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Kol- Pharm 323 Spring > AntiCoag > Flashcards

AntiCoag Flashcards

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1
Q

3 types of drugs effecting coagulation

A

Anticoagulants
Antiplatelet
Thrombolytic Therapy

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2
Q

prevents the formation of clots- VENOUS (DVT)

A

Anticoagulants

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3
Q

inhibits platelet aggregation (arterial - MI/Stroke)

A

Antiplatelet Agents

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4
Q

dissolves life threatening clots

A

Thrombolytic

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5
Q

5 types of anticoag drugs

A
  1. Heparin
  2. Low Molecular Weight Heparin
  3. Vitamin K antagonist
  4. Direct Thrombin Inhibitors
  5. Direct Factor Xa Inhibitors
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6
Q

heparin is the prototype for …

A

heparin unfractionated!

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7
Q

How do anticoagulants work? What do they do?

A

=PREVENT clot formation
—>Increase time it takes the body to form clots

FXN:
-Inhibit synthesis clotting factors (factor X and thrombin)
OR
-Inhibit the activity of clotting factors (Xa, thrombin)

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8
Q

Uses for anticoagulant?

A
  • Prevention of venous thrombosis

- –> DVT, pulmonary embolism, atrial fibrillation can throw clots

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9
Q

Routes for anticoagulants? When would you use which route?

A
  • IV/SubQ = if life threatening = Heparin, LMWH

- Oral= long term use

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10
Q

Heparin is not a ____ ______

A

blood thinner

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11
Q

3 ways heparin fxns?

A
  • Inactivates several clotting factors (factor Xa)
  • inhibits thrombin activity
  • suppresses formation of fibrin.
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12
Q

how is heparin measured?

A

in units

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13
Q

Route and reason for heparin?

A
  • IV immediate action: PE/Stroke/Renal Dialysis – intermittent or continuous
  • SQ-up to 1 hour for effect, abdomen, no aspirate/massage
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14
Q

half life for heparin? hours to reach therapeutic level of heparin?

A

1/2 life = 90 minutes

therapeutic = 6 hours

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15
Q

Antidote for heparin overdose? how often do we use it and why?

A

protamine sulfate (onset 5 min)

-hardly ever used…. -short half life of heparin = can just stop the IV drip and will resolve on its own

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16
Q

2 lab tests when on heparin?

A
  1. aptt

2. Anti-factor Xa level

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17
Q

aPTT measure _____ factor pathway

A

intrinsic

INpatient = IV heparin = INtrinsic =bigger # b/c more sick

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18
Q

Normal vss therapeutic levels of aPTT

A
  • Normal = 40 sec

- Therapeutic levels = 1.5-2X baseline : 60-80 sec

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19
Q

How often do we measure aPTT on IV heparin?

A

every 6 hours

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20
Q

therapeutic levels fo Anti- factor XA levels?

A

0.3-0.7 IU/mL

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21
Q

Side effects of heparin?

A
  1. bleeding

2. HIT

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22
Q

What is HIT? what we monitoring for?

A

(Heparin Induced Thrombocytopenia) - monitor platelets.
->4 days use, body creates antibodies again heparin platelet protein complexes resulting in platelet drop

-If <100,000 or platelets reduce by 50% then stop heparin.

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23
Q

-If______ or platelets reduce by _____ then stop heparin.

A

-If <100,000 or platelets reduce by 50% then stop heparin.

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24
Q

how do you know if your patient is bleeding?

A

-petechiae, blood from orifices, bruises, discolored urine, lumbar pain

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25
who is NOT getting heparin and why?
do not give with epidural or spinal anesthesia | ----> risk of hematoma
26
prototype for | Low Molecular Weight Heparin
enoxaparin(Lovenox)
27
how does enoxaparin(Lovenox) fxn?
same mechanism of action as heparin, but SAFER, better bioavailability - Inactivates several clotting factors (factor Xa) - inhibits thrombin activity - suppresses formation of fibrin.
28
Benefits of enoxaparin(Lovenox)
- No frequent blood tests - Dosage based on weight - Can be administered at home - longer half life - 6x longer
29
What is drug of choice for DVT prevention?
enoxaparin(Lovenox)
30
Side effects of enoxaparin(Lovenox)?
same as heparin! | bleeding, HIT
31
Check ______ before admining enoxaparin(Lovenox)
platelets
32
antidote to enoxaparin(Lovenox)
protamine sulfate, same as heparin
33
enoxaparin(Lovenox)- do or don't expel the bubble? Admin in the ____ only
Don't expel the bubble! | Abdomen only!
34
prototype for Vitamin K antagonist
Warfarin (Coumadin)
35
how does Warfarin (Coumadin) fxn?
Vitamin K antagonist | inhibiting hepatic synthesis of vitamin K dependent clotting factors VII, IX, IX, X, and prothrombin
36
antidote for Warfarin (Coumadin)? | Will see effects in ___ hours
Antidote: Vitamin K (↓ effects in 6 hours)
37
enoxaparin(Lovenox) is only administered
SubQ | i think this is true? lemme know if its not
38
route for Warfarin (Coumadin)? which one has a risk?
Vitamin K antagonist | oral, IV (risk of anaphylaxis), SubQ
39
uses for Warfarin (Coumadin)
Vitamin K antagonist -Prevent DVT, PE, prevent clots in patients with Afib, prosthetic heart valves or who had TIA or recurrent MI
40
Warfarin (Coumadin) is highly ____ bound
protein
41
drug/food interactions with Warfarin ?
Vitamin K antagonist - Inactive by CYP2CP pathway - Foods high in vitamin K , green leafy veg - --> eat consistent amount of high vitamin K foods
42
VKORC1 & CYP2C9 variants =Increased risk of bleeding with which drug?
Warfarin (Coumadin)
43
Can you take Warfarin (Coumadin) while pregnant?
nope
44
Side effects of Warfarin (Coumadin)?
Hemorrhage
45
2 labs tests for Warfarin (Coumadin)?
1. PT | 2. INR
46
What do PT and INR measure : _____________pathway
EXtrinsic pathway warfarin = outpatient =exit hospital
47
Normal range and therapeutic range for PT? test for which drug?
- PT normal 12 sec, Therapeutic = 1-2X baseline (12-24) | - warfarin
48
therapeutic level for INR? Test for which drug?
- INR (Internationalized Ratio) 2.0-3.0 = therapeutic level | - warfarin
49
which is more consistent to test platelets for Warfarin- INR or PT?
INR
50
half life of Warfarin (Coumadin)
Half life: 1.5-2 days
51
Teachings for Warfarin (Coumadin)
-Take same time every day -Balance Vit K foods -Watch s/s bleeding --->labs Soft toothbrush -No straight edge razor -Pain control drugs? Route?- best choice is tylenol! not aspirin/ibuprofen -Venipuncture/ procedures- hold pressure longer, stop coumadin 1 week prior to surgery -Medical Alert Bracelet -Garlic? Gingko? - increase risk of bleeding
52
stop Warfarin (Coumadin) __ ___ prior to surgery
1 week
53
Don't take the 2 supplements ___ or ____ with warfarin
garlic and gingko bilboa | --> increase risk of bleeding
54
Best choice for OTC pain control on Warfarin (Coumadin) is _____
tylenol! | -don't take ASA or Ibuprofen
55
Prototype for Direct Thrombin Inhibitors
Prototype: dabigatran (Pradaxa)
56
How does Prototype: dabigatran (Pradaxa) fxn? What locations of thrombin does it act on?
direct, REVERSIBLE inhibitor of thrombin that is free in blood and bound to clots
57
Route for dabigatran (Pradaxa)
Direct Thrombin Inhibitors | IV, SQ, oral
58
uses for dabigatran (Pradaxa)
Afib; hip/knee replacement (Canada)
59
side effects of dabigatran (Pradaxa)
bleeding, GI
60
Benefits of dabigatran (Pradaxa)
Direct Thrombin Inhibitors - no lab monitoring - lower risk of bleeding - few drug-drug/ drug-food interactions - rapid onset - Set dose
61
stop taking dabigatran (Pradaxa) before ______
surgery
62
antidote for dabigatran (Pradaxa) ?
idarucizumab (Praxbind)
63
prototype for Direct Factor Xa Inhibitors?
Rivaroxaban (Xarelto) | apixaban (Eliquis)
64
how do Rivaroxaban (Xarelto) and apixaban (Eliquis) fxn?
binds with factor Xa and inhibits thrombin
65
route for Rivaroxaban (Xarelto) and apixaban (Eliquis)
oral only! Direct Factor Xa Inhibitors
66
benefits of Rivaroxaban (Xarelto)and apixaban (Eliquis)
Direct Factor Xa Inhibitors - Does not require anticoagulant monitoring - Rapid onset - Fixed dose - Lower bleeding risk - Few drug interactions (CYP3A4)
67
drug interaction with Rivaroxaban (Xarelto) and apixaban (Eliquis)
(CYP3A4)
68
Uses for Rivaroxaban (Xarelto) and apixaban (Eliquis) ?
Post hip/knee replacement, Afib, tx of DVT/PE
69
Side effects of Rivaroxaban (Xarelto) and apixaban (Eliquis)
Bleeding; spinal/epidural hematoma
70
Rivaroxaban (Xarelto) and apixaban (Eliquis) contraindicated in
liver disease and pregnancy
71
antidote forr Rivaroxaban (Xarelto) and apixaban (Eliquis)
andexanet alfa (AndexXa)
72
If on IV heparin and then need to switch to oral agent Rivaroxaban or apixaban (Direct Factor Xa Inhibitors)
- Stop heparin and immediately start oral does. | - May see doubled up doses for a couple of days, then once a day dosing.
73
If on IV heparin and need to switch to oral agent Warfarin.....
- Typically, 2-3 days simultaneous administration - Takes a couple of days for warfarin to take effect - No effect on clotting factors already in circulation - Increased risk of bleeding - Monitor both PTT and PT/INR

Kol- Pharm 323 Spring (41 decks)

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