Thromboembolic Drugs Facts Flashcards
LMW or HMW have increased bioavailability from SC injection site and allow less frequent injections/more predictable dosing
LMW
Adverse effects of heparin
Bleeding
Heparin induces thrombocytopenia (HIT)- give DTI to fix
Contraindications of heparin use
Severe HTN
Active TB
Ulcers in GI
Recent surgeries
FondaparinUX binds where?
To antithrombin to inhibit factor Xa
Which DTI irreversible inhibitor of thrombin?
Lepirudin
Clinical uses for parenteral DTIs
HIT
Coronary angioplasty (bivalirudin and argatoban)
Lepirudin adverse effect
Repeated use can cause anaphylactic rxn
Two stereoisomers of warfarin- what are they and what CYP?
R-warfarin - CYP3A4
S-warfarin- CYP2C9 (3-5x more potent)
Clinical uses of warfarin
Prevent thrombus
Prevent/treat thromboembolism
A-fib
Prosthetic heart valve
Adverse effects warfarin
Teratogenic effect- bleeding disorders in fetus, abnormal bone formation
Skin necrosis, Breast/intestines/extremities infarct
Osteoporosis
Bleeding
VKORC1 - gene responsible for variation in dosing of warfarin. How is it different in different populations?
High dose in AA- more resistant to warfarin
Low dose in Asians- less resistant to warfarin.
Benefit of warfarin?
Long duration of action
Independent of renal function
Antidote available (vit K or PCC)
NOAC factor Xa inhibitors advantages
Orally
No monitoring needed
Rapid onset of action compared to warfarin
NOAC factor Xa inhibitors drawbacks
No antidotes currently
Excreted by kidneys- adjust doses in Renal pts
NOAC direct thrombin inhibitor advantage
Antidote** - idarucizumab
Rapid onset and offset of action
No drug drug interactions
(Worry about Renal pts though)
