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Flashcards in Antithrombotic drugs details Deck (62)
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1

Heparin MOA

Binds Antithrombin III and accelerates its activity> inactivates IIa and Xa of intrinsic pathway.

2

Heparin pharmacokinetics

rapid onset, parenteral (IV, SC) only, cleared by reticuloendothelial system

3

heparin monitoring lab tst

aPTT

4

Heparin Uses

Acute coronary syndrome, venous thromboembolism

5

Heparin adverse rxns + treatment of overdose

Bleeding, thrombocytopenia, narrow therapeutic index, safe in pregnancy. Overdose treated with protamine

6

Heparin drug-drug interactions

NSAIDS increase bleeding risk, antiplatelet agents

7

Heparin advantages and disadvantages

More rapid response than LMWH and completely reversed by protamine

8

LMWH examples

Enoxaparin-Dalteparin

9

LMWH MOA

Binds ATIII > inactivates Xa (but NOT IIa)

10

LMWH pharmacokinetics

3-5hr onset if SC, parenteral (IV or SC), renal clearance

11

LMWH monitoring lab test

Not needed, action is predictable

12

LMWH Uses

Acute coronary syndrome, venous thromboembolism

13

LMWH adverse rxns + treatment of overdose

Bleeding, thrombocytopenia, narrow therapeutic index, safe in pregnancy. Overdose treated with protamine (incomplete though)

14

LMWH drug-drug interactions

NSAIDS increase bleeding risk, antiplatelet agents also increase bleeding tendencies

15

LMWH advantages and disadvantages

Equal efficacy as heparin for VTE with less tendency for bleeding complications and less effect on platelets.

16

Warfarin MOA

Inhibits liver synthesis of Vit K-dep factors (II, VII, IX, and X)

17

Warfarin monitoring lab test

INR (PT)

18

Warfarin pharmacokinetics

Delayed onset(due to turnover of existing clotting factors), oral administration, hepatic metabolism, NOT safe in pregnancy

19

Warfarin Uses

Atrial fibrillation, Venous thromboembolism prophylaxis

20

Warfarin adverse rxns + treatment of overdose

Bleeding, skin necrosis, narrow therapeutic index. Overdose treated with Phytonadione (Vit K) FFP

21

Warfarin drug-drug interactions

CYP450 inhibitors and antibiotics increase effect. CYP450 inducers and dietary Vitamin K decrease effect

22

Warfarin advantages and disadvantages

In atrial fibrillation: advantages include once daily dosing, reversal of effects with vitamin K. Disadvantages include variability in dosage requirements, dietary attention to Vit K, INR monitoring, drug interactions

23

Dabigatran MOA

Direct thrombin (IIa) inhibitor

24

Dabigatran monitoring lab test

Not routinely monitored

25

Dabigatran pharmacokinetics

Peaks at 1-2hrs, steady rate at 2-3 days, oral administration as prodrug, renal elimination, Category C in pregnancy

26

Dabigatran Uses

Atrial fibrillation, Venous thromboembolism

27

Dabigatran adverse rxns + treatment of overdose

Bleeding, gastritis. No antidote for overdose

28

Dabigatran drug-drug interactions

Decreased effect from P-glycoprotein inducers. Increased effect from P-glycoprotein inhibitors

29

Dabigatran advantages and disadvantages

Advantages: lower rates of strokes, doesn’t require INR, no dietary restrictions (all compared to warfarin). Disadvantages: No monitoring lab, no antidote, twice daily dosing, shorter acting, renal clearance, must be stored in original container

30

Ravaroxaban and Apixaban MOA

Direct factor Xa inhibitor