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Blood & Lymph > Antiplatelets, Anticoagulants & Thrombolytics 2 > Flashcards

Antiplatelets, Anticoagulants & Thrombolytics 2 Flashcards

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1
Q

EdoXAban should NOT be used with ______ (4).

A
  1. Rifampin
  2. SSRI/SNRI
  3. Anticoagulants
  4. Antiplatelets
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2
Q

EdoXAban & Betrixaban contraindications (3)

A
  1. lactation
  2. renal impairment
  3. liver impairment
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3
Q

BetriXAban dosing must be reduced for patients taking ______ (rx).

A

P-glycoprotein (P-gp) inhibitors

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4
Q

Dabigatran reduces the risk of _____ & treats ____.

A
  • stroke, PE in nonvalvular a-fib
  • DVT & PE recurrence (or following surgery)

(also prevents thromboembolic events in peds pts)

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5
Q

Dabigatran binds ______.

A

free and clot-bound thrombin

(is not a substrate, inhibitor or inducer of CYP450)

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6
Q

Dabigatran increases risk of _____ if d/c early.

A

thrombotic events

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7
Q

Dabigatran is contraindication

A

mechanical prosthetic heart valve

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8
Q

________ gene is associated w/variable warfarin dose requirements

A

VKORC1 gene

(CYP2C9*2 vs CYP2C9*3 alleles associated w/decreased activity)

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9
Q

Warfarin onset of action:

Peak effect?

A
  • 24 hours
  • delayed 72-96 hours
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10
Q

What is the cause of tissue necrosis as a side effect of Warfarin?

A

Lack of protein C & S

(aka “purple toe syndrome”)

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11
Q

Adverse effects of warfarin include: tissue necrosis, _______ (2).

A
  1. calciphylaxis
  2. acute kidney disease
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12
Q

Warfarin contraindications

A
  1. pregnancy (abnormal bone formation)
  2. malignant hypertension
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13
Q

______ (3) should not be taken with warfarin?

A
  1. amiodarone
  2. cotrimoxazole
  3. caffeine
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14
Q

How do you decide on a does for warfarin?

A

genotype

(note: there can be as much as a 10x difference in dosage)

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15
Q

indirect thrombin inhibitor

(heparin & LMW heparins)

A

enhance activity of antithrombin → inhibits FX & II

(don’t inhibit coagulation factors)

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16
Q

Smaller size _______ (increases/decreases) half-life.

A

increases

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17
Q

_______ (Heparin/LMW heparin) may be used in renal failure, but ______ (Heparin/LMW heparin) may NOT.

A
  • heparin
  • LMW heparin
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18
Q

Heparin vs. LMW heparin route of administration

A
  • Heparin: IV, Sub-Q
  • LMW heparin: Sub-Q
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19
Q

LMW heparin contraindications

A

HIT w/in past 100 days or w/circulating ab

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20
Q

Disadvantage to using heparin

A

frequent monitoring needed for HIT, HITT

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21
Q

Why is heparin mostly used in the hospital setting?

A

heparin: IV or SubQ

(warfarin = PO)

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22
Q

Indications of heparin (5)

A
  1. venous or arterial thrombosis, PE
  2. a-fib
  3. DIC
  4. surgery
  5. blood transfusions, extracorporeal circulation & dialysis

(anticoagulant used in hospital setting)

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23
Q

Heparin MOA & half-life

A
  • binds antithrombin III → enhances protease activity
  • 0.2-2 hrs
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24
Q

Heparin AE (8)

A
  1. osteoporosis
  2. spontaneous vertebral fx
  3. hyperkalemia
  4. hyperlipidemia, rebound hyperlipidemia
  5. alopecia
  6. itching
  7. hyperkalemia
  8. priapism
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25
**HIT (heparin-induced thrombocytopenia)**
AB formation with platelet factor 4 → thrombosis risk due to lowered platelet count
26
HIT can cause serious _____ events
thromboembolic events → amputation or death (DVT, PE, cerebral vein thrombosis, limb ischemia, stroke, MI, mesenteric, renal artery, skin necrosis, gangrene)
27
Patients whose platelet count falls below ______ or who develop recurrent thrombosis should discontinue heparin.
100,000/mm3 (HIT or HITT can occur several weeks after medication discontinuation)
28
HIT is treated with ______ (2).
1. Argatroban 2. Bivalirudin
29
List 2 LMW Heparins
1. *Enoxaparin (Lovenox ®)* 2. Fondaparinux (*Arixtra ®)*
30
What is the difference in the MOA of LWM Heparin or unfractionated (full sized Heparin)?
**_UFH:_** binds to antithrombins at a 1:1 complex to enhances the activity of antithrombin (1000x). Inactivates complexes of factor IIa (thrombin), IX, and X. **_LMWH:_** Shorter motif that reduces thrombin inhibition **but rapidly inactivates factor X**
31
Which has a longer half life: Enoxaparin *(Lovenox ®) or* Fondaparinux (*Arixtra ®)* ?
* Fondaparinux ~ 20 hrs * Enoxaparin ~ 5 hrs (both are LMWH)
32
LMWH *Enoxaparin (Lovenox ®) &* Fondaparinux (*Arixtra ®)* both treat DVT (prophylaxis & acute). Which treats MI and which treats PE?
* *Enoxaparin (Lovenox ®) : MI* * Fondaparinux (*Arixtra ®): PE*
33
Adverse effect of LMWH
thrombocytopenia
34
List 2 direct thrombin inhibitors
1. Argatroban 2. Bivalirudin (used to tx HIT)
35
Bivalirudin *(Angiomax ®)* MOA
HIT & HITT (HITT = heparin-induced thrombocytopenia and thrombosis)
36
You must used caution in prescribing Bivalirudin to patients w/ ______ (2)
1. geriatric → increased bleeding risk 2. renal impairment
37
Which anticoagulant is indicated for thromboprophylaxis after hip arthroplasty?
Desirudin
38
Desirudin route of admin.
twice-daily Sub-Q (dosage adjustment for renal impairment)
39
Argatroban drug interactions (2)
1. Heparin (wait for aPTT test) 2. oral anticoagulant
40
Argatroban MOA
1. direct thrombin inhibitor 2. reversible binding to thrombin active site (work on free and clot bound thrombin)
41
Argatroban half life
~ 1 hour
42
Streptokinase (fibrinolytic Rx) is eliminated via the _______ (2 organs).
1. intestines 2. kidney (protein produced by streptococci, used to tx thrombolysis)
43
Antibodies to ______ (fibrinolytic rx) can last for months to years after administration.
Streptokinase
44
Urokinase half-life?
~ 12 minutes
45
Urokinase MOA
plasminogen → plasmin
46
Urokinase indications
PE (lysis when unstable hemodynamics - failure to maintain BP w/o support)
47
Recombinant form of human tPA
Alteplase
48
Alteplase MOA
selectively binds to fibrin in a thrombus
49
Alteplase indications (3)
1. STEMI (acute MI) 2. PE 3. Ischemic stroke
50
Mutant tPA
Tenectaplase
51
Tenecteplase (mutant tPA) contraindications
severe uncontrolled HTN
52
Fibrinolytic inhibitors are ______ analogs.
lysine
53
Fibrinolytic inhibitor contraindication
evidence of active intravascular clotting process (these rx enhance hemostasis when bleeding continues)
54
Reteplase & Tenecteplase both treat MI. Which treats PE?
Tenecteplase (Fibrinolytic rx)
55
Adverse effects of all 3 fibrinolytic Rx (Alteplase, Reteplase, Tenecteplase)?
major bleeding, including intracranial
56
Andexxa indication & MOA
* Rivaroxaban & Apixaban overdose * binds & sequesters them (also inhibits activity of Tissue Factor Pathway Inhibitor - TFPI
57
Warfarin overdose tx. Indication for use?
* Vitamin K1 * anticoagulant-induced prothrombin deficiency, hemorrhagic disease of newborn, hypoprothrombinemia due ot abx
58
How soon can hemorrhage be controlled with vitamin K1?
~4 hours (normal prothrombin levels obtained in ~13 hours)
59
Heparin overdose tx
Protamine Sulfate
60
Indication for protamine sulfate
heparin overdose, cardiac surgery
61
How soon can heparin be neutralized after protamine sulfate is administered?
5 min
62
2 Adverse effects of protamine sulfate
1. sudden drop of BP 2. bradycardia
63
Protamine sulfate drug interactions
abx: cephalosporins & penicillins
64
Idarucizumab MOA
binds free & thrombin-bound Dabigatran → neutralization (reverses anticoagulation effects of Dabigatran)
65
When is Idarucizumab used (2)?
1. emergency surgery/urgent procedures 2. life-threatening uncontrolled bleeding (Dabigatran reversal)
66
Idarucizumab may cause adverse reactions in patients with \_\_\_\_\_\_.
fructose intolerance

Blood & Lymph (29 decks)

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