Anticoagulants

Question 1

Heparin

Answer 1

MOA: inhibits clot formation
SQ or IV
Must closely monitor platelets & PTT/aPTT (goal PTT 1.5-2.5x normal // 33-88secs)
Low Dose Indications: DVT prophylaxis/prevention of dialysis catheter clotting
High Dose Indications: DVT, PE or clotting disorder
A/E: HIT, hemorrhage
Antidote: Protamine Sulfate

Question 2

Enoxaparin (Lovenox)

Answer 2

MOA: inhibits clot formation
Low Molecular Weight Heparin (LMWH)
Lab monitoring NOT necessary
Longer half-life than heparin 
pts often sent home with self-injections
A/E: anemia, hemorrhage, bruising, hematoma at injection site, fever, peripheral edema, increased LFTs

Question 3

Protamine Sulfate

Answer 3

Heparin Antidote
MOA: weak anticoag, heparin antagonist
A/E: bradycardia, flushing, hpn, n/v, dyspnea
Used to counteract heparin or enoxaparin toxicity

Question 4

Argatroban

Answer 4

MOA: direct thrombin inhibitor, inhibits formation of some coagulation factors and platelet aggregation
For pts that are allergic to Heparin
PTT must be monitored
IV only
A/E: chest pain, hpn, hemorrhage, h/a, nausea, vomiting, diarrhea, rash, dyspnea, cough, fever

Question 5

Warfarin (Coumadin)

Answer 5

oral
MOA: interferes w production of vit K dependent clotting factors
1/2 life of 42 hrs
MUST monitor INR often- NARROW therapeutic index
Don’t drastically change vit K in intake
CATEGORY X
ANTIDOTE: Vit K, FFP
A/E: hemorrhage, hemoptysis, black tarry stools, alopecia, itching, rash, chills, nausea, vomiting, diarrhea, bloating, flatulence
Therapeutic: INR= 2-3

Question 6

Rivaroxaban (Xarelto)

Answer 6

inhibits thrombin
freq lab monitoring not necessary,
not recc for pts w artificial heart valves
unknown antidote

Question 7

Dabigatran (Pradaxa)

Answer 7

factor X inhibitor
freq lab monitoring not necessary,
not recc for pts w artificial heart valves
unknown antidote

Question 8

Apixaban (Eliquis)

Answer 8

inhibits factor Xa
freq lab monitoring not necessary,
not recc for pts w artificial heart valves
unknown antidote