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CPR 2 Exam 1 > Wolff PAD > Flashcards

Wolff PAD Flashcards

1
Q

MOA of Cilostazol?

A
  • type 3 PDEI, this prolongs life of cAMP in platelets and cells
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2
Q

Effects and clinical application of Cilostazol?

A
  • Used for intermittent claudication
  • inhibits platelet aggregation
  • acts as vasodilator
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3
Q

AE of Cilostazol?

A
  • HA
  • Diarrhea
  • Palpitations
  • dizzy
  • peripheral edema
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4
Q

BBW for Cilostazol?

A

Contraindicated in those with HF, its use decreases survival in class III and IV HF

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5
Q

Unfractionated Heparin MOA?

A
  • mix of long polysaccharide chains
  • Pentasaccharide sequence found along length that binds and activates antithrombin III to inhibit factor Xa via formation of thrombin
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6
Q

Effects and clinical use of heparin?

A
  • Blocks generation of thrombin and inactivates thrombin
  • prevents red clot formation
  • Used for PE, stroke, DVT, DIC, MI
  • Can be used in pregnancy
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7
Q

Antidote to Heparin and pharmacokinetics?

A
  • protamine, with many positive charges that bind ionically with negative heparin
  • Given IV or SC as can’t cross cell mem
  • intensive monitoring of plasma levels with PTT
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8
Q

Contraindications/warnings for Heparin?

A
  • thrombocytopenia and uncontrollable bleeding
  • surgeries involving brain eye or spinal cord
  • liver/kidney disease
  • HITT
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9
Q

What is enoxaparin and it’s MOA?

A
  • low molecular weight heparin
  • shorter length heparin that inhibits factor Xa preventing red clots
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10
Q

Clinical application of Enoxaparin?

A
  • prevent DVT after surgery
  • tx DVT w/wo PE
  • Prevent ischemic complications
  • safe in pregnancy
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11
Q

Pharmacokinetics of Enoxaparin?

A
  • easier to use with predictable dosing
  • first choice for tx/prevent DVT
  • long half life
  • costly
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12
Q

Toxicities of Enoxaparin?

A
  • bleeding (protamine is antidote)
  • HITT
  • severe neurologic injury with spinal puncture or epidural
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13
Q

What is Fondaparinux and MOA/effects?

A
  • Synthetic pentasaccharide identical to antithrombin binding structure of heparin
  • Selectively inhibits factor Xa preventing conversion of prothrombin to thrombin
  • slightly more effective than enoxaparin but increased risk of bleeding
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14
Q

Use of fondaparinux?

A
  • prevent/tx DVT
  • tx PE use with warfarin
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15
Q

Toxicities of Fondaparinux?

A
  • bleeding NOT reversible with protamine
  • does not cause heparin induced thrombocytopenia
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16
Q

Compare Heparin vs LMW Heparin MOA?

A
  • Heparin inhibits factor Xa and thrombin and requires PTT monitoring
  • LWM Heparin only blocks Xa and doesn’t require monitoring
17
Q

What is Bivalirudin?

A
  • Blocks thrombin directly
  • reversibly inhibits thrombin at the catalytic site and substrate binding site
18
Q

Uses of Bivalirudin and pharmacokinetics?

A
  • in combo with aspirin to patients undergoing coronary angioplasty
  • Given IV
  • Expensive
19
Q

Bivalirudin toxicities?

A
  • As effective as Heparin and doesn’t require antithrombin and causes less bleeding
  • NO antidote
  • anaphylaxis with repeated use
20
Q

Argatroban MOA, use and pharmacokinetics, and toxicities?

A
  • Directly binds catalytic site of thrombin
  • Prophylaxis and tx of thrombosis in patients with HIT
  • Efficacy monitored by PTT
  • Given IV short half life
  • Risk of hemorrhage and hematuria
21
Q

Warfarin MOA?

A
  • Vitamin K antagonist
  • Decreases production of biologically active forms of calcium dependent clotting factors II, VII, IX and X, protein C and S
22
Q

Clinical uses of Warfarin?

A
  • Most widely used for long term prophylaxis of thrombosis for prevention of:
    • DVT
    • Thromboembolism with mechanical heart valves
    • A. fib
    • not useful in emergency
23
Q

Contraindications for Warfarin?

A
  • Severe thrombocytopenia or uncontrolled bleeding
  • any surgery with eye brain or spinal cord
  • hemophilia ulcer or alcoholic patients
24
Q

Pharmacokinetics of Warfarin?

A
  • 100% bioavailability
  • eliminate by liver in bile
  • Slow onset and offset
  • monitored with prothrombin time ratio
    • want INR of 2-3
25
Q

Warfarin toxicites?

A
  • Bleeding
    • if occurs discontinue and administer vitamin K slowly
    • fresh whole blood/ plasma if urgent
  • Crosses placenta and causes death
26
Q

Rivaroxaban MOA and effects and advantage over warfarin?

A
  • Direct inhibiitor of activated factor X
  • directly inhibits production of thrombin
  • Advantages:
    • rapid onset
    • fixed dose
    • lower bleeding risk
    • fewer drug interaction
    • no need for iNR
27
Q

Clinical uses of Rivaroxaban?

A
  • prevent DVT and PE after surgery
  • prevention of stoke in patients with nonvalvular atrial fib
  • andexanet alfa is antidote
  • used off label for HIT
28
Q

Toxicities of Rivaroxaban? (7)

A
  • bleeding
  • epidural hematoma
  • major intracranial retinal bleeds
  • adrenal bleeds
  • avoid with hepatic/renal impairment
  • unsafe for pregnancy
  • don’t combine with other anticoagulatns
  • interacts with CYP3A4
29
Q

What is apixaban comparable to, but better than?

A

Rivaroxaban, it has same benefits but with less bleeding

30
Q

Dabigatran MOA?

A
  • Direct oral anticoagulant that inhibits thrombin
  • directly blocks thrombin
31
Q

Dabigatran 5 advantages over Warfarin?

A
  • rapid onset
  • no need to monitor
  • few drug/food interactions
  • low risk of bleeding
  • same dose for all patients
32
Q

Dabigatran uses, contraindications, and pharmacokinetics?

A
  • prevent stroke and systemic embolism with nonvalvular a fib
  • contraindicated for those with mechanical heart valves
  • pills are unstable and kept in specific environment
33
Q

Toxicities of Dabigatran and antidote?

A
  • bleeding
  • antidote is idarucizumab
34
Q

How do you monitor heparins, warfarins, DOAC factor Xa inhibtors, and DOAC direct thrombin inhibitors?

A
  • heparin
    • PTT
  • Warfarin
    • INR
  • Factor Xa inhibitor
    • anti-Xa
  • Direct thrombin inhibitor
    • diluted TT

CPR 2 Exam 1 (21 decks)

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