Antithrombotic Agents

Question 1

Venous thrombi are composed mainly of _____ and _______ with relatively few ______.

Answer 1

fibrin; trapped red blood cells; platelets

Question 2

______ are composed mainly of fibrin and trapped red blood cells with relatively few platelets.

Answer 2

Venous thrombi

Question 3

Arterial thrombi are composed mainly of _____ held together by small amounts of _____.

Answer 3

platelet aggregates; fibrin

Question 4

______ are composed mainly of platelet aggregates held together by small amounts of fibrin.

Answer 4

Arterial thrombi

Question 5

How is UA/NSTEMI treated?

Answer 5

Aspirin

± clopidogrel or prasugrel or ticagrelor

± UFH or LMWH or fondaparinux

± GPIIb/IIIa inhibitor

Question 6

How is an Acute MI (STEMI) treated?

Answer 6

Aspirin

+ clopidogrel or prasugrel or ticagrelor

+ UFH or LMWH or fondaparinux

± GPIIb/IIIa inhibitor

Question 7

What medications are given before PCI?

Answer 7

Aspirin

+ clopidogrel or prasugrel or ticagrelor

+ UFH or LMWH or bivalirudin

± GPIIb/IIIa inhibitor

Question 8

How is A-fib treated?

Answer 8

Warfarin or dabigatran or rivaroxaban or apixaban

Question 9

What does the CHA2DS2-VASc acronym stand for?

Answer 9

Congestive HF-Hypertension-Age ≥ 75-

Diabetes-Stroke-Vascular disease-Age 65-74-Sex (female)

Question 10

How does Warfarin work?

Answer 10

Inhibit synthesis of Vit K-dependent clotting factors II, VII, IX, and X

Question 11

How does Heparin work?

Answer 11

Combines with antithrombin III (ATIII) to inactivate active clotting factors (IIa, IXa, Xa, XIa, XIIa)

Question 12

How do LMWHs/Fondaparinux work?

Answer 12

they combine with antithrombin III (ATIII) to inactivate Xa

Question 13

How do Hirudin, Dabigatran work?

Answer 13

they directly inactivate IIa (thrombin)

Question 14

Which drug directly inactivates IIa (thrombin)?

Answer 14

Hirudin

Dabigatran

Question 15

How does Rivaroxaban work?

Answer 15

Directly inactivates Xa

Question 16

Which drug directly inactivates Xa?

Answer 16

Rivaroxaban

Question 17

Which drug combines with antithrombin III (ATIII) to inactivate Xa?

Answer 17

LMWHs

Fondaparinux

Question 18

Which drug combines with antithrombin III (ATIII) to inactivate active clotting factors (IIa, IXa, Xa, XIa, XIIa)?

Answer 18

heparin

Question 19

Which drug inhibits synthesis of Vit K-dependent clotting factors II, VII, IX, and X?

Answer 19

warfarin

Question 20

What test is used to monitor heparin therapy?

Answer 20

aPTT

Question 21

What is a normal aPTT value?

Answer 21

26-33 sec

Question 22

Prolonged clotting time in the aPTT indicates a defect in?

Answer 22

the intrinsic pathway

Question 23

What test is used to monitor warfarin therapy?

Answer 23

PT

Question 24

The aPTT test is used to monitor ____ therapy.

Answer 24

heparin

Question 25

The PT test is used to monitor ____ therapy.

Answer 25

warfarin

Question 26

What is a normal PT time?

Answer 26

12-14 sec (but now reported using INR)

Question 27

What does ECT stand for?

Answer 27

Ecarin Clotting Time

Question 28

What is Ecarin Clotting Time (ECT) used for?

Answer 28

to monitor anticoagulant therapy with direct thrombin (IIa) inhibitors (hirudin and dabigatran)

Question 29

Which test is used to monitor anticoagulant therapy with direct thrombin (IIa) inhibitors (hirudin and dabigatran)?

Answer 29

Ecarin Clotting Time (ECT)

Question 30

Name 2 LMWHs.

Answer 30

Enoxapirin (Lovenox) Dalteparin (Fragmin)

Question 31

What are Enoxapirin (Lovenox) and Dalteparin (Fragmin)?

Answer 31

LMWHs

Question 32

______ (side effect) is more likely with heparin than LMWH but NOT with fondaparinux.

Answer 32

Thrombocytopenia

Question 33

Thrombocytopenia is more likely with heparin than LMWH but NOT with ______.

Answer 33

fondaparinux

Question 34

Thrombocytopenia is more likely with _____ than _____ but NOT with fondaparinux.

Answer 34

heparin; LMWH

Question 35

What is the heparin antidote?

Answer 35

protamine

Question 36

Can heparin be given in pregnancy? Can warfarin?

Answer 36

heparin = yes warfarin = no

Question 37

What kind of drug is Dabigatran (Pradaxa)?

Answer 37

a newer oral anticoagulant (NOAC) non-vitamin K antagonist *** inhibits factor IIa (thrombin)

Question 38

What kind of drugs are Rivaroxaban (Xarelto), Apixaban (Eliquis), and Edoxaban (Savaysa)?

Answer 38

newer oral anticoagulants (NOACs) non-vitamin K antagonist *** inhibit factor Xa