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Coagulation Drugs Flashcards

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1
Q

What drug activity is dependent on Antithrombin II?

A

Heparin

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2
Q

Heparin mainly affect w/ steps of the coagulation cascade?

A

Xa & Thrombin

Also effects: IXa, XIa, XIIa (aPTT pathway)

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3
Q

What drug accelerates the activity of ATII x 1000?

A

Heparin

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4
Q

What anti-coagulant is used before surgery, during operations, in IV catheters, for in-patient anticoagulation bridging?

A

Heparin

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5
Q

What form of heparin is used in IV?

A

High Molecular weight

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6
Q

What form of Heparin in used in subQ injections?

A

Low Molecular weight

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7
Q

Are the effects of Heparin immediate or delayed?

A

Immediate

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8
Q

Is the PTT or PT pathway the therapeutic target of Heparin?

A

PTT

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9
Q

What drug can you give to stop Heparin induced hemorrhage?

A

Protamine sulfate

heParin –> Protamine, share a P

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10
Q

What autoimmune reaction can occur as a result of Heparin use?

A

Heparin induced Thrombocytopenia (HIT)

Pt is never able to be on Heparin again

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11
Q

Caution with Heparin use in pts w/ what dysfunction (2)

A

Renal

Hepatic

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12
Q

Heparin is contraindicated in what pts? (4)

A
  1. Actively bleeding
  2. Hemophilia/other blood clotting disorders
  3. Hypersensitivity (previous HIT)
  4. During/after surgery on the brain, spinal cord, eye
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13
Q

Enoxaprin HMW or LMW heparin?

A

LMW

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14
Q

What synthetic pentasaccharide acts on factor Xa?

A

Fondaparinux

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15
Q

Do Enoxaprin and Fondaparinux have any effect on Thrombin?

A

No, only inhibitory action is on factor Xa

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16
Q

What is the DOC for subQ anti-coagulation therapy?

A

LMW drugs: Enoxaprin and Fondaparinux

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17
Q

Is HMW or LMW Heparin safe in pregnanct, outpatient bridging, once/day dosing?

A

LMW drugs: Enoxaprin and Fondaparinux

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18
Q

Will LMW Heparin (Enoxaprin and Fondaparinux) increase or lower the incidence of HIT?

A

Lower

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19
Q

Will protamine also work as a reversal agent on Enoxaprin and Fondaparinux?

A

Won’t completely reverse Enoxaprin

No effect on Fondaparinux

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20
Q

Dabigatran (Pradaxa) is from what class of anticoagulants?

A

Direct Oral thrombin inhibitors

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21
Q

Do you monitor Dabigatran with PTT?

A

No b/c predictable anticoagulant effects

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22
Q

Dabigatran is contraindicated in pts w/ what?

A

mechanical heart valves

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23
Q

What is the antidote for Dabigatran?

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A

Idarucizumab (PRAXbind)

24
Q

Black box warning for Dabigatran?

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A

Avoid abrupt discontinuation w/o alternative anticoagulation?

25
What class of meds are: RivaroXABAN (Xarelto) and ApiXABAN?
Direct Oral Inhibitors of factor Xa | -XABAN
26
What drug is given in the prevention of stroke pts w/ non-valvular A-fib?
Dabigatran
27
What drug is used for DVT, PE, and future clot prophylaxis?
Rivaroxaban & Apixaban
28
Direct Oral Factor Xa inhibitors are contraindicated in pts w/ what?
Liver disease, renal failure Cleared by Kidney and Liver (CYP34A)
29
What is the antidote for Direct Factor Xa Inhibitors?
Factor Xa decoy (AndexXA)
30
Inhibition of the reduction of Vit. K is the MOA for what drug?
Warfarin
31
What clotting factors does Warfarin block?
II, VII, IX, X, Protein C & S
32
Are the effects of Warfarin immediate or delayed?
Delayed, peak effect after 48 hours
33
What lab is used to monitor Warfarin therapy?
INR
34
How long will Warfarin stay in your system after discontinuing?
4-5 days (t1/2 = 36 hrs)
35
Is Warfarin given to prevent emboli or target already formed thrombi?
Prevent emboli, DVT, thrombi (so given chronically). | No effect on already formed thrombi
36
What drug is co-administered w/ Warfarin during initiation of therapy? Why?
Heparin Warfarin quickly reduces levels of protein C during therapy initiation --> Warfarin induced thrombosis --> cutaneous necrosis and infarct
37
Vit. K and fresh frozen plasma are reversal agents for what anti-coagulant?
Warfarin Vit K = slower reversal FFP = fast reversal
38
Bowel hemorrhage is an adverse of what anti-coagulant?
Warfain
39
Is Warfarin safe in pregnancy?
No (can cross placenta)
40
T or F: Warfarin interacts w/ a high # of drugs?
TRUE Drugs that affect: Vit. K, Clotting factors - estrogen (oral contraceptives), platelet aggregation/function (aspirin), inhibit/induce liver microsomal enzymes
41
What class of drug is Alteplase/Tissue plasminogen activator (tPA)?
Fibronlytic agent
42
What drug converts plasminogen to plasmin?
Alterplase/tPA
43
What drug lysis clots?
Alterplase/tPA
44
Antidote for Alterplase/tPA?
Aminocaproic acid and whole blood if necessary
45
Aminocaproic acid and Tranexamic acid are what class of drugs?
Antifibrinolytics - given as reversal for fibrinolytic therapy
46
Aminocaproic acid and Tranexamic acid are contraindicated in what pts?
Pt w/ DIC, upper GU bleed (can lead to excessive clotting)
47
What 3 drugs are inhibitors of Thrombogenesis (increase bleeding time)?
Clopidogrel Aspirin Abciximab
48
What drug irreversible inhibits COX enzyme?
Aspirin
49
What drug is used as secondary prevention of CV events in pts w/ established CVD?
Aspirin
50
What two oral drugs irreversibly block ADP receptor on platelets?
Clopidogrel and Ticagrelor
51
When would you use Clopidogrel and Ticagrelor OVER Aspirin?
If pt has aspirin allergy
52
What 2 meds are DOC for pts w/ coronary stents?
Ticagrelor (lower # death/CV endpoints) > Clopidogrel
53
Clopidigrel interacts with what drugs?
CYP2C19. Ex: Omperazole
54
What IV med is an Ab to GP IIb/IIIa receptor?
Abciximab
55
How does Abciximab decrease platelet aggregation?
Inhibits GP IIb/IIIa receptors from binding to fibrinogen
56
When is Abciximab used?
Due cardiac procedures
57
Adverse effects of Abciximab?
Bleeding and thrombocytopenia

Pharm II (13 decks)

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