Anticoagulants

Question 1

binds with antithrombin 3 and forms a complex irreversible inactivates thrombin and factor Xa

Answer 1

unfractioned heparin

Question 2

monitored by aPTT (measures function of intrinsic pathway of coagulation cascade

Answer 2

unfractioned heparin

Question 3

not a clot buster, it will prevent the fibrin clots from forming

Answer 3

heparin

Question 4

treats

1) DVT prophylaxis
2) acute DVT
3) prophylaxis and acute pulmonary embolism
4) acute MI to prevent extension and formation

Answer 4

Heparin

Question 5

1) bleeding
2) induced thrombocytopenia (swell foot) - occurs when Ab armada against heparin complex to platelet factor 4
3) hyperaldosteronism
4) hypoaldosteronism causes hyperkalemia
5) osteoporosis

Answer 5

heparin ADR

Question 6

results in paradoxical thrombosis in the setting of thrombocytopenia

Answer 6

HIT

Question 7

reverses the anticoagulant effect of unfractioned heparin

Answer 7

protamine sulfate

Question 8

binds to antithrombin 3: forms complex inhibits factor Xa with less of an effect on thrombin

Answer 8

LMWH

Question 9

does not require PTT monitoring
has prolonged half life
protamine sulfate less effective
eliminated renally and can stay in system if there is renal insufficiency

Answer 9

LMWH

Question 10

safe in pregnancy

Answer 10

heparin

Question 11

lowest risk of HIT

Answer 11

fondaparinux

Question 12

binds to antithrombin 3 with higher specificity; inhibits factor Xa with less effect on thrombin

Answer 12

fondaparinux

Question 13

blocks vitamin k epoxide reductase; preventing factors 2 7 9 10 form being produced and also proteins C and S

Answer 13

warfarin

Question 14

promotes gamma carboxylation

Answer 14

vit K

Question 15

occurs at glutamic acid residue on factors 2 7 9 10

Answer 15

gamma carboxylation

Question 16

1st clotting factor to be reduced when starting warfarin

Answer 16

factor 8

Question 17

onset 8-12 hrs
full clinical effect takes 3 days
oral admin
long half life

Answer 17

warfarin

Question 18

monitor using PT and INR

Answer 18

warfarin

Question 19

goal INR is _____ for prevention and treatment of thrombosis

Answer 19

2-3

Question 20

treats

1) long term anticoagulation in a fib
2) dvt prophylaxis

Answer 20

warfarin

Question 21

crosses placental barrier and can cause a hemorrhagic disorder or prevent carboxylation reactions in bone

Answer 21

ADR warfarin

Question 22

anticoagulation protein C is reduced early in warfarin therapy - hypercoagulable state initially

Answer 22

ADR warfarin

Question 23

induces skin necrosis due to hypercoagulable state

Answer 23

warfarin

Question 24

coadmic of heparin when starting warfarin prevents the early hypercoagulable state

Answer 24

heparin bridge

Question 25

warfarin anticoagulation can be reversed with

Answer 25

Vit K

Question 26

immediate reversal treatment of warfarin anticoagulation

Answer 26

fresh frozen plasma

Question 27

increase rifampin, phenobarbital, phenytoin

Answer 27

decrease effects of warfarin

Question 28

decrease antibiotics, antifungals, SSRIs

Answer 28

increase effects of warfarin

Question 29

direct thrombin inhibitors

Answer 29

argatroban dabigatran bivalirudin

Question 30

directly bind to and irreversibly inhibit thrombin do not require antithrombin 3 monitor by aPTT

Answer 30

direct thrombin inhibitors

Question 31

100% metabolized in liver half life 40-50 min used in HIT and renal failure

Answer 31

argatroban

Question 32

``` renal elimination oral med does not require monitoring used in A fib rapidly reversed by idarucizumab (monoclonal Ab) ```

Answer 32

dabigatran

Question 33

can replace heparin treats HIT 20% renal elimination(rest metabolic)

Answer 33

bivalirudin

Question 34

specific irreversible thrombin (2a) inhibitor from leech saliva

Answer 34

hirudin

Question 35

IV renal elimination use to treat HIT

Answer 35

lepirudin

Question 36

direct factor Xa inhibitors

Answer 36

rivaroxaban and other xabans

Question 37

does not require monitoring half life - ~10 hrs no antidote given in fixed doses

Answer 37

rivaroxaban and other xabans

Question 38

used to prevent DVTs | prevention of stroke and systemic embolism in non valvular atrial fib

Answer 38

rivaroxaban and other xabans

Question 39

dont use in kidney or liver dysfunction 25-50% renal metabolism use P450 and P glycoprotein for metabolism and excretion

Answer 39

rivaroxaban and other xabans

Question 40

lyse thrombi by catalyzing the formation of the endogenous fibrinolytic plasmin from plasminogen

Answer 40

fibrinolytics

Question 41

not clot specific helps activate plasminogen to plasmin antigenic (derived by streptococci)

Answer 41

streptokinase

Question 42

clot specific acting mainly on fibrin bound plasminogen natural activator

Answer 42

alteplase (tPA)

Question 43

antidotes in excessive bleeding

Answer 43

antifibrinolysins (aminocaproic and tranexamic acids)

Question 44

decreases TXA2 irreversibly inhibits COX 1 in platelets - decreases activation low doses prevent MI and recurrence; prophylaxis in Atrial arryh and TIAs

Answer 44

aspirin

Question 45

stop before surgery and pregnancy | increases GI bleeding 2x over placebo

Answer 45

aspirin

Question 46

block ADP receptors on platelets - decrease activation (irreversibly)

Answer 46

clopidogrel prasugrel ticagrelor

Question 47

alternatives to ASA in TIAs, post MI, and unstable angina

Answer 47

clopidogrel prasugrel ticagrelor

Question 48

ADR 1) hemorrhage 2) leukopenia 3) thrombocytopenia purpura

Answer 48

clopidogrel prasugrel ticagrelor

Question 49

most effective anti platelet and a monoclonal Ab

Answer 49

Abciximab

Question 50

antagonists that bind to glycoprotein 2b/3a receptors - decrease aggregation by preventing the cross linking reaction inhibit final common pathway

Answer 50

Abciximab eptifibatide tirofiban

Question 51

used mainly in acute coronary syndrome and postangioplasty

Answer 51

Abciximab eptifibatide tirofiban

Question 52

mimic Glanzmanns thrombasthenia and bernard soulier syndrome

Answer 52

Bp 2b/3a receptor blockers

Question 53

inhibit adenosine uptake to RBC = increase adenosine in blood

Answer 53

dipyridamole

Question 54

inhibits cGMP phosphodiesterase activity , increasing cGMP - vasodilation

Answer 54

dipyridamole

Question 55

combine with aspirin to treat TIA; no effect alone

Answer 55

dipyridamole

Question 56

cAMP phosphodiesterase 3 inhibit - increase cAMP - platelet aggregation inhibit and vasodilation

Answer 56

cilostazol

Question 57

treats intermittent claudication (leriche syndrome)

Answer 57

cilostazol