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Pharm Fall 2019 > Ex3 Anticoagulants > Flashcards

Ex3 Anticoagulants Flashcards

(74 cards)

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1
Q

Big offender in bleeding disorders

A

herbals: garlic, fish oil, ginko

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2
Q

Disorders of Hemostasis: definition

A

increased risk of bleeding

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3
Q

Prothrombotic states: definition

A

increased risk for clotting

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4
Q

HIT

A

prothrombotic state

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5
Q

antiphospholipid antibody syndrome

A

prothrombotic state

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6
Q

DIC

A

prothrombotic state AND disorder of hemostasis

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7
Q

Liver disease

A

prothrombotic state AND

disorder of hemostasis

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8
Q

Hemophilias

A

disorder of hemostasis

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9
Q

Von Wilibrand disease

A

disorder of hemostasis

Factor 8 low

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10
Q

Vitamin K dependent clotting factors

A

Factors 2, 7, 9, 10

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11
Q

Vitamin K deficiency

A

disorder of hemostasis

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12
Q

Heparin MOA

A

Binds to antithrombin III

–>inhibits fxn factors

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13
Q

LMWH differs from UFH

A

More specific for inhibition of Xa

Renal excretion

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14
Q

UFH differs from LMWH

A

quick on, quick off, metabolized via endothelium

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15
Q

T/F: heparins & warfarin are dialyzable

A

False

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16
Q

UFH advantages

A

short half life, renal dysfxn does not impact clearance, antidote available

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17
Q

UFH disadvantages

A

frequent lab monitoring, HIT

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18
Q

LMWH advantages

A

no lab monitoring needed

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19
Q

LMWH disadvantages

A

Cannot be fully reversed

Renal elimination

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20
Q

Tx for HIT

A

direct thrombin inhibitors

Bivalrudin/Argatroban

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21
Q

aPTT is effected by

A

UFH

not affected by LMWH

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22
Q

Lab monitoring used in CABG

A

ACT

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23
Q

Anti-factor Xa Lab Test

A
  • both LMWH/UFH
  • most often for LMWH
  • UFH: used for heparin resistance
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24
Q

DOC: UFH reversal

A

protamine

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25
Protamine contraindications
-fish allergy
26
Protamine adverse effects
- Anaphylaxis (fish allergy, vasectomy, pt on NPH) - acute pulm vasoconstriction, hypotension, bradycardia - slow infusion
27
Protamine dose
1 mg protamine reverses 100 units UFH IV
28
Protamine dose based on
UFH over past 2-3 hours
29
Max protamine
50 mg in 10 minutes
30
Reversal agent LMWH
None specific to LMWH | -protamine partially effective
31
Dosage for LMWH reversal
- 1mg protamine per 1 mg enoxaparin given w/in last 8h | - Max dose 50mg
32
After max dose protamine
0.5 mg for every 1mg (LMWH) and 100 units (UFH) if bleeding continues
33
reason Recombinant factor VIIa not used often
high risk for thrombosis
34
4F-PCC contraindicated
- HIT - Heparin allergy (only factor product +heparin)
35
Vitamin K antagonist
Warfarin
36
Warfarin MOA
Inhibits activation of Vit.K dependent clotting factors (Factors 2, 7, 9, 10, Protein C+S)
37
Onset Warfarin
Full anticoagulation effect not achieved until 4 days
38
What is needed during initiation of warfarin?
LMWH/UFH d/t hyper-coagulable state
39
reversal of warfarin | elective/nonurgent surgery
oral/iv vitaminK
40
reversal of warfarin | urgent surgery
4 factor PCC + IV vitamin K
41
reversal of warfarin | minor bleeding
iv vitamin k
42
reversal of warfarin | major bleeding
4 factor PCC + IV vitamin k
43
risk of PCC
increased risk of thromboembolic event
44
unique aspect of dabigatran
dialyzable (57% over 4h)
45
Bivalrudin/argatroban reversal
Supportive care/time
46
Dabigatran reversal
- activated charcoal if w/in 2 hours | - Idarucizumab direct reversal
47
no role for reversal if presentation ________ after cessation of therapy
3-5 half lives
48
No role for ______ to reverse DTIs
plasma
49
advantages of NOACs
no lab monitoring
50
disadvantages of NOACs
not indicated for mechanical valve
51
Direct factor Xa inhibitors - which are dialyzable?
Apixaban (minimal) | No - Rivaroxaban, Edoxaban
52
Standard monitoring for NOACs
-thrombin time -CBC w/ differential -renal/hepatic function (dabi - only renal fxn)
53
S/S OD dabigatran
aPTT > 2.5x control
54
Reversal of rivaroxaban, apixaban
Andexxa - w/in 2h: active charcoal - bolus then infusion
55
injectable Xa inhibitor
Fondaparinux | -no direct reverse (only activated PCC)
56
What should you do prior to neuraxial anesthesia?
Check Azra guidelines
57
avoid neuraxial anesthesia in patients taking
fibrinolytics/thrombolytics
58
length of time to d/c heparin prior to neuraxial anesthesia
4-6h
59
ideal situation if pt on anticoagulants & needs to go to OR
bridge with short acting parenteral therapy (UFH/LMWH)
60
Warfarin should be held _____ prior to OR
5 days
61
LMWH should be held _____ prior to OR
24h
62
UFH should be held _____ prior to OR
4h
63
antiplatelet agents
- clopidogrel, prasugrel, ticagrelor, cangrelor - aspirin, NSAIDs - dipyridamole
64
Prodrugs
Clopidogrel | Prasugrel
65
inhibitors (antifungal/sedatives/antiepileptics) with clopidogrel
prevents breakdown of drug to active form | *same w/ prasugrel
66
Percent platelet inhibition
aspirin - 20 clopidogrel - 40 prasugrel - 70 ticagrelor - 95
67
Reversible platelet binding
Ticagrelor
68
IV antiplatelet agent
cangrelor | continuous infusion
69
metabolism of cangrelor
metabolized by dephosphorylation - restores platelets QUICKLY * independent of organ dysfunction * not dialyzable
70
AE desmopressin
tachyphylaxis
71
Antiplatelet agents in high risk pts before surgery
Cangrelor or glycoprotein IIb/IIIa inhibitors
72
Glycoprotein IIb/IIIa inhibitors
tirofiban | eptifibatide
73
antifibrinolytic agents
aminocaproic acid | tranexamic acid
74
risk of tranexamic acid
seizures d/t possible block of GABA receptors

Pharm Fall 2019 (33 decks)

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