Cardio: Drugs Used for PAD and DVT

Question 1

MOA of Cilostazol

Answer 1

PDE-3 inhibitor

• increase cAMP, decrease platelet aggregation
• also works fo vasodilate

Question 2

When would you use cilostazol?

Answer 2

Intermitten claudication

Question 3

Adverse effects of cilostazol?

Answer 3

Headache, edema

-other non-specifics

Question 4

Can you use cilostazol in pts with HF?

Answer 4

No, it is contraindicated

Question 5

What are some pharm treatments for DVT? (parenteral, oral, clot busters)

Answer 5

parenteral: Heparin, LMWH, fondaparinux, hirudin analogs, argatroban

Oral: warfarin, thrombin inhibitors, factor Xa inhibitors

Clot busters: -plase (TPAs)

Question 6

Non-pharm options to treat DVT?

Answer 6

Stockings, Stents, IVC filter

Question 7

MOA of Heparin

Answer 7

Long polysaccharine that binds and activates ATIII to inhibit Factors Xa and IIa

Rapid onset in treating Red Clots in PE, stroke, DVT, DIC

Question 8

Which is rapid onset: Heparin or Warfarin?

Answer 8

Heparin

Question 9

Is heparin safe in pregnancy?

Answer 9

Yes, “Keep your baby Heppy with Heparin”

Question 10

What is the antidote to heparin or Low Molecular Weight Heparin (LMWH) OD?

Answer 10

Protamine

Question 11

Is heparin given orally or parenterally?

Answer 11

Perenterally. Only IV or SubQ

IM=hematoma

Question 12

What do you monitor with heparin and warfarin?

Answer 12

Heparin: PTT

Warfarin: PT
-war takes place outside, extrinsic

Question 13

What are contrainidcations for all the drugs used for DVT?

Answer 13

Bleeding (hemophilia/thrombocytopenia) and stroke

Question 14

What specific reaction can happen with heparin?

Answer 14

HIT

-paradoxical increase in thrombotic events due to reduced platelet counts via activation

Question 15

What drugs are LMWH?

Answer 15

Enoxaparin, Delteparin, tinazeparin

Question 16

MOA of LMWH?

Answer 16

Inhibits Xa, prevents red clots

-little effect on existing thrombin

Question 17

Clinical use of LMWH

Answer 17

Prevention of DCT after knee/hip surgery
Treatment of DVT w/ or w/o PE history
Prevention of ischemic events in ACS

Question 18

Is enoxaparin safe in pregnancy?

Answer 18

Yes

Question 19

Which is more reliable, LMWH or heparin?

Answer 19

LMWH is easier to use, has a longer half life, and is now the first choice to prevent DVT

Question 20

Toxicities associated with LWMH?

Answer 20

Bleeding, HIT, neuro injury

Question 21

MOA of fondaparinux

Answer 21

Binds Xa, preventing II->IIa

Question 22

Which one is more effective, fondaparinux or LMWH?

Answer 22

Fondaparinux is more effective, but bleeding risk is higher

Question 23

How do you administer fondaparinux?

Answer 23

SubQ Everyday

-long half life (too long?)

Question 24

Clinical applications of fondaparinux

Answer 24

Prevention of DVT
Acute PE with warfarin
Acute DVT with warfarin

Question 25

Is fondaparinux reversible with protamine?

Answer 25

No

Question 26

Does fondaparinux cause HIT?

Answer 26

No

Question 27

What are the Hirudin analogs?

Answer 27

Bivalirudin

Question 28

MOA of Bilvalirudin?

Answer 28

Reversible inhibition of thombin

Question 29

Clinical applications of bivalirudin?

Answer 29

Limited, second line therapy combined with asparin for angioplasty

Question 30

Route of entry for bivalirudin?

Answer 30

Must be given IV | -parenteral

Question 31

Toxicities of bilvirudin

Answer 31

Bleeding, but much less than heparin

Question 32

MOA of argatroban

Answer 32

Binds catalytic site of thrombin | -can be used to restore platelet counts after HIT

Question 33

Clinical aplications for Argatroban

Answer 33

Prophylaxis and treatment of HIT -monitored w PTT Probably will be test Q

Question 34

Route of entry for argatroban

Answer 34

IV, short half life

Question 35

MOA of Warfarin

Answer 35

Oral Inhibitor of vitamin K y-epoxide reductase | -decreases factors II, VII, IX, X and protein C/S

Question 36

Clinical applications of Warfarin

Answer 36

Long term prophylaxis of thrombosis | -especially in those with a-fib and mechanical heart valves

Question 37

Contraindications of warfarin?

Answer 37

Active bleeds or factor deficiency

Question 38

How do you monitor warfarin?

Answer 38

PT/INR (eliminated by liver) | -goal=between 2-3

Question 39

Is warfarin safe in pregnancy?

Answer 39

No, crosses the placenta and disrupts bone formation

Question 40

What are the first two factors/proteins affected in warfarin?

Answer 40

Factor VII and Protein C

Question 41

Why does warfarin cause skin necrosis?

Answer 41

Protein C has a shorter half-life, so it creates a hypercoagulable state

Question 42

MOA of Rivaroxaban (and other xabans)

Answer 42

direct (oral) inhibitor of Factor Xa (activated factor X)

Question 43

What are the advantages of Rivaroxaban over Heparin?

Answer 43

``` Rapid, Fixed dose, less bleeding, Fewer interactions, No need to monitor INR ```

Question 44

Clinical applications of rivaroxaban?

Answer 44

Prevention of DVT after knee/hip replacement | Prevention of stroke in a-fib

Question 45

What is important when taking rivaroxaban?

Answer 45

Must dose on time (short half life)

Question 46

Route of entry for the direct factor X inhibitors?

Answer 46

Orally, with high bioavailability

Question 47

Contraindications to rivaroxaban?

Answer 47

Bleeds Renal/hepatic impairment Pregnancy

Question 48

MOA of dabigatran

Answer 48

direct (oral) thrombin inhibitor

Question 49

Route of entry of warfarin?

Answer 49

Oral

Question 50

Clinical application of dabigatran

Answer 50

Prevention of stroke in those with non-valvular A-fib

Question 51

If dabigatran safe in those with mechanical heart valves?

Answer 51

Nope, recently contrainidcated

Question 52

Antidote to dabigatran toxicity?

Answer 52

Idarucizumab

Question 53

Antidote to Xa inhibitors?

Answer 53

Andexanet alfa

Question 54

What is important to remember when storing dabigatran?

Answer 54

Must keep it in the manufacturer bottle | -pills are unstable==keep dry and room temp