anticoagulants

Question 1

What is a thrombosis

Answer 1

a normal response to hemorrhage when a blood clot forms in the vascular system

Question 2

what can thrombosis lead to

Answer 2

PE, Stroke, MI

Question 3

signs of PE?

Answer 3

dyspnea, tachycardia, (massive = dyspnea, syncope, HOTN, cyanosis) (small = pleuritic pain, cough, hemoptysis)

Question 4

what is virchow’s triad?

Answer 4

hypercoagulability, stasis, endothelial injury

Question 5

what can help prevent DVT?

Answer 5

ambulation, compression stockings, anticoagulants

Question 6

risk factors for developing PE

Answer 6

CHD, stroke, paralysis

Question 7

name the indirect thombin inhibitors

Answer 7

heparin, Lovenox, Fondaparinux

Question 8

Where is most heparin derived from?

Answer 8

pigs

Question 9

MOA of indirect thrombin inhibitors?

Answer 9

conformational change binds antithrombin, inactivates factor Xa and thrombin (II)

Question 10

what factor is most closely related to bleeding risk?

Answer 10

focus on factor Xa

Question 11

what should the CrCl be above to use direct thrombin inhibitors?

Answer 11

30%

Question 12

What indirect thrombin inhibitor can be used in pregnancy?

Answer 12

Lovenox

Question 13

which indirect thrombin inhibitor does not require close monitoring

Answer 13

enoxaparin, fondaparinux

Question 14

half life of heparin?

Answer 14

1-5 hours

Question 15

half life of lovenox?

Answer 15

4-6 hours

Question 16

half life of fondaparinux?

Answer 16

17 hours

Question 17

how are indirect thrombin inhibitors monitored?

Answer 17

aPTT, anti-factor Xa levels

Question 18

reversal agent for heparin?

Answer 18

protamine sulfate

Question 19

what is HIT?

Answer 19

heparin induced thrombocytopenia, drop in platelets 5-10 days after exposure (150k-200k)

Question 20

What is HITT?

Answer 20

heparin induced thrombocytopenia with thrombosis - Ab against heparin/platelet factor 4 results in platelet activation

Question 21

Can patients with HITT use heparin again?

Answer 21

NO

Question 22

what labs should be ordered for baseline before starting heparin therapy?

Answer 22

platelets

Question 23

What are the oral factor Xa inhibitors

Answer 23

rivaroxaban, apixaban

Question 24

how are oral direct factor Xa inhibitors different from warfarin?

Answer 24

shorter half-lives

Question 25

Which direct factor Xa inhibitor can be used prophylactically with sx?

Answer 25

Rivaroxaban

Question 26

What oral direct factor Xa inhibitor can reduce stroke risk in nonvalvular Afib?

Answer 26

Apixaban

Question 27

how are direct factor Xa inhibitors excreted?

Answer 27

renally, dose adjust for renal impairment

Question 28

How are direct factor Xa inhibitors metabolized?

Answer 28

CYP3A4, p-glycoprotein

Question 29

ADR of direct factor Xa inhibitors

Answer 29

peripheral edema, dizziness, HA, diarrhea, bleeding

Question 30

what factor does rivaroxaban work on?

Answer 30

factor Va

Question 31

what factor do oral direct thrombin inhibitors work on?

Answer 31

factor Iia

Question 32

Name the oral direct thrombin inhibitor

Answer 32

Dabigatran (pradaxa)

Question 33

MOA of dabigatran

Answer 33

sits on exosite 1 of thrombin

Question 34

uses for dabigatran?

Answer 34

prevention of stroke and systemic embolism in pts with nonvalvular Afib

Question 35

Do bleeding rates differ between dabigatran and warfarin?

Answer 35

no

Question 36

when does dabigatran need to be dose adjusted?

Answer 36

renal impairment - 75mg

Question 37

ADR of dabigatran

Answer 37

bleeding, dyspepsia, gastritis-like sxs, GI hemorrhage

Question 38

what can be used as an anti-coagulant in HIT/HITT?

Answer 38

argatroban

Question 39

what lab is used to monitor direct/indirect thrombin inhibitors?

Answer 39

aPTT (should be 1.5-3x the normal)

Question 40

how do oral antiplatelets work?

Answer 40

bind to ADP and downregulate Iib/IIIa which decreases platelet sticking to each other

Question 41

name the oral antiplatelets

Answer 41

ticlid, plavix, effient, brillinta

Question 42

what metabolizes clopidogrel?

Answer 42

2C19 (2 step reaction)

Question 43

how is brillinta metabolised and dosed?

Answer 43

it is an active drug (faster onset) and needs to be taken twice a day

Question 44

what drug can decrease clopidogrel efficacy?

Answer 44

nexium, PPIs

Question 45

what causes clopidogrel resistance?

Answer 45

genetic basis that increases CYP2C19

Question 46

according to the CHARISMA study, do oral antiplatelets decrease risk of death?

Answer 46

nope

Question 47

ADR for antiplatelets

Answer 47

bleeding, rash, pruritis, GI hemorrhage, TTP

Question 48

how soon does clopidogrel begin to work?

Answer 48

10-11 days

Question 49

why is ticlid not used?

Answer 49

BID, life-threatening hematologic reactions

Question 50

Which oral antiplatelet is weight-based?

Answer 50

effient

Question 51

Who should not use effient?

Answer 51

\>75 y/o, \<60kg

Question 52

uses for oral antiplatelets

Answer 52

recent MI, stroke prevention

Question 53

what oral antiplatelet is used for prophylactic treatment with a stent for 1 year?

Answer 53

clopidogrel

Question 54

Name a vitamin K antagonist

Answer 54

warfarin

Question 55

what does warfarin have no effect on?

Answer 55

fully carboxylated molecules (anticoagulants)

Question 56

how long does it take for warfarin to work?

Answer 56

3-5 days

Question 57

What is the protein C phenomenon?

Answer 57

reduced levels with warfarin

Question 58

What does warfarin bind to?

Answer 58

albumin

Question 59

Target INR

Answer 59

2 through 3

Question 60

How many INRs need to be above 2 to be stabilized on warfarin?

Answer 60

2

Question 61

what drugs increase warfarin effect?

Answer 61

amiodarone, ginkgo, omeprazole

Question 62

what drugs decrease warfarin effect?

Answer 62

estrogens, protease inhibitors, st john's wart

Question 63

reversal agent for warfarin

Answer 63

phytonadione (vitamin K)