anticoagulant drugs

Question 1

what is the MOA of unfractionated heparin ?

Answer 1

unfraxtionated heparin binds to anti thrombin 3 , which makes it more active and in turn inactivates factor 2a and factor 10

Question 2

what are two clinical forms of heparin ?

Answer 2

unfractionated
low molecular weight

Question 3

how is unfractionated heparin administered ?

Answer 3

IV

Question 4

how do we monitor the effect of unfractionated heparin ?

Answer 4

PTT

Question 5

what is the reversal agent used for unfractionated heparin ?

Answer 5

protamine , used for heparin overdose

Question 6

what are the uses for heparin ?

Answer 6

bridging agent for warfarin use
used for acute management of DVT and PE
used for prophylaxis

Question 7

what are the side effects associated with UFH ?

Answer 7

bleeding and thrombocytopenia
osteoprosis
elevated AST/ALT

Question 8

what type of reaction is HIT ?

Answer 8

type 2 hypersensitivity reaction

Question 9

what is the life threatening part of HIT ?

Answer 9

arterial and vein thrombosis

Question 10

how do we make a definitive diagnosis of HIT ?

Answer 10

HIT antibody test

Question 11

what is the name of LMWH ?

Answer 11

enoxaparin

Question 12

what is the MOA of enoxaparin ?

Answer 12

only inhibits factor 10 a

Question 13

what is the advantage of giving LMWh over UFH ?

Answer 13

dose based on weight
given subcut not IV
lower incidence of HIT

Question 14

what is the level of thrombin time in LMWH vs UFH ?

Answer 14

in LMWH the thrombin time is not affected like UFH

Question 15

how can we monitor the levels of LMWH ?

Answer 15

by checking the levels of anti factor 10 a

Question 16

when do we need to monitor the 10 a levels when using LMWH ?

Answer 16

in patients who have renal failure and obese patients

Question 17

who are the direct inhibitors of Xa ?

Answer 17

apixaban

Question 18

what is dabigatran used for ?

Answer 18

HIT

Question 19

what are the uses of factor Xa inhibitors ?

Answer 19

apixaban can be used for atrial fibrillation instead of warfarin

Question 20

what is the mechanism of action of dabigatran ?

Answer 20

direct thrombin inhibitor

Question 21

what are the two drugs men kolo that increase thrombin time ?

Answer 21

unfractionated heparin
Direct thrombin inhibitor

Question 22

what are the uses of direct thrombin inhibitors ?

Answer 22

patients with HIT
atrial fibrillation
acute coronary syndrome

Question 23

what are the vitamin K dependant factors ?

Answer 23

1972
10 , 9 , 7 and 2
protein c and protein S

Question 24

what is the MOA of warfarin ?

Answer 24

vitamin k epooxidase reductase inhibitors which prevents the activation iof clotting factors gene associated is VKORC1

Question 25

what is the association between warfarin and protein c deficiency ?

Answer 25

causes skin necrosis in protein C deficiency

Question 26

how can we monitor heparin vs warfarin ?

Answer 26

heparin - PTT warfarin - PT

Question 27

what is the usual target for INR for patients on warfarin therapy ?

Answer 27

2-3

Question 28

what is the association between long term antibiotic use and vitamin K ?

Answer 28

long term antibiotic use is associated with decreased GI flora , eventually increasing the INR

Question 29

what drugs are associated with increasing the level of warfarin in the blood ?

Answer 29

P450 drugs

Question 30

which of the factors have the shortest half life ?

Answer 30

factor 7 , it is the first factor to fall after warfarin administration hence the monitoring with PT

Question 31

what is the one exception where you dont need heparin to bridge for warfarin ?

Answer 31

atrial fibrillation

Question 32

what are the side effects of warfarin ?

Answer 32

teratogenic bleeeding skin necrosis in preotein c defeciency

Question 33

what is the reversal drug for warfarin ?

Answer 33

vitamin K but its slow or fresh frozen plasma

Question 34

what is the reversal drug for dabigatran ?

Answer 34

idarcuzimab

Question 35

what is the reversal drug for direct factor 10a inhibitors ?

Answer 35

andexanet alfa

Question 36

what are the thrombolytics ?

Answer 36

break down thrombin by the conversion of plasmin into plasminogen ateplase

Question 37

when are thombolytics contraindicated ?

Answer 37

when there is history of active bleeding