Coag Drugs

Question 0

Heparin affects which factors (5)

Answer 0

Mainly: Xa and Thrombin
Also: IXa, XIa, and XIIa

Question 1

HMW heparin binds to?

Answer 1

Antithrombin III

Question 2

heparin antidote

Answer 2

protamine sulfate

Question 3

LMW heparin MOA

Answer 3

inhibits factor Xa

Question 4

protamine sulfate & LMW heparin (2)

Answer 4

does not completely reverse Enoxaprin

No effect of Fondaparinux

Question 5

LMW indications (3)

Answer 5

subcutaneous injection- not IV
Replacement for warfarin in pregnancy
Lower incidence of heparin-induced thrombocytopenia

Question 6

direct thrombin inhibitors (3)

Answer 6

lepirudin
argatroban
dabigatran

Question 7

heparin contraindications (3)

Answer 7

Renal or hepatic dysfunction
Active bleed, hemophilia, after brain/spinal cord/eye surgery
Hx of heparin-induced thrombocytopenia

Question 8

Lepirudin MOA

Answer 8

highly specific direct inhibitor of thrombin

from leeches

Question 9

Lepirudin use & cautions

Answer 9

Alternative in HIT
IV only
hypersensitivity rxns
Caution in pts w/ poor renal fxn- use argatroban instead

Question 10

Argatroban MOA

Answer 10

direct inhibitor of thrombin

Question 11

Argatroban use and cautions (4)

Answer 11

given as alternative in HIT
cleared by liver
IV
caution w/ poor liver fxn- use lepirudin instead

Question 12

dabigatran MOA

Answer 12

Oral direct thrombin inhibitor

Question 13

dabigatran use (3)

Answer 13

prevention of stroke in A Fib pts
Predictable anticoag effects- not monitored by PTT
Cleared by kidneys

Question 14

dabigatran black box warning?

Answer 14

avoid abrupt discontinuation w/o alternative anticoagulation

Question 15

oral factor Xa inhibitors (2)

Answer 15

Rivaroxaban (Xarelto)

Apixaban (Eliquis)

Question 16

rivaroxaban (xarelto) use (3)

Answer 16

DVT
PE
future clots

Question 17

xarelto & eliquis contraindications (2)

Answer 17

renal failure

liver disease

Question 18

warfarin MOA

Answer 18

Inhibits vitamin K epoxide reductase

Question 19

Warfarin interferes with which clotting factors?

Answer 19

II
VII
IX
X
Protein C & S

Question 20

heparin is monitored by?

Answer 20

PTT

Question 21

warfarin is monitored by?

Answer 21

INR

Question 22

Warfarin uses (5)

Answer 22

Prevent emboli development
DVT
Thromboembolism
No effect on already-formed thrombi
Given chronically

Question 23

Warfarin antidotes (2)

Answer 23

Vitamin K: takes time

FFP: immediate

Question 24

Warfarin adverse effects (3)

Answer 24

Hemorrhage warfarin-induced thrombosis ---> cutaneous necrosis & infarction liver enzyme changes

Question 25

Warfarin contraindications (4)

Answer 25

pregnancy- category X Vit K- antibiotics OCPS Aspirin

Question 26

thrombolytic agents (3)

Answer 26

Alteplase (t-PA) Reteplase Tenecteplase

Question 27

Thrombolytic Agents MOA (2 things)

Answer 27

converts plasminogen to plasmin | lyses thrombus from within

Question 28

what does clot selective mean

Answer 28

higher activity for fibrin-bound plasminogen vs. plasma plasminogen

Question 29

Alteplase uses (2)

Answer 29

lysis of clots to re-establish tissue perfusion | severe PE, DVT, and arterial thromboses

Question 30

treatment of Alteplase-related bleeding?

Answer 30

aminocaproic acid and whole blood

Question 31

Alteplase contraindications

Answer 31

stroke pts

Question 32

Antifibrolytics (2)

Answer 32

Aminocaproic acid | Tranexamic acid

Question 33

Antifibrinolytic MOA (2)

Answer 33

inhibits plasminogen activation | inhibits streptokinase activity ---> decrease plasmin formation

Question 34

antifibrinolytic uses (3)

Answer 34

bleeding disorders adjunct in hemophilia reveral of fibrinolytic therapy

Question 35

Aminocaproic acid adverse effects (3)

Answer 35

Intravascular thrombosis Hypotension Nasal stuffiness

Question 36

Aminocapric acid contraindications (2)

Answer 36

DIC | genitourinary bleeding

Question 37

aspirin MOA

Answer 37

irreversible inhibition of COX enzyme --> decreased TXA2

Question 38

clopidigrel MOA (2)

Answer 38

irreversibly blocks the ADP receptor on platelets | inhibits platelet aggregation

Question 39

clopidigrel uses (3)

Answer 39

aspirin allergy decrease thrombolytic events following MI & stroke prevent thrombosis in pts undergoing coronary stent placement

Question 40

clopidigrel adverse rxns

Answer 40

bleeding | drug interactions via CYP2C19

Question 41

abciximab, eptifibatidine, tirofiban MOA

Answer 41

decrease platelet aggregation by inhibiting GPIIb/IIIa receptors from binding fibrinogen

Question 42

hemostasis achieved by (3)

Answer 42

Vascular contraction Platelet adhesion, activation, and aggregation Fibrin formation & platelet plug

Question 43

arteries, high flow will form

Answer 43

white thrombus

Question 44

veins, low flow will form

Answer 44

red thrombus- dangerous