Flashcards in Anticoagulants: vit K antagonists Deck (45):
What is the first MOA of warfarin
Inhibits post-translational carboxylation of coag factors II (protrombin), VII, IX, and X
What is the 2nd MOA of warfarin
Inhibits 2 vit-k sensitive synthetic enzymes
How is warfarin reversed?
Pharmacological doses of Vit K
What is the Vit K agent used to reverse warfarin?
What is the risk with IV phyotonadion?
Rare risk of anaphylaxis with rapid infusion
How do you start warfarin?
With heparin in cases of A-fib, DVT, PE
How long does it take warfarin to provide full anticoagulation?
How do you measure warfarin effects?
With prothrombin time (PT) and international normalized ration (INR)
What is the therapeutic INR range for AFib, DVT, PE?
What is the therapeutic INR range for mechanical heart valves?
How long does it take a dose of warfarin to become effective?
What is a complication of starting 10 mg of warfarin daily?
Warfarin induced skin necrosis
What drug interaction can cause increased risk of bleeding with warfarin and what do they do to the INR?
Drugs that inhibit CYP2C9
What drugs inhibit CYP2C9 and negatively interact with warfarin?
What drug interaction can cause increase risk of thrombosis with warfarin and what do they do to the INR?
Drugs that induce CYP2C9
Decrease the INR
What drugs induce CYP2C9 and negatively interact with warfarin?
What are some sources of high dietary folate
Leafy green vegetables
Supratherapeutic INR treatments
See slide 47
What is an example of an anti-factor XA inhibitor and how does it come?
What is fondaparinux?
How is fondaparinux eliminated?
When is fondaparinux contraindicated?
What is an unlabled use of fondaparinux?
DVT prophylaxis in pts w/ a h/o HIT
What is Rivaroxaban (Xarelto)?
An oral direct Xa inhibitor
What is a benefit of Rivaroxaban?
No lab monitoring
What is the reversal agent of Rivaroxaban?
What is the MC adverse effect of rivaroxaban?
What are some examples of bivalent direct thrombin inhibitors (DTIs)
What are some examples of univalent DTIs
What is an advantage of DTIs
They can be used in pts w/ h/o HIT-II
What is argatroban used for?
To treat HIT
How is argatroban given and how is it monitored?
Monitored w/ PTT
What is an advantage of argatroban?
It is not renally eleminated so it can be used in pts w/ HIT and poor renal fxn
Which drug was withdrawn by AstraZenaca in 2006?
What DTI is given orally?
What lab testing does dabigatran require?
Does dabigatran have a reversal agent?
FDA approved 2015
What is the dabigatran reversal agent?
What is idarucizumab?
Human monoclonal antibody
What is the MOA of idarucizumab?
It binds to pradaxa
How do you deliver idarucizumab?
Two consecutive 2.5 gram doses IV
What is a negative of idarucizumab?
$3500 for 1 dose
What is andexanet alfa?
A factor xa decoy protein
*factor Xa inhibitor reversal agent*
What drugs does andexanet alfa correct?