Anticoagulants, Thrombolytics, Antiplatelet Therapies Flashcards Preview

Pharmacology II > Anticoagulants, Thrombolytics, Antiplatelet Therapies > Flashcards

Flashcards in Anticoagulants, Thrombolytics, Antiplatelet Therapies Deck (39):
1

What are the 3 phases of coagulation

1. Initiation
2. Amplification
3. Propagation

2

Anticoagulants

-Heparin
-Direct thrombin inhibitors
-Direct factor Xa inhibitors
-Warfarin
-DOAC

3

Antiplatelet

-Aspirin
-ADP inhibitors (Clopidogrel)
-Glycoprotein IIb/IIIa inhibitors

4

Which factors does Warfarin affect?

"1972"
2, 7, 9, 10

5

Which components does heparin affect?

2, 10

6

When should you put someone with a DVT or PE on aspirin?

-if they've had a DVT/PE
-No contraindication

7

In a patient who has had their first DVT episode, how long should they be anticoagulated for?

3 months

(Heparin or Warfarin or LMWH)

8

Parenteral anticoagulation is given....

BEFORE: dabigatran, edoxaban

NOT GIVEN: rivaroxaban, apixaban

OVERLAP: Warfarin

9

How is heparin dose calculated?

actual body weight

10

How is heparin monitored?

activated partial thromboplastin time (aPTT)

11

How is heparin reversed?

protamine sulfate IV

12

Thrombocytopenia

<100,000/uL platelet count

-more common with unfractionated heparin than LMWH

13

What is the principle difference in pharmacologic activity between LMWH and UFH?

relative inhibition of factor Xa and thrombin

14

LMWH: advantages over UFH

-more predictable dose response
-clearance doesn't depend on dose
-less chance of thrombocytopenia
-less need for monitoring
-->SAFER for extended administration

15

How is LMWH (Enoxaparin) dose determined?

weight based

16

If patient has pork allergy they can't take heparin or LMWH. What should you put them on?

Fondaparinux

17

Monitoring: LMWH versus Warfarin

LMWH: aPTT

Warfarin: Prothrombin time (INR)

18

What is important to remember about starting Warfarin treatment?

when first initiated there is thrombosis due to protein C deficiency

19

Which Factor is affected first with Warfarin initiation?

Factor 7

order: 7, 9, 10, 2

20

Do DOACs have a reversal agent?

no

21

Which DOAC is a prodrug, targets thrombin, and needs to be adjusted if the patient has renal impairment?

Dabigatran

22

Which DOAC is most bioavailable ?

Rivaroxaban (xarelto)

23

Which DOACs work on factor Xa

Rivaroxaban
Apixaban
Edoxaban

24

Which DOAC is taken QD and must be taken with food?

Rivaroxaban (Xarelto)

25

Which DOAC has to be taken twice a day, but can be taken with or without food?

Apixaban (Eliquis)

26

How long is anticoag therapy recommended after DVT or PE?

at least 3 months

27

How long must heparin and warfarin be overlapped?

7 days

28

Does Rivaroxaban need to be used with heparin?

no

29

What is the goal INR for a mechanical heart valve?

2.5-3.5

30

What is the starting dose for Warfarin in a patient that can have daily INRs drawn?

5mg

31

How many times is the INR checked in the first 5 days of warfarin therapy?

5x

32

When should you get to INR goal for warfarin?

2-3 is only the goal on day 5. Before this you want it lower

33

What are dose adjustments based on for Warfarin?

total weekly dose

34

At what INR should you consider oral Vitamin K?

INR above 10

35

When can LMWH be discontinued?

After 5 days and 24 hours of INR in correct range

36

When should Warfarin be discontinued before a surgery?

4-5 days prior to surgery

37

Which two DOACs can you start at INR <2 when switching from Warfarin?

Dabigatran
Apixaban

38

Thrombolytics: MOA

convert plasminogen to plasmin

39

Direct thrombin inhibitors

Ex. Bivalirudin**, Desirudin, Argatroban

MOA: binds to thrombin and inhibits its enzymatic action

indication: anticoagulation in patient with heparin-induced thrombocytopenia (HIT)**