Antithrombotics extras (do last)

Question 1

What is the BBW for antithrombotics?

Answer 1

spinal anesthesia/puncture –> hematoma –> paralysis

Question 2

The treatment for HIT is__________.

Answer 2

Fondaparinux or argatabon.

Do NOT give warfarin.

Question 3

Pentasaccharide increases _________ affinity for _________ (direct pathway).

Answer 3

Antithrombin

Factor Xa

Question 4

Activation of ____________ will form a fibrinogen bridge for platelet aggregation.

Answer 4

GP IIb/IIIa

Question 5

What inhibits Factor IIa (thrombin)?

Answer 5

Dabigatran
Fondaparinus
Warfarin

Question 6

What are indications for use of thrombolytics?

Answer 6

ischemic stroke <4 h

MI untreatable by PCI <14 h

Question 7

Idarucizumab (Praxbind) is the antidote for ___________.

Answer 7

Dabigatran

Question 8

Why is it important to start heparin along with warfarin?

Answer 8

Warfarin has a slow onset of action because existing functional clotting factors have to turn over. If you do not give heparin, there may be an initial procoagulant effect due to inhibition of Protein S and C.

Question 9

Alteplase mechanism of action

Answer 9

binds fibrin to activate plasminogen on a fresh clot

Question 10

What drugs REVERSIBLY blocks GP IIb/IIIa from binding to fibrinogen and vWF

Answer 10

Abciximab
Tirofiban
Eptifibatide

Question 11

What are the DIRECT Factor Xa inhibitors?

Answer 11

Ribaroxaban

Apixaban

Question 12

What inhibits Factor Xa?

Answer 12

Warfarin
Rivaroxaban
Enoxaparen

Question 13

Streptokinase mechanism of action

Answer 13

activates circulating plasminogen

Question 14

The benefit of using Ribiroxaban or Dabigatran

Answer 14

there is a predictable response, do not need routine monitoring (in comparison to warfarin!)

Question 15

What are the DIRECT factor IIa (thrombin) inhibitors?

Answer 15

Dabigatran

Others used only in invasive cardiology

Question 16

Drugs that inhibit Pgp/CYP34A will ________ efficacy of Rivaroxaban.

Answer 16

increase efficacy

Question 17

Long polysaccharide chains bridge ___________ and __________.

Answer 17

Antithrombin

Factor IIa

Question 18

What inhibits factor VIIa?

Answer 18

Warfarin

Question 19

Why does heparin require IV or SQ administration?

Answer 19

it is very acidic so always negatively charged, highly sulfated, does not cross GI/placenta/brain barrier

Question 20

Do not give Aspirin to people < age ______ because it may cause _____ syndrome in the setting of a viral infection/vaccine.

Answer 20

19

Reye

Question 21

The goal/target of anticoagulation is to diminish activity of Factors _______ and/or _______.

Answer 21

Xa

IIa

Question 22

Inhibition of COX-2 results in____

Answer 22

Decrease in pro inflammatory prostaglandins and an increase in anti-inflammatory lipoxins

Question 23

Clopidogrel and Prasugrel irreversibly block ____________.

Answer 23

P2Y12, the ADP purine receptor on platelet

Question 24

What is the antidote for heparin?

Answer 24

Protamine Sulfate

inactivates heparin by ionic binding to polysaccharide chains

Question 25

Aspirin is metabolized in the liver to _________.

Answer 25

salicylic acid

Question 26

Half life is inversely proportional to _________ of the heparins.

Answer 26

chain length

Question 27

HIT develops when _______ binds to heparin and the body forms antibodies to the complex.

Answer 27

PF4, released from platelet granules

Question 28

LMW Heparin (Enoxaparin) and Fondaprinux are eliminated by the ________.

Answer 28

kidney

Question 29

What irreversibly blocks COX-1?

Answer 29

Aspirin

Question 30

Warfarin is metabolized by __________ in the liver. People who are poor metabolizers are at increased risk of ____________.

Answer 30

CYP2C9 | MI, stroke

Question 31

What does gamma carboxyglutamate (Gla) do?

Answer 31

Chelates calcium to enable factors VII, IX, and Xa as well as Protein C and Protein S to the platelet membrane

Question 32

What does antithrombin do?

Answer 32

neutralizes coagulation proteases

Question 33

Drugs that induce Pg will __________ efficacy of Dabigtran.

Answer 33

Decrease

Question 34

Inhibition of COX-1 decreases platelet recruitment/activation by what mechanism?

Answer 34

Decreases arachidonic acid conversion to thromboxane (TXA2), which is needed for fibrinogen bridging

Question 35

________(antithrombin catalyst) can be used in pregnant women as long as there are no preservatives in it.

Answer 35

Heparin

Question 36

Contraindications for Aspirin

Answer 36

NSAID hypersensitivity | asthma/rhinitis/nasal polyps

Question 37

Aspirin is excreted by the _______.

Answer 37

Kidney

Question 38

Overdose of Aspirin results in ______

Answer 38

uncoupling of oxidative phosphorylation | metabolic acidosis, seizures, coma