thromboembolitic disorder drugs Flashcards
Heparin
anticoagulant, enhances antithrombin
MOA: inactivates factor Xa and thrombin
-fast acting
-large polar molecule so only admin by injection
use: rapid anti-coagulation needs, DVT, open heart surgery, ECMO, pulmonary embolism, stroke, preffered during pregnancy
**ADRS: deparin-induced thrombocypotenia, there is an increased risk for spinal/epidural hematoma **
Xindicated: thrombocytopenia, surgery of eye brain spinal cord, active lumbar puncture of anesthesia,
labs: aPTT and antifactor Xa
warfarin
anticoagulant
-prevents activation of vitamin K
-less intense than heparin, cannot be used while pregnant
-used more prophylactally
LABS: PT, INR
____
Enoxaparin and Dalteparin
end in parin, these are lower molecular weight heparins
-fixed dose
Dabigatran
anticoagulant: direct thrombin inhibitor
PO
use: AFIB, DVT and PE, prevention with hip and knee surgery
ADRs: GI disturbances
antidote: idarucizumab (praxbind)
drug-drug interactions: avoid ketoconazole, amiodarone, verpamil
advantages: rapid onset, few drug/food interactions
Argatroban
anticoagulant: direct thrombin inhibitor
IV form of this drug
use: pts who develop HIT
Rivaroxaban (Xarelto)
factor Xa inhibitors
PO admin
uses: prevent DVT/PE, afib, etc
check renal function
drug interactions: HIV antivirals, anti Sz, anti fungals, no use in pregnancy
ANTIDOTE: andexnet (andexxa)
Apixaban (Eliquis)
factor Xa inhibitors
uses: prevent DVT/PE, afib, etc
check renal function
drug interactions: HIV antivirals, anti Sz, anti fungals, no use in pregnancy
Aspirin
antiplatelet
MOA: irreversible inhibition of cyclooxygenase (COX), which is required to synthesize TXA2
indications: ischemic stroke, TIA, angina, prevention of MI, coronary stenting
clopidogrel (plavix)
antiplatelet (used alone or with ASA)
MOA: ADP Antagonist, prevents ADP stimulated plt aggregation
reduction or prevention of clots in stents, reduction of incidence of cerebral vascular accident, acute coronary syndrome, MI,
effective in peripheral arterial disease
ADR: ThromboticThrombocytopenicPurpura, abdominal pain, dyspepsia, diarrhea
Proton pump inhibitors may reduce GI bleed but also reduces clopidogrel effectiveness
Ticagrelor (Brilinta)
antiplatelet
MOA: ADP receptor antagonist
Abciximap (ReoPro)
antiplatelet
MOA: GP2b3a Receptor Antagonist, it stops the final step in platelet aggregation
use: prevent ischemic events in ACS pts, also during percutaneous coronary interventions like shunting
considerations: often used in combo therapy with aspirin and heparin
alteplase (activase) and other -plase
thrombolytics: fibronolytics
MOA: promote conversion of plasminogen to plasmin
plasim degrades the fibrin matrix in thrombi
use: severe thrombotic disease, acute MI, PE, stroke,
advantages: des not cause allergic reactions or induce hypotension
warfarin drug interactions
drugs that promote bleeding: heparin, antiplatelet
drugs that decrease the effect of warfarin: seizure meds like carbamazepine, phytoin, oral contraceptives, rifampin
drugs that increase the warfarin effect: antifungals like the azoles, cimetidine, amiodarone
why take Heparin and Warfarin together?
pt needs anticoagulation and PO meds for home therapy,
heparin inhibits thrombin, warfarin inhibits synthesis of vit K dependent clotting factors
heparin is immediate effect, while warfarin is delayed
but need to check labs b/c once INR is within therapeutic anticoagulant range, HEPARIN IS DISCONTINUED
