Chapter 16 xD

Question 1

Warfarin- MoA

Answer 1

Blocks reduction of oxidized vitamin K and prevents the post translational carboxylation of coagulation factors 2,7,9 and 10

Question 2

Warfarin- Clinical use

Answer 2

Longterm treatment of thromboembolic disorders:

• DVT
• Thrombosis in pt with atrial fibrillation and artificial valve
• Treatment of MI

Question 3

Warfarin- Adverse effects

Answer 3

• Bleedings

- Fetal warfarin syndrome

Question 4

Warfarin- interactions

Answer 4

• Salicylates potentiate anticoagulant effect
• Rifampin and barbiturates induce CYP enzymes and decrease anticoagulant effect
• Cholestyramine decrease absorption
• GIMS FACE inhibit metabolism and increase risk of bleeding

Question 5

Warfarin- Contraindication

Answer 5

Pregnancy

Question 6

Heparin and related drugs- MoA

Answer 6

Heparin->Potentiate activity of endogenous antithrombin 3, an inhibitor of factor 2 and active factor 10
LMWHs and Fondaparinux->Inactivate factor 10

Question 7

Heparin- Clinical use

Answer 7

• Acute thromboembolic disorders (Pulmonary or peripheral embolism, DIC, and DVT)
• Prevention of clotting (in arterial and heart surgery, blood transfusions, renal dialysis and during blood sample collection)
• Prevention of stroke due to emboli from acute atrial fibrillation

Question 8

LMWHs- Clinical use

Answer 8

• Prevention of venous thromboembolism (associated with abdominal surgery or knee-or-hip replacement surgery)
• Prevent ischemic complication of unstable angina or NSTEMI
• Used in acute coronary syndrome and angioplasty

Question 9

Fondaparinux- Clinical use

Answer 9

-Prevention of DVT in pt with hip-fracture, or hip-or knee replacement surgery

Question 10

Heparin and related drugs- Adverse effects

Answer 10

Heparin->Bleeding, thrombocytopenia, and hyperkalemia
LMWHs->Bleeding, and thrombocytopenia
Fondaparinux-> Bleeding

Question 11

Bivalirudin, Argatroban and Dabigatran- MoA

Answer 11

Inhibit thrombin

Question 12

Bivalirudin- Clinical use

Answer 12

Prevent thrombosis in pt with UA or acute MI (including those undergoing coronary angioplasty and stent insertion)

Question 13

Argatroban- Clinical use

Answer 13

Treatment of thrombosis in Pt with HIT or undergoing PCIs for MI

Question 14

Dabigatran- Clinical use

Answer 14

• Reduce risk of stroke and PE in pt with nonvalvular atrial fibrillation
• Prevention of DVT in pt undergoing hip-replacement surgery

Question 15

Dabigatran- Adverse effect

Answer 15

• Increased risk of bleeding

- Dyspepsia and gastritis

Question 16

Apixaban, Edoxaban and rivaroxaban- MoA

Answer 16

Inhibit active factor 10

Question 17

Apixaban, Edoxaban and rivaroxaban- Clinical use

Answer 17

• Reduce risk of stroke and systemic embolization in pt with nonvalvular atrial fibrillation
• Prevention of DVT and PE in pt undergoing knee-or hip replacement surgery

Question 18

Apixaban, Edoxaban and rivaroxaban- Adverse effects

Answer 18

Bleeding

Question 19

Aspirin- MoA

Answer 19

Irreversible inhibition of COX and the synthesis of prostaglandins from arachidonic acid

Question 20

Aspirin- Clinical use

Answer 20

-Prevention of thromboembolic diseases (MI, stroke,

chronic limb ischemia etc.)

Question 21

Aspirin- adverse effects

Answer 21

GI bleeding and peptic ulcers, renal and hepatic dysfunction, lithium toxicity, hyperkalemia, platelet inhibition, premature closure of ductus arteriosus and Reye syndrome

Question 22

Aspirin- interactions

Answer 22

• Increases hypoglycemic effect of sulfonylureas
• Increases risk of GI bleeding and ulcers associated with methotrexate and valproate
• Inhibits uricosuric effect of probenecid

Question 23

Dipyridamole- MoA

Answer 23

It leads to coronary vasodilation and inhibition of platelet aggregation by blocking platelet uptake of adenosine

Question 24

Dipyridamole- Clinical use

Answer 24

• Used with aspirin in stroke prevention

- Produce vasodilation in myocardial perfusion imaging in pt with CAD

Question 25

Dipyridamole- Adverse effects

Answer 25

GI distress, headache and rash

Question 26

Cilostazol- MoA

Answer 26

Vasodilation and platelet inhibition by inhibition of type 3 PDE and thus inhibition of cAMP breakdown

Question 27

Cilostazol- Clinical use

Answer 27

-Treatment of intermittent claudication (pain and weakness in limbs due to arterial occlusion)

Question 28

Cilostazol- Adverse effects

Answer 28

Headache

Question 29

Clopidogrel, prasugrel, ticagrelor and cbangrelor- MoA

Answer 29

Inhibit platelet ADP receptors which inhibit activation of GP-2b/3a receptors and prevents ADP-induced platelet aggregation

Question 30

Clopidogrel, prasugrel, ticagrelor and cbangrelor- Clinical use

Answer 30

- Prevention of MI and stroke | - Prevention of thrombosis in sickle cell anemia, PCI and claudication

Question 31

Clopidogrel, prasugrel, ticagrelor and cbangrelor- Adverse effects

Answer 31

Bleeding, GI distress, hypercholesterolemia and neutropenia

Question 32

Clopidogrel- interactions

Answer 32

-PPIs (Omeprazole) inhibit clopidogrel activation by CYP

Question 33

Abciximab, Tirofiban and Eptifibatide- MoA

Answer 33

Inhibitors of platelet GP-2b/3a receptors and platelet aggregation

Question 34

Abciximab, Tirofiban and Eptifibatide- Clinical use

Answer 34

Prevent thrombosis in pt undergoing angioplasty and stent replacement

Question 35

Abciximab, Tirofiban and Eptifibatide- Adverse effects

Answer 35

Bleeding

Question 36

Vorapaxar- MoA

Answer 36

Occupies PAR-1 receptors, and inhibits thrombin access to its target receptor and thus prevents thrombin-mediated platelet aggregation

Question 37

Vorapaxar-Clinical use

Answer 37

Reduce thrombotic cardiovascular events

Question 38

Vorapaxar-Adverse effects

Answer 38

Bleeding

Question 39

Thrombolytic agents- names and MoA

Answer 39

Reteplase, alteplase, streptokinase, tenecteplase and anistreplase -They are recombinant forms of human t-PA which convert plasminogen to plasmin. Plasmin lead to clot dissolution

Question 40

Thrombolytic agents- Clinical use and adverse effects

Answer 40

- Used to treat thromboembolic diseases | - Adverse effect is bleeding

Question 41

Stop bleedings caused by: | -Warfarin, Heparins, Dabigatran and Fibrinolysis

Answer 41

Warfarin->Phytonadione Heparins->Protamine sulfate Dabigatran->Idarucizumab Fibrinolysis->Aminocaproic acid

Question 42

Contraindications to thrombolytics

Answer 42

Hemorrhage, hemophilia, hypertension, hypersensitivity, pregnancy, and Trauma/surgery (HHHHPT)