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Pharmacology Unit 3 > Antithrombotics > Flashcards

Antithrombotics Flashcards

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1
Q

What are the COX/Prostiglandin inhibitors

A

Aspirin and other NSAIDs

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2
Q

What are the ADP/P2Y12 inhibitors

A

Clopidogrel, prasugrel, ticagrelor

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3
Q

What are the PDE/adenosine uptake inhibitors

A

dipyridamole, ciolstazol

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4
Q

What are the glycoprotein 2b/3a inhibitors

A

abciximab, integrilin

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5
Q

What is a LMWH drug name

A

enoxaparin

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6
Q

What is a vitamin K antagonist

A

Warfarin

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7
Q

What is a direct thrombin inhibitor

A

dabigatran

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8
Q

What is a factor Xa inhibitor

A

rivaroxaban, apixaban, edoxaban

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9
Q

aspirin is what type of antithrombotic and what class

A

Antiplatelet
COX inhibitor

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10
Q

clopidogrel is what type of antithrombotic and what class

A

antiplatelet
ADP/P2Y12 inhibitor

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11
Q

ticagrelor is what type of antithrombotic and what class

A

antiplateelet, ADP/P2Y12 inhibitor

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12
Q

dipyridamole is what type of antithrombotic and what class

A

Antiplatalet, PDE/adenosine uptake inhibitor

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13
Q

cilostazol is what type of antithrombotic and what class

A

PDE/Adenosine uptake inhibitor
Antiplatelet

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14
Q

abciximab is what type of antithrombotic and what class

A

antiplatelet
Glycoprotein 2b/3a inhbitor

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15
Q

integrilin is what type of antithrombotic and what class

A

antiplatelet
Glycoprotein 2b/3a inhbitor

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16
Q

enoxaparin is what type of antithrombotic and what class

A

Anticoagulant
Low molecular weight heparin

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17
Q

Warfarin is what type of antithrombotic and what class

A

Anticoagulan
Vitamin K antagonist

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18
Q

Dabigatron is what type of antithrombotic and what class

A

anticoagulant
direct thrombin inhibitor

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19
Q

rivaroxaban is what type of antithrombotic and what class

A

anticoagulant
Factor Xa inhibitor

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20
Q

edoxaban is what type of antithrombotic and what class

A

anticoagulant
Factor Xa inhibitor

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21
Q

Describe Aspirin’s MOA vs other COX inhibitors

A

ASA binds irreversibly (acetylates) COX, and platelets can’t make more COX, so the effect is perminant until new platelets form.
Other COX inhibitors have a reversible effect, and the effect only lasts a few hours, may interfere with ASA if taken at the same time (i.e. ibuprofen)

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22
Q

ASA toxicities

A

GI upset, hearing loss, tinitus (esp with high chronic doses)
A- Asthma (bronchospasm)
S- Salicylism (toxicity, tinnitus, virtigo, tachycardia, tachypena, acidosis, convulsions, hallucinations)
P- PUD
I- Intestinal/GI blood loss
R- Reye syndrome
I- itch, hives, rash
N- noise (tinnitus in high doses)

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23
Q

Dosing for ASA

A

81mg or 162 mg sometimes, long term CVD prevention. Combined with other antiplatelets if secondary prophylaxis

325mg used in acute phase following CVD event

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24
Q

ASA can trigger what type of anemia

A

G6PD deficiency anemia, hemolytic anemia

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25
Labeled indications for clopidogrel
Plavix, ADP inhibitor, antiplatlet ACS, Secondary Stroke prevention, PAD - Other ADP inhibitors are only for ACS (Prasugrel/Effient, Ticagrelor/Brillenta)
26
Which drug is the best choice for intermittent claudication
Cilostazol PO BUT not for HF PDE/adenosine uptake inhibitor. Inhibit platlet aggregation and vasodilation.
27
You should look to a different anti-platlet if your patient has which different conditions that contraindicate them to ASA
- Hypersensitivity to NSAIDs or Salicylates - Chickenpox or Reye syndrome, breastfeeding - Asthma, rhinitis, nasal polyps
28
In a patient who has thrombocytopenia, which antiplatelet agent is preferred
Clopidogrel- Plavix- over ASA
29
Key toxicity of ticagrelor
Dyspnea (up to 20%)
30
A patient who is on an ADP inhibitor is complaining of dyspnea. Which med is most likely to be causing this
Brillenta (Ticegralor)- dyspnea in 20% of people who take it
31
Which ADP inhibitor is contraindicated in patients who have history of TIA/Stroke
Prasugrel (Effient) Increased bleeding risk, avoid it or give a lower dose if >75 or <60kg
32
IV option for ADP inhibitors
Cangrelor (Kengreal)
33
What is the BBW for clopidogrel
Deminished antiplatlet effect in pts with 2 LOF alleles in CYP2C19 gene. In pts who are compliant with this medication but still have thrombotic event or normal P2Y12 activity, consider an ASSAY to show fx or another P2Y12 inhibitor Clopidogrel has this problem but not other P2Y12 because it is the prodrug, the others are not
34
Drugs contraindicated while taking Plavix
CYP2C19 inhibitors Omeprazole and esomeprazole Rifampin (R in RIPE)
35
Cilostazol indications
PDE inhibitor, inhibit platlet aggregation USUALLY for claudication sx Post-PCI procedure, secondary stroke prevention, or unable to take aspirin or P2Y12 inhibitors BBW: HF patients
36
Lab monitering for UFH
PTT or aPTT no effect on PT/INR
37
MOA of UFH
Intrensic pathway via Anti thrombin activation
38
Describe the indications for UFH
Inpatient treatment for tight control of anticoagulation IV administration usually Short 1/2 life, so good for patients who are waiting to get surgery Preferred in renal failure and pregnancy
39
Key toxicities of UFH
Heparin induced thrombocytopenia osteoporosis if used for many months heparin resistance (PTT remains low)
40
UFH antidote
Protamine
41
Dosing goal of UFH
Titrate to goal aPTT- requires baseline measure and other measures after. Not feasable outside of hospital setting
42
When to use SC injection of UFH
for DVT prophylaxis Prevent venous thromboembolism in medical surgical pts every 8-12 hour dosing Don't need to moniter PTTs
43
Enoxaparin type of medication
LMWH, Lovenox MOA: Inhibits factor Xa
44
Lab monitering for enoxabaparin
No lab monitering needed Minimal changes to PT/INR and PTT
45
Indications for enoxaparin
Lovenox (Enoxoparin) Numerous-- almost all anticoagulation tx and prophy. Use as alternate to UFH or DOACs Usually given SC or IV (usually just given SC) AVOID with recent HIT.
46
What type of excretion does enoxaparin use
renal excretion- if renal dysfunction, give less frequent doses at a lower dose Doesn't cross placenta, ok in pregnancy
47
Toxicities of enoxaparin
HIT- lower risk than UFH, but avoid if recent HIT
48
What lab value do you moniter for heparin
Moniter PLTs to ensure no HIT Lab monitering with PTT
49
VTE tx and prophy for a patient with confirmed HIT or suspected
Can't use UFH or LMWH, so use fondaparinux (Arixtra)
50
Between UFH and LMWH, which has renal excretion?
LMWH is renally excreted
51
Between UFH and LMWH, which needs lab monitering
UFH needs lab monitering with PTT Not required in LMWH
52
Half-life for UFH vs LMWH
Much shorter half life for UFH, preferred in pts pending sx
53
Lab monitering for apixaban/rivaroxaban
NONE needed
54
Reversal for direct factor Xa inhibitors
Andexxa (Andexanet alfa)
55
Place in therapy for dabigatran (Pradaxa)
Directly inhibits thrombin (Direct thrombin inhibitor) Stroke prevention in A fib Can be used for VTE tx and prophy
56
Andexxa is the reversal for which DOACs
Rivaroxaban(Xarelto), Apixaban(Eliquis), endoxaban Dabigatran (Pradaxa) is praxbind
57
Which DOAC do you HAVE to take food with
Xarelto (rivaroxaban)
58
2 BBWs for DOACs
1) Premature discontinuation increases risk of thrombosis 2) spinal/epidural hematoma (also for LMWHs)
59
Lab test for Warfarin
INR Goal is INR of 2-3
60
Indications for Warfarin
Cardiac valve replacement Slow Onset- takes 4-5 days to set on, so use bridging w UFH or LMWH
61
Antidote for Warfarin
Vitamin K(Phytonadione) and PTT (KCentra)
62
Absolute contraindications for warfarin
GI ulcers and pregnancy
63
Key PK drug interactions with warfarin
1) Amioderone and fluconazole, CYP2C9 inhibitors, decrease hepatic metabolism (Increase INR, stays in system for longer, Check INR every day if on these because it may be high (too much bleeding)). 2) CYP2C9 inducers (Increase hepatic metabolism)
64
Drugs that interact with warfarin and increase INR
FFAB-5 - Fluconazole - Fluoroquinolones - Flagyl - Amiodarone - Bactrim
65
Dietary sources of Vitamin K management when on Warfarin
Green leefy veggies have lots of vitamin K ( Warfarin antidote), so eat same amount and adjust warfarin dose based on that).
66
Place in therapy for Alteplase/tenecteplase
Acute ischemic stroke ACS if unable to get PCI Acute PE
67
Risks> Benefits for Thrombolytics
MI: - Active internal bleeding - Hx of recent stroke - Recent (3mo) intracranial or intraspinal sx or serious head trauma - Neoplasms, av malformations, aneurysms - Bleeding diathesis - Severe uncontrolled HTN

Pharmacology Unit 3 (10 decks)

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