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SPR2015_Week3 > Anticoagulant Agents Table > Flashcards

Anticoagulant Agents Table Flashcards

(72 cards)

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1
Q

Heparin (Unfractionated [UFH])

Mechanism of Action?

A

Binds ATIII –> inactivates IIa and Xa

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2
Q

Heparin (Unfractionated [UFH])

Onset of action?

A

Rapid (minutes if IV w/ LD)

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3
Q

Heparin (Unfractionated [UFH])

Administration route?

A

Parenteral (IV / SC)

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4
Q

Heparin (Unfractionated [UFH])

Elimination?

A

Dose-dependent t1/2 – cleared by reticuloendothelial system

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5
Q

Heparin (Unfractionated [UFH])

Monitoring lab test

A

aPTT

can use anti-factor Xa prn

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6
Q

Heparin (Unfractionated [UFH])
Adverse Effects?
narrow therapeutic index

A

Bleeding / thrombocytopenia

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7
Q

Heparin (Unfractionated [UFH])

Safety in pregnancy?

A

Safe

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8
Q

Heparin (Unfractionated [UFH])
DDIs
NSAIds Incr bleeding risk with all anticoagulants?

A

Antiplatelet agents

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9
Q

Heparin (Unfractionated [UFH])

Overdose Treatment?

A

Protamine

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10
Q

Heparin (Unfractionated [UFH])

Uses

A

ACS / VTE

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11
Q

Low-Molecular Weight Heparin [LMWH],
(Enoxaparin - Dalteparin)
Mechanism of Action?

A

Binds ATIII –> inactivates Xa

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12
Q

Low-Molecular Weight Heparin [LMWH],
(Enoxaparin - Dalteparin)
Onset of action

A

3-5 hours SC

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13
Q

Low-Molecular Weight Heparin [LMWH],
(Enoxaparin - Dalteparin)
Administration route

A

Parenteral (IV / SC)

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14
Q

Low-Molecular Weight Heparin [LMWH],
(Enoxaparin - Dalteparin)
Elimination

A

Renal clearance (decr dose in renal failure)

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15
Q

Low-Molecular Weight Heparin [LMWH],
(Enoxaparin - Dalteparin)
Monitoring lab test

A

Not needed, action predictable
Dosed on mg/kg basis
(can use anti-factor Xa prn)

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16
Q

Low-Molecular Weight Heparin [LMWH],
(Enoxaparin - Dalteparin)
Adverse Effects?
narrow therapeutic index

A

Bleeding / thrombocytopenia

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17
Q

Low-Molecular Weight Heparin [LMWH],
(Enoxaparin - Dalteparin)
Safety in pregnancy

A

Safe

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18
Q

Low-Molecular Weight Heparin [LMWH],
(Enoxaparin - Dalteparin)
DDIs
NSAIds Incr bleeding risk with all anticoagulants?

A

Antiplatelet agents

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19
Q

Low-Molecular Weight Heparin [LMWH],
(Enoxaparin - Dalteparin)
Overdose Treatment Protamine

A

Protamine

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20
Q

Low-Molecular Weight Heparin [LMWH],
(Enoxaparin - Dalteparin)
Uses

A

ACS / VTE

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21
Q

Warfarin

Mechanism of Action

A 
Inhibits liver synthesis of Vit K-
dep factors (II, VII, IX, and X)
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22
Q

Warfarin

Onset of action

A

Delayed (hours to days)

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23
Q

Warfarin

Administration route

A

Oral

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24
Q

Warfarin

Elimination

A

Hepatic metabolism – CYP2C9

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25
Warfarin | Monitoring lab test
INR (from PT)
26
Warfarin Adverse Effects? *narrow therapeutic index*
Bleeding, skin necrosis
27
Warfarin | Safety in pregnancy
NOT safe --> Category X
28
Warfarin DDIs NSAIds Incr bleeding risk with all anticoagulants?
incr effect: CYP450-inhibitors, abx, | decr effect: CYP450 inducers, dietary Vit K
29
Warfarin | Overdose Treatment Protamine
Phytonadione (Vit K1) – FFP
30
Warfarin | Uses
A Fib / VTE prophylaxis
31
Dabigatran [D] Rivaroxaban [R] – Apixaban [A] Mechanism of Action
[D] Direct thrombin (IIa) inhibitor | [R]-[A] Direct factor Xa inhibitor
32
Dabigatran [D] Rivaroxaban [R] – Apixaban [A] Onset of action
[D]: peak 1-2 h, 2-3 d to steady state | [R]-[A]: peak action 2.5-4h
33
Dabigatran [D] Rivaroxaban [R] – Apixaban [A] Administration route
[D] Oral – administered as prodrug [R]-[A] Oral
34
Dabigatran [D] Rivaroxaban [R] – Apixaban [A] Elimination
[D] Primarily renal (decr dose if renal impairment) - BID | [R]-[A] hepatic CYP3A, [A] BID
35
Dabigatran [D] Rivaroxaban [R] – Apixaban [A] Monitoring lab test
[D]-[R] not routinely monitored | for [D] can use ECT-precise or aPTT qualitative if needed
36
Dabigatran [D] Rivaroxaban [R] – Apixaban [A] Adverse Effects
[D] Bleeding, gastritis symptoms | [R] Bleeding
37
Dabigatran [D] Rivaroxaban [R] – Apixaban [A] Safety in pregnancy
[D]-[R]-[A] Category C– not studied
38
Dabigatran [D] Rivaroxaban [R] – Apixaban [A] DDIs NSAIds Incr bleeding risk with all anticoagulants?
decr effect: [D]-[R]-[A] P-glycoprotein inducers (rifampin, dronedarone) incr effect: [D]-[R]-[A] P-glycoprotein inhibitors; [R] CYP3A4 inhibitors
39
Dabigatran [D] Rivaroxaban [R] – Apixaban [A] Overdose Treatment
[D]-[R]-[A] no specific antidote | hemostatic measures: FFP, RBCs
40
Dabigatran [D] Rivaroxaban [R] – Apixaban [A] Uses
``` [D] A Fib (FDA approved), VTE (non-FDA approved) [R] A Fib, DVT-PE prevention after total hip or knee replacement [A] A Fib ```
41
Aspirin | Mechanism of Action
Low dose (81 mg) “selective” inhibition of platelet COX-1 (irreversible)
42
Aspirin | Onset of action
Can be rapid
43
Aspirin | Administration route
Oral-once daily
44
Aspirin | Elimination
Hepatic
45
Aspirin | Adverse Effects
Gastric upset, bleeding
46
Aspirin | Safety in pregnancy
Pregnancy category C/D (3rd)
47
Aspirin | DDIs
incr bleeding risk w/anticoagulants
48
Aspirin | Uses
Acute MI-Unstable angina (ACS) | PCI / 2° prevention MI-stroke
49
Ticagrelor [T] Clopidogrel [C]-Prasugrel [P] Mechanism of Action
Inhibition of platelet ADP (P2Y12) receptor [C]-[P] irreversible [T] reversible Efficacy ([P]-[T] > [C])
50
Ticagrelor [T] Clopidogrel [C]-Prasugrel [P] Onset of action
Onset-2 hrs; peak 2-5 hrs if loading | dose used, otherwise 3-7 days
51
Ticagrelor [T] Clopidogrel [C]-Prasugrel [P] Administration route
[C]-[P] Oral prodrug-once daily | [T] Oral – twice daily
52
Ticagrelor [T] Clopidogrel [C]-Prasugrel [P] Elimination
[C]: activated by CYP2C19, then renal and fecal excretion [P]: activated by CYP3A4/2B6 [T]: CYP3A4 metabolism to active metabolite
53
Ticagrelor [T] Clopidogrel [C]-Prasugrel [P] Adverse Effects
Bleeding ([P]-[T] > [[C]) [C]: Dyspepsia, gastritis, HA [T]: Dyspnea, bradyarrhythmias
54
Ticagrelor [T] Clopidogrel [C]-Prasugrel [P] Safety in pregnancy
[C] Pregnancy category B | [P]-[T] Pregnancy category C
55
Ticagrelor [T] Clopidogrel [C]-Prasugrel [P] DDIs
[C]: PPIs may block activation of prodrug by CYP2C19 NO DDI with [P] + PPIs
56
Ticagrelor [T] Clopidogrel [C]-Prasugrel [P] Uses
Acute MI-Unstable angina, | PCI
57
Dipyridamole | Mechanism of Action
Inhibits phosphodiesterase in platelets --> incr cAMP --> incr PGI2 anti-aggregation effect
58
Dipyridamole | Onset of action
dfdf
59
Dipyridamole | Administration route
Oral
60
Dipyridamole | Elimination
Hepatic: phase II conjugation
61
Dipyridamole | Adverse Effects
Dizziness, HA, nausea, GI upset
62
Dipyridamole | Safety in pregnancy
Pregnancy category B
63
Dipyridamole | DDIs
dfdf
64
Dipyridamole | Uses?
2° prevention MI-stroke
65
Abciximab [A]–Eptifibatide [E] Tirofiban [T] Mechanism of Action
``` Blocks platelet GIIb/IIIa receptor preventing fibrinogen binding and platelet aggregation [A]: monoclonal antibody [E]: cyclic peptide [T]: non-peptide ```
66
Abciximab [A]–Eptifibatide [E] Tirofiban [T] Onset of action
Rapid onset
67
Abciximab [A]–Eptifibatide [E] Tirofiban [T] Administration route
Parenteral infusion
68
Abciximab [A]–Eptifibatide [E] Tirofiban [T] Elimination
[A]: renal, t1/2 ∼ 30 min [E]: renal, t1/2 ∼ 2.5 hrs [T]: renal, t1/2 ∼ 2 hrs
69
Abciximab [A]–Eptifibatide [E] Tirofiban [T] Adverse Effects
Bleeding
70
Abciximab [A]–Eptifibatide [E] Tirofiban [T] Safety in pregnancy
[A]: Pregnancy category C [E]: Pregnancy category B [T]: Pregnancy category B
71
Abciximab [A]–Eptifibatide [E] Tirofiban [T] DDIs
kjk
72
Abciximab [A]–Eptifibatide [E] Tirofiban [T] Uses
PCI

SPR2015_Week3 (13 decks)

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