Coagulation

Question 1

Factor Xa inhibitor examples

Answer 1

Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Endoxaban (Savaysa)
Betrixaban (Bevyxxa)

Question 2

Warfarin (Coumadin)

Inhibits synthesis

Answer 2

of vitamin K–dependent clotting factors X, IX, VII, and II (prothrombin)

Question 3

Heparin

Binds with

Answer 3

antithrombin III

Inactivates factors IXa, Xa, XIIa, XIII

Question 4

Low-molecular-weight heparin (LMWH)

Regular heparin is processed

Answer 4

into smaller molecules

Question 5

examples of LMWH and action

Answer 5

Enoxaparin (Lovenox), dalteparin (Fragmin)

Inactivates factor Xa

Question 6

Fondaparinux (Arixta)

Selective inhibitor of

Answer 6

antithrombin III and factor Xa inhibitor

Question 7

Heparin and LMWH sometimes will be given as a bridge until

Answer 7

warfarin is effective

Question 8

Warfarin is well absorbed when taken

Answer 8

orally

Question 9

warfarin is metabolized by and half life

Answer 9

CYP1A2 and 2C9

Half-life of 3 to 4 days

Question 10

Warfarin precautions and contraindications

Answer 10

Pregnancy category X
Use cautiously in patients with fall risk, dementia, or uncontrolled hypertension
Avoid in hypermetabolic state

Question 11

Warfarin ADR

Answer 11

Bleeding
Antidote is vitamin K
Allergic reactions

Question 12

Warfarin Drug Interactions

Answer 12

Bleeding
Antidote is vitamin K
Allergic reactions

Question 13

Warfarin anticoagulant effect may be decreased by

Answer 13

Oral contraceptives, carbamazepine, etc.

Vitamin K–containing foods

Question 14

Warfarin clinical use and dosing

Answer 14

Start at 5 mg per day (7.5 mg/day if weight greater than 80 kg)

Question 15

Warfarin is the drug of choice for

Answer 15

Drug of choice for deep vein thrombosis (DVT) and pulmonary embolism (PE

Question 16

Consider lower dose of Warfarin if

Answer 16

Older than 75 years
Multiple comorbid conditions
Elevated liver enzymes
Changing thyroid status

Question 17

Dose of warfarin is to maintain an INR between

Answer 17

2 and 3

Question 18

Warfarin monitoring

Answer 18

INR daily until in therapeutic range for 2 consecutive days
Then two or three times weekly for 1 to 2 weeks
Then less frequently but at least every 6 weeks

Question 19

Factor Xa directly inhibits

Answer 19

Factor Xa in the clotting cascade

Question 20

Factor Xa reduction in

Answer 20

risk of stroke and systemic embolism in nonvalvular atrial fibrillation

Question 21

Factor Xa is used as prophylaxis of

Answer 21

DVT following knee replacement surgery

Question 22

Per the American college of clinical pharamcy the treatmen tfor DVT or PE after initial stabilization is

Answer 22

Factor Xa (dibigatron, rivaroxaban, apixaban or endoxaban for 3 months.)

Warfarin is second line

Question 23

Factor Xa inhibitors and interacting drugs

Answer 23

Betrixaban and P-glycoprotein (P-gp) inhibitors
Apixaban and P-gp or CYP3A4 inhibitors
Rivaroxaban and P-gp/CYP3A4 inducers
Vorapaxar and CYP3A inhibitors

Question 24

Oral Direct Thrombin Inhibitors example

Answer 24

Dabigatran (Pradaxa)

Question 25

Dabigatran is the only

Answer 25

oral direct thrombin inhibitor available for clinical use

Question 26

Dabigatran is an orally administstred

Answer 26

prodrug that is converted in the liver to dabigatran, an active direct thrombin inhibitor that inhibits clot-bound and circulating thrombin

Question 27

dabigatran half life

Answer 27

12 to 17 hours (normal renal function)

Question 28

Dabigatran use

Answer 28

prevention and management of VTE, stroke prevention in afib and ischemic heart disease

Question 29

Dabigatrain contraindications

Answer 29

prosthetic heart values or pregnancy

Question 30

dabigatrain

Answer 30

no monitoring

Question 31

dabigatrain monitoring

Answer 31

none

Question 32

dabigatran before initiation

Answer 32

platelet count, PT, aPTT – after that no routine monitoring

Question 33

dabigatran SE

Answer 33

GI

Question 34

ASA MOA and how long to efffects last

Answer 34

binding irreversibly to the enzyme cyclooxygenase in platelets, which inhibits the formation of thromboxane A2, a powerful inducer of platelet aggregation. **Effects may persist up to a week.

Question 35

ASA indication

Answer 35

prevention of stroke & MI

Question 36

Adenosine diphosphate (ADP) receptor blockers – Examples

Answer 36

Ticlopidine & Clopidogrel (examples)

Question 37

Adenosine diphosphate (ADP) receptor blockers – MOA

Answer 37

irreversibly block the ADP receptors, altering the plasma membrane of platelets.

Question 38

Glycoprotein IIb/IIIa receptor antagonists | MOA*:

Answer 38

block the glycoprotein IIb/IIIa receptors

Question 39

Glycoprotein IIb/IIIa receptor antagonists - Indication

Answer 39

prevent thrombi in recent MI, stroke or PCI

Question 40

With warfarin monitor

Answer 40

intake of Vit K. eg. green leafy vegitables