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Pharmacology 2: Section 1 > Anti-Coagulants & Anti-Platelets > Flashcards

Anti-Coagulants & Anti-Platelets Flashcards

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1
Q

Drugs that inhibit platelet aggregation to prevent thrombus formation.

A

Anti-Platelets

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2
Q

What are Anti-Platelets primarily used for?

A

Prevention of Arterial Thrombosis

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3
Q

Medication that irreversibly inhibits Cyclooxygenase-1 (COX-1) and Thromboxane A2

A

Aspirin

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4
Q

Medications that inhibit the P2Y12 receptor and block ADP-induced platelet aggregation.

A

Clopidogrel (Plavix)
Ticagrelor

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5
Q

GPIIb/IIIa Inhibitors

A

Abciximab
Eptifibatide

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6
Q

Medications that inhibits phosphodiesterase and adenosine uptake.

A

Dipyridamole
Cilostazol

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7
Q

Aspirin is used for the primary prevention of what pathology?

A

Myocardial Infarction

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8
Q

Adverse effect of Aspirin that occurs in pediatric populations.

A

Reye’s Syndrome
(Liver + Brain Swelling)

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9
Q

What are the signs and symptoms of Aspirin overdose?

A

Tinnitus
Vertigo
Nausea, Vomiting, Diarrhea
Hyperventilation
Respiratory Alkalosis
Metabolic Acidosis
Hypokalemia
Hypoglycemia

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10
Q

A Salicylate level of what would indicate Aspirin overdose?

A

> 40mg/dL

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11
Q

How do you treat Aspirin overdose?

A

ABCs
Activated Charcoal
Sodium Bicarbonate
Dialysis

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12
Q

Irreversible inhibitors of P2Y12 or ADP receptor.

A

Clopidogrel
Prasgurel

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13
Q

What are the indications for Clopidogrel (Plavix)

A

Unstable Angina
NSTEMI
STEMI
Stroke
Peripheral Arterial Disease

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14
Q

What is an adverse event that can occur due to Clopidogrel?

A

Thrombotic Thrombocytopenic Purpura
(Blood clots in small blood vessels)

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15
Q

What medications can Clopidogrel interact with?

A

CYP-2C19 Inhibitors
Omeprazole

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16
Q

If a patient has an allergy to Aspirin, what medication can be used as an alternative?

A

Plavix

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17
Q

Medication that is more potent and than Plavix and is preferred in ACS when strong anti-platelet action is required.

A

Prasugrel (Effient)

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18
Q

How is Prasugrel metabolized?

A

Prodrug

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19
Q

What is Prasugrel a substrate of?

A

CYP-2C19

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20
Q

What medication should be avoided with Prasugrel (Effient)

A

Omeprazole

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21
Q

What is the indication for Prasugrel (Effient)

A

STEMI

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22
Q

When is Prasugrel (Effient) contraindicated?

A

History of TIA or Stroke

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23
Q

What patients should you be very cautious with when using Prasugrel (Effient)

A

Elderly (75+)
Only if Diabetic or prior MI

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24
Q

Patients below what weight need a reduced dose of Prasugrel?

A

< 60kg

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25
Medication that is a reversible inhibitor of P2Y12 or ADP.
Ticagrelor (Brilinita)
26
When is Ticagrelor used?
Acute Coronary Syndrome + Aspirin (Maximum Aspirin dose of 100mg)
27
What drugs does Ticagrelor interact with?
CYP3A4 Inhibitors 5x increase with Anti-Fungal!
28
When is Ticagrelor contraindicated?
History of Intracranial Hemorrhage
29
Medications that bind to and irreversibly Inhibits GPIIb/IIIa receptors and block platelet aggregation.
GPIIB/IIIA Antagonists (Abciximab + Eptifibatide & Tirofiban)
30
When are GPIIB/IIIA antagonists used?
Percutaneous Coronary Intervention Acute Coronary Syndromes
31
What patients should you be cautious with when prescribing GPIIb/IIIa antagonists?
Renal Dysfunction (reduce dose)
32
What are some adverse drug reactions of Abciximab?
Anaphylaxis Thrombocytopenia
33
What are some adverse drug reactions of Eptifibatide & Tirofiban?
Anaphylaxis Thrombocytopenia Renal Dysfunction
34
Medication that inhibits platelet function by inhibition adenosine uptake and cGMP phosphodiesterase activity (PDE3 Inhibitor)
Dipyridamole
35
When is Dipyridamole used?
With another Agent (Aspirin or Warfarin)
36
What are the adverse effects of Dipyridamole (PDE3 Inhibitor)
Headaches GI Distress Dizziness
37
PDE3 Inhibitor that is used for Intermittent Claudication.
Cilostazol (Pletal)
38
What can cause interactions with Cilostazol (Pletal)
High Fat Diet = ↑ Level Grapefruit = ↑ Level via CYP3A4
39
Medications used for prevention of Venous Thromboembolism and stroke prevention in A-Fib.
Anti-Coagulants
40
What are the three factors that contribute to the formation of blood clots in Virchow's Triad?
Endothelial Injury Hypercoagulability Stasis
41
Vitamin K Antagonist that inhibits Vitamin K epoxide reductase.
Warfarin
42
Direct Factor Xa Inhibitors (Oral)
Apixaban (Eliquis) Rivaroxaban (Xarelto)
43
Direct Thrombin Inhibitors (Oral)
Dabigatran (Pradaxa)
44
Medication that binds to Antithrombin III and allows for the inhibition of Thrombin and Factor Xa
Heparin
45
Type of Heparin that is preferred for outpatient use.
Low Molecular Weight Heparins
46
What clotting factors are inhibited by Warfarin? (S.N.T.T = Snot)
VII (7) IX (9) X (10) II (2)
47
What proteins are inhibited by Warfarin?
Protein C and S
48
When is Warfarin indicated?
DVT + PE from Valvular and Non-Valvular A-Fib Stroke Prophylaxis during: - Cardioversion - Rate Control Therapy Reduce risk of embolism after MI
49
What must you bride with Warfarin until you reach a therapeutic INR?
Indirect Thrombin Inhibitor
50
What are some adverse effects of Warfarin?
Bleeding Teratogenic Skin Necrosis CYP2C9 VKORC1
51
When using Warfarin, what is the goal INR?
2 - 3
52
What is the reversal agent for Warfarin and when is it given?
Vitamin K (orally) INR of 4.5 - 10 or Pre-Surgery Fresh Frozen Plasma for active bleeding
53
What medication can increase INR due to interacting with Warfarin?
Amiodarone
54
What medication can decrease INR due to interaction with Warfarin?
Rifampin
55
What Direct Factor Xa Inhibitor should be taken with food for doses above 10mg?
Rivaroxaban (Xarelto)
56
Medications that are metabolized by CYP3A4 and P-Glycoprotein. Should be avoided in patients with severe renal and hepatic impairment.
Direct Factor Xa Inhibitors (Apixaban + Rivaroxaban)
57
What are the ABCs of prescribing Apixaban?
A = Age 80+ B = Body Mass ≤ 60kg C = Creatinine 1.5+ DO NOT GIVE IF AT LEAST 2 of THESE
58
Direct Thrombin Inhibitors that are given Parenteral.
Bivalirudin Argatroban
59
Direct Thrombin Inhibitor that is given parenterally for Percutaneous Coronary Intervention (PCI)
Bivalirudin
60
Direct Thrombin Inhibitor that is given parenterally for Heparin-Induced Thrombocytopenia (HIT) and PCI
Argatroban (Acova)
61
Direct Thrombin Inhbitor that is given orally. It does not require routine monitoring, doesn't interact with CYP450, and has a rapid onset and offset.
Dabigatran (Pradaxa)
62
What are the Black Box Warnings on Dabigatran (Pradaxa)
Spinal + Epidural Hematomas Abrupt Discontinuation
63
What is the reversal agent for Direct Oral Anti-Coagulants (Factor Xa) such as Eliquis and Xarelto
Andexxa
64
What is the reversal agent for Dabigatran?
Idarucizumab
65
Binds to enzyme inhibitor antithrombin III and inactivates clotting factors IIa (Fibrin) and Xa
Unfractionated Heparin
66
Binds to Antithrombin III but not Fibrin.
Low Molecular Weight Heparin Synthetic Heparin
67
Heparin that is used primarily in the prevention of clotting in arterial and cardiac surgery and to maintain patency of IV devices and for Dialysis patients.
Unfractionated Heparin
68
Name three Low-Molecular Weight Heparins.
Enoxaparin Dalteparin Tinzaparin
69
When is Low-Molecular Weight Heparin preferred? (TOP)
Trauma Oncology Pregnancy
70
Patients taking Direct Oral Anticoagulants (Eliquis + Xarelto) can have weight false reading?
Falsely Elevated PTT Levels
71
What is an advantage of Unfractionated Heparin?
NO RENAL DOSING
72
Adverse drug reactions caused by Heparin.
HIT Platelet Factor 4-Heparin (5-14 days after starting Heparin)
73
How do you treat HIT?
Stop Heparin NO PLATELET TRANSPLANT Replace with Fondiparinux
74
What is the reversal agent for Heparin?
Protamine
75
Medications that cause fibrinolysis by binding to fibrin in a clot and converting entrapped plasminogen to active plasmin.
Fibrinolytics (Clot Busters)
76
Name three Fibrinolytics.
Alteplase Reteplase Tenecteplase
77
When do you use Fibrinolytics?
Stroke PE STEMI
78
How soon must a Fibrinolytic be given after symptom onset?
Within 3 hours
79
Contraindications for Fibrinolytics.
Bleeds Stroke in last 3 months Brain or Spine surgery in last 3 months Serious head trauma in last 3 months Uncontrolled Severe Hypertension Brain lesions or aneurysm or malformation
80
What are some advantages of Tenecteplase over Alteplase
Better Outcomes at 90 days Cheaper Less bleeding Less Adverse Drug Reactions

Pharmacology 2: Section 1 (4 decks)

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