensive; anticoagulant; enaxoparin, dalteparin

Question 14

LMWH: uses, monitoring, side effects, cautions

Answer 14

Used for ACS, atrial fibrillation, medical/surgical VTE prophylaxis, prosthetic heart valves, trauma, and VTE; monitor sx/sy of bleeding, h/h platelets, anti-Xa levels; side effects of bleeding and thrombocytopenia; careful for renal failure/pregnancy/obesity;

Question 15

Factor Xa Inhibitor

Answer 15

Anticoagulant; fondaparinux; factor Xa Inhibitor; used for ACS, VTE prophylaxis, VTE, valve replacement; subQ dosing once a day; could decrease risk of thrombocytopenia

Question 16

Warfarin

Answer 16

Anticoagulant, blocked Vitamin K from being utilized in the clotting cascade (VII, IX, X, II clotting factors depend on K); used for prophylaxis of venous thrombosis, treatment of VTE, prevention of secondary embolism, acute MI, valvular heart disease, a-fib, heart valves, anti-phospholipid antibody syndrome; monitor s/sx of bleeding, H/h, and platelets; side effects= bleeding and skin necrosis; lots of contraindications! (Pregnancy, surgery, CVA, senile, alcoholic, dissecting aorta); administered orally (takes a few days before effect is seen, so start with a parenteral agent); requires close monitoring and is highly affected by diet/meds/genetics

Question 17

Direct Thrombin Inhibitor

Answer 17

Anti-Coagulant; dabigatran (Pradaxa); used for non-valvular a-fib and treatment and secondary prevention of VTE; orally administered twice daily; monitor bleeding, h/h, renal function; side effects = bleeding, GI effects;

Question 18

Oral Factor Xa Inhibitor

Answer 18

Rivaroxaban (xarelto), apixaban (Eliquis), edoxaban (savaysa); used for non-valvular a-fib, treatment and secondary prophylaxis for VTE; monitor s/sx of bleeding, h/h, renal function; side effects = bleeding

Question 19

Aspirin

Answer 19

An anti-platelet; used for chronic stable/unstable angina; primary/secondary MI prevention; treatment of MI; PCI/PCTA/CABG; primary/secondary TIA/stroke prevention; atrial fib; side effects= GI intolerance and bleeding; monitor bleeding; caution with children, GI bleed, or allergy to NSAIDs

Question 20

Antiplatelet Agents: P2Y12 Inhibitors

Answer 20

Blocks thienopyridine from becoming part of the GP-IIb and IIIa aggregation; clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta); used with aspirin for at least 1 year in patients who are post-ACS, undergoing PCI, and sometimes CABG; to use it alone, it is for secondary stroke prevention, PAD, and as an alternative to aspirin; monitor bleeding and CV events; side effects= bleeding, headache, dyspnea; cautions= active bleeding, history of stroke, patients who are elderly or less than 60kg, chronic aspirin dose;

Question 21

Glycoproteins IIb/IIIa Inhibitor

Answer 21

An antiplatelet; Abciximab (Reopro), Eptifibatide (Integrilin), Tirofiban (Aggrastat) inhibits platelet aggregation by preventing fibrinogen from binding to the GP IIb/IIIa receptor; used for ACS; not available orally, so only administered IV; monitor s/sx of bleeding, h/h, platelets, and renal fxn; side effects= bleeding; no reversal agent;

Question 22

Thrombolytics

Answer 22

Breakdown already formed thrombus –> re-establish blood flow; streptokinase, alteplase, reteplase, tenecteplase; tissue plasminogen activator that helps break down clots (produces a cascade that leads to clot being broken down); used for stroke, AMI, massive PE, or catheter clearance; monitor bleeding/vitals; cautions= history of CVA, GI bleed, trauma, or major surgery; HTN; aortic dissection; active bleeding; suspected ICH

Question 23

Statins: mechanism of action

Answer 23

Atorvastatin (lipitor), fluvastatin (lescol), etc.Decrease cholesterol production in the liver, up-regulates LDL surface receptors –> LDL breakdown –> VLDL production –> decreases LDL production; has other benefits such as plaque reduction, antioxidant effects, and antithrombotic effects; HMG-CoA reductive inhibitors (the pathway that makes cholesterol); statins stop HMG-CoA from becoming mevalonate which eventually becomes cholesterol

Question 24

Statins: uses, monitoring, side effects

Answer 24

used for dyslipidemia, post-MI, primary prevention of CV disease; monitor lipids, CPK, baseline LFTs; side effects= headache, GI, myalgia, rhabdomyolysis (rare but very serious); caution=liver disease

Question 25

Fabric Acid Derivatives

Answer 25

Primarily used for hypertriglyceridemia alone or in conjunction with other agents; lipoprotein lipase enzyme –> decrease TG levels and VLDL breakdown; gemfibrozil (lopid) and fenofibrate (tricor);

Question 26

Other Lipid Lowering Agents

Answer 26

Nicotinic Acid (niacin), vitamin B3, which decreases LDL synthesis, may cause flushing; bile acid sequesterants (cholestyramine-Questran); ezetimibe (zetia); bile acid and ezetimibe decreases GI absorption; use caution when combining a statin + a fabric acid;

Question 27

Special Considerations of Anti-Coagulants

Answer 27

Be aware of increased risk of bleeding in patients on these meds (especially post-hip/knee surgery); be aware of patients with hemophilia; watch out for myopathies secondary to lipid lowering agents; help with compliance