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IPCS 3 > Anticoagulant Drugs > Flashcards

Anticoagulant Drugs Flashcards

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1
Q

Heparin MOA

A
  1. binds to antithrombin and inactivates factor IIa and Xa
  2. prevents fibrinogen–> fibrin
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2
Q

Unfractioned Heparin prophylaxis

A

SQ: 5000U q8 or q12

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3
Q

Unfractioned heparin VTE Tx

A

IV: 80u/kg IV bolus then 18u/kg/hr infusion

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4
Q

unfractioned heparin ACS/STEMI Tx

A

IV: 60u/kg bolus then 12u/kg/hr infusion

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5
Q

SE UFH

A

HIT, Hyperkalemia, osteoporosis

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6
Q

UFH antidote

A

protamine-completely reverses

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7
Q

UFH monitoring

A

caution with pork allergy
aPTT (goal 1.5-2x control) or heparin assay (goal 0.3-0.7) q6h til therapeutic then q24h
half life=1-2hr

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8
Q

low molecular weight heparin examples

A

Enoxaparin (Lovenox), Dalteparin (Fragmin)

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9
Q

lovenox prophylaxis

A

30mg SQ q12 or 40mg SQ qd
CrCl <30: 30mg qd

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10
Q

lovenox treatment

A

1mg/kg q12 (to nearest 10mg)
CrCl<30: 1mg/kg q24

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11
Q

LMWH SE

A

anemia, elevated LFTs, HIT, hyperkalemia, thrombocytopenia, osteoporosis, injection site bruising

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12
Q

LMWH antidote

A

protamine- incompletely reverses

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13
Q

preferred pregnancy agents

A

UFH and LMWH

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14
Q

LMWH monitoring

A

Anti-Xa level-obesity, pregnancy, renal failure

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15
Q

Warfarin (Coumadin, Jantoven) class

A

Vit K antagonist

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16
Q

Warfarin MOA

A

decreases Factors II, IV, IX, X and Protein C and S through competitive inhibition of subunit 1 of VKOR complex

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17
Q

Warfarin initial dosing

A

10mg qd x2d then 5mg qd
may start <5mg qd if old, malnourished, hepatic impairment, CHF, high risk of bleeding

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18
Q

Warfarin dose adjustments

A

based on INR
target INR 2-3 except mechanic heart valve (2.5-3.5)

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19
Q

Warfarin SE

A

purple-toe syndrome, skin necrosis
many drug interactions (CYP3A4), NTI

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20
Q

warfarin in pregnancy

A

AVOID

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21
Q

Warfarin antidote

A

Vitamin K +/- Kcentra or FFP

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22
Q

Factor Xa inhibitors

A

Rivaroxaban (Xarelto), Apixaban (Eliquis), Edoxaban (Savaysa), Fondaparinux (Arixtra)

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23
Q

FXa inhibitor MOA

A
  1. Xarelto and Eliquis directly inhibit factor Xa
  2. Fondaparinux indirectly inhibits factor Xa
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24
Q

Xarelto non-valvular AFib dosing

A

20mg qd

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25
Xarelto DVT prophylaxis dosing
10mg qd if hip/knee replacement, duration for 35 days for hip and 12 days for knee
26
Xarelto DVT/PE Tx
15mg BID for 21d then 20mg qd
27
Xarelto BBW
premature discontinuation increases risk of thrombotic events TAKE WITH FOOD
28
Xarelto SE
anemia, more bleeding than warfarin
29
FXa inhibitor conversion
d/c warfarin and start: Xarelto when INR <3 Edoxaban when INR <2.5 Apixaban when INR <2
30
Eliquis, Xarelto, off-use Edoxaban antidote
Andexxa
31
FXa inhibitor warnings
no use in pregnancy avoid interacting agents (P-gp inhibitors/inducers for all DOACs and CYP3A4 inhib/inducers for apixiban/rivaroxaban) Eliquis/Xarelto increase INR concern w/ all DOACs in patients <50kg or >120kg
32
Arixtra route
SQ
33
Arixtra SE
anemia, thrombocytopenia, hypokalemia CrCl <30: AVOID USE
34
Direct Thrombin Inhbitors (DTIs)
Argatroban (IV), Dabigatran (Pradaxa) oral
35
DTI MOA
1. directly inhibit thrombin (Factor IIa) 2. binds to and inhibits the active site of free and fibrin bound thrombin
36
Argatroban HIT dosing
2mcg/kg/min Max: 10mcg/kg/min
37
HIT
heparin-induced thrombocytopenia
38
Argatroban PCI dosing
350mg/kg (bolus) then 25mcg/kg/min
39
PCI
percutaneous coronary intervention
40
Argatroban SE
anemia, chest pain, GI hemorrhage
41
Argatroban monitoring
aPTT raises INR
42
Pradaxa non-valvular AFib dosing
150mg bid
43
Pradaxa DVT/PE Px and Tx dosing
150mg bid
44
Pradaxa DVT Px knee/hip replacement dosing
110mg on day of surgery and 220mg qd for min of 10-14 days up to 35 days
45
Pradaxa BBW
thrombotic events
46
Pradaxa SE
dyspepsia, gastritis-like symptoms, bleeding, hemorrhage
47
Pradaxa antidote
Idarucizumab (Praxbind)
48
Pradaxa inititation
requires at least 5 days parenteral anticoag before initiation in Tx of DVT/PE do not open/chew caps and keep in original container D/C Warfarin and start Pradaxa when INR<2 use w/ EXTREME caution in patients >75yo
49
Protamine reverses
completely: UFH incompletely: LMWH, lovenox, fragmin
50
Protamine MOA
Protamine (alkaline protein molecule, large + charge) and Heparin (acidic, - charge) when combined form a stable salt diminishing the anticoag activity
51
Protamine considerations
IV only rapidly reverses UFH BBW: hypersensitivity (fish)
52
Praxbind (Idarucizumab) reverses
Pradaxa (Dabigatran)
53
Praxbind MOA
humanized MAb fragment that has an affinity for dabigatran that is ~350 times greater than that of thrombin
54
Praxbind considerations
neutralized anticoag effect w/in minutes lasts 24hrs, if pradaxa not cleared after 24hr, give another dose of Praxbind (ex. renal failure) most common SE: headache Monitor: re-elevation of coag parameters
55
KCentra reverses
VitK Antag: Warfarin off label: FXa drugs
56
Kcentra MOA
Prothrombin Complex Concentrate (PCC): (II, VII, IX, X and Protein C and S)
57
Kcentra considerations
BBW: arterial and venous thromboembolic complications advantages to FFP (fresh frozen plasma): lower infusion volume, lower infection rate, less complications, rapid reversal
58
NovoSeven reverses
warfarin-related intracerebral hemorrhage
59
NovoSeven MOA
Factor VIIA (recombinant) VKA-dependent glycoprotein that promotes hemostasis by activating the extrinsic pathway of the coag cascasde
60
NovoSeven considerations
BBW: thrombosis high cost
61
Fresh frozen plasma reverses
Warfarin
62
FFP considerations
high volumes of FFP may be problematic in all pts esp those sensitive to rapid fluid shifts (HF)
63
Vitamin K reverses
Warfarin
64
Vitamin K MOA
promotes liver synthesis of clotting factors II, IV, IX, X
65
Vitamin K considerations
Formulations: oral: 2.5-5mg when INR>10 (no bleeding) or minor bleeding w/ any INR IV: 5-10mg infused slowly due to anaphylaxis indicated in emergency situations or major bleeding (in addition to PCC)
66
Hemodialysis reverses
removes 57-68% of Pradaxa w/in 4hrs removes 20% of Edoxaban
67
Andexxa reverses
Eliquis and Xarelto
68
Andexxa MOA
inactive recombinant modified Human Factor Xa Protein
69
Andexxa considerations
BBW: thrombosis, ischemic events, cardiac arrest, sudden death off-label reversal of Edoxaban
70
Bleeding symptoms
tachycardia, SOB, blood-loss, blood in stool, urine, blowing nose, brushing teeth
71
Bleeding signs
increased RR, increased HR, decreased BP

IPCS 3 (5 decks)

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