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Pharm Exam 2 > 18/19 - Antithrombotic Agents > Flashcards

18/19 - Antithrombotic Agents Flashcards

1
Q

MOA aspirin

A

irreversibly block COx1 in platelets which reduces TXA2 production

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2
Q

MOA dipyridamole

A

elevates cAMP levels which reduce Ca2+ levels which reduces activation of platelets

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3
Q

P2Y12 antagonists

A

clopidogrel and prasugrel irreversibly inhibit P2Y12

ticagrelor and cangrelor are reversible

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4
Q

contraindication for clopidogrel

A

omeprazole use

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5
Q

what enzyme activates clopidogrel?

A

CYP2C19

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6
Q

which P2Y12 antagonists would you use for a patient with intracranial bleeding?

A

clopidogrel or cangrelor

NOT prasugrel or ticagrelor they have higher bleeding rates but better results

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7
Q

GP IIb and IIIa antagonists

A

abciximab
eptifibatide
tirofiban

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8
Q

highest risk GPIIb/IIIa antagonist

A

abciximab

monoclonal antibdoy directed against the GP but also antiinflammatory

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9
Q

MOA vorapaxar

A

protease activated receptor antagonist

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10
Q

dual antiplatelet therapy

A

aspirin and P2Y12 antagonist

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11
Q

triple antiplatelet therapy

A

warfarin
aspirin
clopidogrel

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12
Q

MOA of heparin

A

accelerates rate of factor Xa inhibition

(only loner heparin molecules) also increases AT induced inhibition of thrombin

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13
Q

for heparin…. clearance ______ as dose increases

A

decreases

dose-dependent clearance

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14
Q

t1/2 __– as dose increases for heparin

A

increases

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15
Q

what system is used to monitor heparin

A

partial thromboplastin time PTT

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16
Q

if bleeding is severe with heparin, what can be administered

A

protamine sulfate

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17
Q

risk of long term heparin use

A

osteoporosis

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18
Q

type I v. type II heparin induced thombocytopenia

A

type 1- of little clinial consequence, first 2-5 days

type 2: immune thrombocytopenia with antibodies generated towards PF4/heparin complex —> venous and arterial thrombosis

more common in women and surgical pts

more common with unfractionated heparin

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19
Q

low molecular weight heparin =

A

enoxaparin

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20
Q

contraindications for enoxaparin and fondaprinux

A

renal insufficiency

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21
Q

heparin v. enoxaparin

A

enoxaparin - lower risk and better dosing with longer half-life

protamine only partially reverses enoxaparin

22
Q

MOA fondaparinux

A

inhibits factor Xa

23
Q

what is used to monitor enoxaparin and fondaprinux

A

anti-factor Xa assay

24
Q

bind at both the fibrin binding site and the active site of thrombin

A

bivalirudin and lepirudin

25
Q

bind only to the active site of thrombin

A

argatroban and dabigatran

26
Q

only oral direct thrombin inhibitor

A

dabigatran

27
Q

direct thrombin inhibitors versus heparin

A

both can inhibit soluble thrombin

DTIs can inhibit thrombin bound to fibrin

28
Q

major drawback to direct thrombin inhibitors

A

specific antidotes do not exist

29
Q

why is warfarin useful for longterm management

A

orally active

30
Q

MOA warfarin

A

vitamin K antagonist at vitamin K reductase

31
Q

vitamin K dependent factors

A

II
VII
IX
X

32
Q

warfarin dosing

A

takes 3-5 days to reach full antithrombotic effect with long half life

33
Q

what enzyme metabolizes warfarin

A

CYP2C9

34
Q

what method is used to monitor warfarin

A

prothrombin time is generally used

35
Q

target INR for warfarin

A

2-3

36
Q

the effect of warfarin is _______ with

  • antibiotics
  • NSAIDs
  • 5-HT reuptake inhbitors
  • statins
A

increased

37
Q

the effects of warfarin are _________ with

  • rfampin
  • barbiturates
  • carbamazepine
A

decreased

because they all increase hepatic metabolism

38
Q

decreased hepatic functionwith liver disease can __ the clearance of warfarin and __– INR

A

decrease

increase

39
Q

diseases of the intestine such as crohn disease that reduce vitamin k absorption ______- the INR of warfarin

A

increase

40
Q

hypoalbuminemia will have what effect on warfarin

A

increase INR

41
Q

what causes necrosis with warfarin

A

fall in prtn C

42
Q

direct Xa inhibitors

A

rivaroxaban

apixaban

43
Q

which is better direct Xa inhibitors or warfarin

A

direct Xa inhibitors

aka oral anticoagulants

44
Q

what is dabigatran contraindicated for>

A

mechanical heart valves

use warfarin instead

45
Q

can you take warfarin during pregnancy?

A

no

but you can take heparin and heparin like drugs

46
Q

what is needed for fibrinolysis?

A

tPA and plasminogen

47
Q

what is the role of urokinase plasminogen activator

A

converts plasminogen into plasmin

48
Q

recombinant human t-Pa

A

alteplase

49
Q

modified recombinant human t-PA

A

reteplase

50
Q

STEMI

A

tissue plasminogen activators used

not used for NSTEMIs or over 75 or past 12 hrs

51
Q

block interaction of plasmin with fibrin

A

aminocaproic acid and tranexamic acid

used to treat hemophilia and reverse fibrinolytic bleeding

Pharm Exam 2 (12 decks)

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