blood meds

Question 1

LMWH

Answer 1

anticoagulant
enhances antithrombin (blocks Xa)
SubQ
use special assay to monitor (better bioavailable)
1/2 life 6-12 hours
Tx can be used in pregnancy
AE Bleeding, osteoporosis HIT
kidney clearance

Question 2

warfarin

Answer 2

anticoagulant
Vit K antagonist (glutamate carboxylation; F 2,7,9,10 C S)
slow onset and long 1/2 life
narrow therapeutic index; monitor with INR, Vit K to reverse
metabolized in liver and kidney
AE bleeding, teratogen, skin necrosis, purple toe syndrome

Question 3

Argatroban

Answer 3

Anticoagulant
Direct thrombin inhibitors
Continuos IV- monitor with APTT
short 1/2 life
TX HIT
metabolized by liver
AE Bleeding

Question 4

lepirudin and bivalirudin

Answer 4

anticoagulant
direct thrombin inhibitors
from medical leaches
short 1/2 life-monitor APTT
renal metabolism
Tx HIT
AE bleeding

Question 5

dabigatran

Answer 5

anticoagulant
direct thrombin inhibitor
onset 2 hours
1/2 life 14-17 hours- no monitoring required
Tx stroke and VTE prevention (non valvular afib; surgery); tx VTE
renal excretion
no antidote
AE bleeding

Question 6

Rivaroxaban

Answer 6

anticoagulant
FXa inhibitor
onset 2-3 hours
1/2 hours 7-11 hours-no monitoring required
TX stroke and VTE prevention and tx
some renal excretion
no antidote
AE bleeding

Question 7

apixaban

Answer 7

anticoagulant
FXa inhibitor
onset 2 hours
1/2 life 8-15 hours-no monitoring required
little renal metabolism
TX stroke  and VTE prevention
no antidote
AE Bleeding

Question 8

ASA

Answer 8

antiplatelet
irreversibly inhibits COX1-> kills platelet for its life (7-10 days)
PO
AE Bleeding, GI ulceration, allergy and bronchospasm, interstitial nephritis, papillary necrosis, Salicism, Reye’s Disease

Question 9

P2Y12 receptor antagonist (plavix)

Answer 9

antiplatelet
blocks activation of ADP receptor
AE Bleeding, Gi irritation, thrombo/neutropenia

Question 10

Glycoprotein IIb/IIIa antagonists (abciximab, tirofiban, eptifibritide)

Answer 10

antiplatelet
blocks binding of fibrinogen on thrombocytes
IV
tx acute coronary procedures
AE bleeding, thrombocytopenia

Question 11

UFH

Answer 11

anticoagulant
Enhance Antithrombin (blocks Ia, Xa and IIa)
IV or Subq
1/2 life 1-2 hours
monitor by APTT (unpredictable bioavailabiltity)
Tx: used when immediate anticoagulant is needed; when quick reversal may be necessary (protamine); can be used in pregnancy
AE bleeding, osteoporosis, HIT

Question 12

dipyridamole

Answer 12

antiplatelet
multiple mechanisms (+prostacyclin, -adenosine deanimase, phosphodiesterase)
used with ASA
also vasodilator
PO and IV
AE bleeding, HA

Question 13

streptokinase

Answer 13

fibrinolysis
complexes with plasminogen to activate plasmin
IV or cath direct
not fibrin specific 
AE bleeding, antigenic, hypotension

Question 14

Urokinase

Answer 14

Fibrinolysis
concentrated from urine; protease->activates plasmin
non antigenic
IV
Not fibrin specific
AE bleeding

Question 15

TPA

Answer 15

fibrinolysis
recombinant TPA, activates plasmin
not antigenic
fibrin specific
short 1/2 life, used with heparin
AE bleeding