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Pharmacy Practice V > Antiplatelets and Anticoagulants > Flashcards

Antiplatelets and Anticoagulants Flashcards

1
Q

What are the Antiplatelet Medications?

A
  1. Plavix
  2. Effient
  3. Brillinta
  4. Kengreal
  5. Zontivity
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2
Q

What are the CI’s of Antiplatelets?

A

Active Bleeding

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3
Q

What is a major DDI for Antiplatelets?

A

NSAIDs = Increased GI bleeding
ASA = Increased bleeding

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4
Q

How long do you hold antiplatelets prior to CABG?

A

Plavix: 5 days
Ticagrelor: 5 days
Prasugrel: 7 days

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5
Q

What is the indication for Plavix?

A

Post ACS, PCI, and CVA

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6
Q

What is the pharmacology of Plavix?

A

Irreversible binding/platelet ADP receptor

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7
Q

What is the Black Box Warning for Plavix?

A

CYP2C19 Poor Metabolizers = Asians
this patient population cannot convert prodrug plavix to its active form

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8
Q

What are drugs that can interact with Plavix?

A
  1. Omeprazole
  2. Esomeprazole
  3. Fluoxetine
  4. Grapefruit
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9
Q

What is the indication for Prasugrel?

A

Post ACS and PCI

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10
Q

What is the pharmacology of Prasugrel?

A

Irreversible binding/platelet ADP receptors

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11
Q

What is the Black Box Warning for Prasugrel?

A

AVOID with age >75 yrs unless DM s/p MI (high risk)

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12
Q

When is Prasugrel use CI’d?

A

Prior TIA (transient ischemic attack)/CVA (cerebrovascular accident)

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13
Q

What is the indication for Ticagrelor?

A

ACS with PCI

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14
Q

What is the pharmacology of Ticagrelor?

A

Reversible binding/platelet ADP receptors

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15
Q

What is the Black Box Warning for Ticagrelor?

A

ASA >100 mg/day decrease ticagrelor effectiveness

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16
Q

What should be avoided when using Ticagrelor?

A

Strong 3A4
AVOID Lovastatin or Simvastatin >40 mg/day

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17
Q

What is an Intermittent Claudication Agent?

A

Cilostazol

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18
Q

What is the Indication for Intermittent Claudication Agents?

A

Decrease symptoms, increasing symptom free walking duration/time

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19
Q

What drugs interact with Cilostazol?

A
  1. Diltiazem
  2. Grapefruit
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20
Q

What is CI’d with use of Cilostazol?

A

CHF of ANY SEVERITY

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21
Q

When should you DC Cilostazol?

A

Use with ASA or Plavix with no improved symptoms in >3 months

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22
Q

How should you administer Cilostazol?

A

Taken on empty stomach 30 mins before or 2 hrs after meals

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23
Q

How long does it take to see effect of Cilostazol?

A

May see effects in 2 weeks, up to 12 weeks for full effect

24
Q

Cilostazol may induce or produce what A/Es?

A
  1. Diarrhea
  2. Dizzy
  3. Palpitations
  4. Tachycardia
  5. Arrhythmia
  6. Hypotension
  7. Thrombocytopenia
25
Q

What are the CI’s for Anticoagulants?

A

Active Bleeding

26
Q

What are the DDIs for Anticoagulants?

A

NSAIDs
Concomitant Antiplatelet therapy = increased bleeding risk

27
Q

What are the Anticoagulant Agents of CHOICE for Nonvalvular AF/VTE/Cancer associated VTE?

A

DOACS, but not Pradaxa

28
Q

What is the Anticoagulant Agent of CHOICE for Valvular AF?

A

Warfarin

29
Q

Valvular AF is defined as what when warfarin is the preferred choice?

A

Moderate/Severe Mitral Valve Stenosis, Mechanical Values and Hypercoagulable disorders (anti phospholipid syndrome)

30
Q

Warfarin acts on what clotting factors?

A

X, Prothrombin II, and VII

31
Q

Apixaban, Betrixaban, Edoxaban, and Rivaroxaban acts on what clotting factors?

A

Xa

32
Q

Dabigatran acts on what clotting factors?

A

Thrombin IIa

33
Q

What are the indications for Warfarin?

A

AF, Mechanical Valves, and VTE

34
Q

What are the DDIs of Warfarin?

A

FAB5 and BAMIF

35
Q

What is BAMIF?

A

Bactrim
Amiodarone
Metronidazole
Itraconazole
Fluconazole

36
Q

What is CI’d with Warfarin?

A

Pregnancy

37
Q

What is the INR Goal for AF/VTE when on Warfarin?

A

2-3

38
Q

What is the INR Goal for Mechanical Mitral Valve when on Warfarin?

A

2.5-3.5

39
Q

If a patient is >80 yrs which DOAC should you dose adjust with?

A

Apixaban

40
Q

For patients <60 kg which DOAC should you dose adjust with?

A

Apixaban and Edoxaban

41
Q

At what BMI would DOACs demonstrate minimal efficacy?

A

> 40

42
Q

Pradaxa has indications for what?

A

Nonvalvular AFib, VTE, DVT, Knee/Hip Replacement

43
Q

Rivaroxaban and Apixaban has indications for what?

A

Nonvalvular AFib, VTE, DVT, Knee/Hip Replacement

44
Q

Edoxaban has indications for what?

A

Nonvalvular AFib and VTE

45
Q

What is the pharmacology for Pradaxa?

A

Reversible Direct Thrombin Inhibitor

46
Q

What are the patient counseling points of Pradaxa?

A

Store and administer from original container (stable 4 months)
Swallow whole

47
Q

What is the reversal agent for Pradaxa?

A

Idarucizumab/Praxbind

48
Q

What is the absolute bioavailability for Rivaroxaban?

A

Dose dependent, lower bioavailability with doses <15

49
Q

What are the patient counseling points of Rivaroxaban?

A

10 mg tabs can be taken w/ or w/o food
15-20 mg tabs should be taken with evening meal for best absorption

50
Q

What is the reversal agent for Rivaroxaban and Apixaban?

A

Andexanet Alfa/Andexxa

51
Q

What is the main difference between dosing for Apixaban?

A

Prevention: 2.5 BID
Treatment: 10 BID then 5 BID

52
Q

When should you initiate Edoxaban after VTE?

A

After 5-10 days of parenteral anticoagulant

53
Q

When is Edoxaban CI’d?

A

CrCl >95 or <15

54
Q

What drugs cause a dose limit of 30 mg/day to Edoxaban?

A
  1. Verapamil
  2. Azithromycin
  3. Clarithromycin
  4. Eythromycin
55
Q

Does Edoxaban have a reversal agent?

A

NO

Pharmacy Practice V (19 decks)

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