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PHARM > hemostatsis and thrombosis Rx > Flashcards

hemostatsis and thrombosis Rx Flashcards

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1
Q

vita k antag

A

warfarin (po and IV)

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2
Q

warfarin moa

genetics? only effective when?

A

Inhibits vitamin K epoxide reductase component 1
(VKORC1). Preventing the formation of vitamin K
dependent clotting factors (II, VII, IX, X, protein C, protein S).

The VKORC1 gene is polymorphic resulting in different affinities for warfarin.

Only effective in vivo

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3
Q

warfarin adrs

A

Bleeding (can be life threatening)- GI bleeding most common
Rash
Skin necrosis
Taste disturbance
“Purple toe” syndrome

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4
Q

warfarin dental

A

Bleeding- most procedures can be done without
holding medication

Antibiotic use after dental procedure may increase
risk of bleeding

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5
Q

unfractionated heparin

A

heparin (sq and IV)

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6
Q

heparin moa

works when?

A

Activation of antithrombin III, thereby inactivating Factor Xa and Thrombin (factor II).
Inhibits coagulation in vivo and in vitro

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7
Q

heparin adrs

A

Bleeding (can be life threatening)
Thrombosis- both HAT and HIT
Osteoporosis
Aldosterone inhibition-leading to hyperkalemia
Hypersensitivity reaction

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8
Q

heparin dental

A

Bleeding/bleeding gum
Although unlikely to be on heparin during dental
treatment

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9
Q

Low Molecular Weight Heparin (LMWH names

forms

A

Enoxaparin
Dalteparin
Tinzaparin
Available: SQ

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10
Q

LMWH moa

in vivo/vitro?

A

Activation of antithrombin III, thereby inactivating Factor Xa.

Smaller portion of the heparin molecule therefore not large enough to interact with thrombin (factor II).

Inhibits coagulation in vivo and in vitro.

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11
Q

LMWH adrs

A

Same as UFH
Bleeding (can be life threatening)
Thrombosis- both HAT and HIT- HIT less common with
LMWHs
Osteoporosis
Aldosterone inhibition-leading to hyperkalemia
Hypersensitivity reaction

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12
Q

LMWH dental

A

Bleeding- most procedures can be done without
holding medication

Coagulation tests (PT/aPTT) are insensitive to anticoagulant effects of LMWHs

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13
Q

Direct Thrombin Inhibitors

forms

A

Argatroban-Available: IV
Bivalirudin- Available: IV
Dabigatran- Available: PO

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14
Q

direct thrombin inhibitors moa

A

Binds to the fibrin- binding sites of thrombin preventing the conversion of fibrinogen

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15
Q

direct thrombin inhibitors adrs/ names

A

Argatroban/Bivalirudin: bleeding (life threatening)

Dabigatran: Bleeding (can be life threatening)- new reversal agent available and Dyspepsia/gastritis with dabigatran due to formulation

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16
Q

direct thrombin inhibitors dental

A

Bleeding- Although unlikely to be on argatroban or bivalirudin during dental treatment

Bleeding- most procedures can be done without holding dabigatran

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17
Q

factor Xa inhibitors

forms

A

Apixaban-Available: PO
Edoxaban- Available: PO
Fondaparinux- Available: SQ
Rivaroxaban- Available: PO

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18
Q

factor Xa inhibitors moa

A

Binds to factor Xa and
prevent the conversion
of prothrombin to
thrombin

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19
Q

factor Xa inhibitors adrs

A

bleeding

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20
Q

factor Xa inhibitors dental

A

Bleeding- most procedures
can be done without
holding medications

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21
Q

cox inhibitor

A

aspirin (PO)

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22
Q

aspirin MOA

A

Inhibits cyclo-oxygenase 1 (COX 1). Prevents formation of prostaglandin which is subsequently converted to
thromboxane A2

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23
Q

aspirin adrs

A

Bleeding (GI most common)
Dyspepsia
Rash
Angioedema
Tinnitus
Respiratory distress

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24
Q

aspirin dental

A

Bleeding- although most procedures can be completed without holding medication

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25
P2Y12 inhibitors and forms
Cangrelor- Available: IV Clopidogrel- Available: PO Prasugrel- Available: PO Ticagrelor- Available: PO
26
P2Y12 inhibitor moa
Inhibition of ADP binding at the P2Y12 receptor
27
P2Y12 inhibitors adrs/ names
Cangrelor- Bleeding (major) and Renal insufficiency Clopidogrel/ Prasugrel/ Ticagrelor- * Bleeding more common when combined with ASA * Skin rash (more common with clopidogrel) * Thrombocytopenia * Dyspnea and elevated serum creatinine- unique to ticagrelor
28
P2Y12 inhibitors dental
Bleeding- although it is unlikely patients will be on cangrelor during tx Clopidogrel/ Prasugrel/ Ticagrelor: Bleeding- it is recommended to continue therapy through dental procedure.
29
Glycoprotein IIb/IIIa inhibitors | forms
Eptifibatide Tirofiban Both Available: IV
30
Glycoprotein IIb/IIIa inhibitors moa
Bind to GP IIb/IIIa receptor preventing the final common pathway of platelet aggregation
31
Glycoprotein IIb/IIIa inhibitors adrs/ names
Bleeding- highest incidence of all antiplatelet medications Thrombocytopenia Eptifibatide and Tirofiban
32
Glycoprotein IIb/IIIa inhibitors dental
Bleeding- although it is unlikely patients will be on these medications during procedure
33
PAR-1 antagonist name | form
Vorapaxar Available: PO
34
vorapaxar moa
Antagonist of the PAR-1 inhibiting thrombin receptor agonist peptide (TRAP)- induced platelet aggregation Does not effect the conversion of fibrinogen to fibrin by thrombin
35
vorapaxar adrs
bleeding
36
vorapaxar dental
Bleeding-no recommendations made regarding whether or not to hold medication during procedure
37
Fibrinolytic Therapy (Plasminogen activators) | form
Alteplase Reteplase Tenecteplase Available: IV
38
Fibrinolytic Therapy (Plasminogen activators) moa
Binds to tissue bound fibrin and plasminogen converting plasminogen to plasmin (fibrin specific)
39
Fibrinolytic Therapy (Plasminogen activators adr
bleeding (mostly at infusion site)
40
Fibrinolytic Therapy (Plasminogen activators dental
Bleeding- although it is unlikely that a patient will be receiving these medications during procedure
41
Antifibrinolytic Therapy (Hemostatic agents) | forms
Aminocaproic acid Tranexamic acid Available: PO and IV
42
Antifibrinolytic Therapy (Hemostatic agents moa
Competitive inhibition of plasminogen activation by binding to plasminogen At higher concentrations non- competitive inhibition of plasmin
43
Antifibrinolytic Therapy (Hemostatic agents) adrs | IV vs PO
IV- hypotension and giddiness PO- headache, abdominal pain, and nasal/sinus symptoms
44
Antifibrinolytic Therapy (Hemostatic agents) dental
Used as an off-label indication to prevent or treat dental bleeding
45
Enoxaparin moa
LMWH: Activation of antithrombin III, thereby inactivating Factor Xa. Smaller portion of the heparin molecule therefore not large enough to interact with thrombin (factor II). Inhibits coagulation in vivo and in vitro.
46
dalteparin moa
LMWH Activation of antithrombin III, thereby inactivating Factor Xa. Smaller portion of the heparin molecule therefore not large enough to interact with thrombin (factor II). Inhibits coagulation in vivo and in vitro.
47
tinzaparin moa
Activation of antithrombin III, thereby inactivating Factor Xa. Smaller portion of the heparin molecule therefore not large enough to interact with thrombin (factor II). Inhibits coagulation in vivo and in vitro.
48
Argatroban moa
Binds to the fibrin- binding sites of thrombin preventing the conversion of fibrinogen
49
bivalirudin moa
Binds to the fibrin- binding sites of thrombin preventing the conversion of fibrinogen
50
dabigatran moa
Binds to the fibrin- binding sites of thrombin preventing the conversion of fibrinogen
51
apixaban moa
Binds to factor Xa and prevent the conversion of prothrombin to thrombin
52
edoxaban moa
Binds to factor Xa and prevent the conversion of prothrombin to thrombin
53
fondaparinux moa
Binds to factor Xa and prevent the conversion of prothrombin to thrombin
54
rivarobaxan moa
Binds to factor Xa and prevent the conversion of prothrombin to thrombin
55
Cangrelor moa
Inhibition of ADP binding at the P2Y12 receptor
56
clopidigrel moa
Inhibition of ADP binding at the P2Y12 receptor
57
prasugrel moa
Inhibition of ADP binding at the P2Y12 receptor
58
ticagrelor moa
Inhibition of ADP binding at the P2Y12 receptor
59
Eptifibatide moa
Bind to GP IIb/IIIa receptor preventing the final common pathway of platelet aggregation
60
tirofiban moa
Bind to GP IIb/IIIa receptor preventing the final common pathway of platelet aggregation
61
Alteplase moa
Binds to tissue bound fibrin and plasminogen converting plasminogen to plasmin (fibrin specific)
62
reteplase moa
Binds to tissue bound fibrin and plasminogen converting plasminogen to plasmin (fibrin specific)
63
tenecteplase moa
Binds to tissue bound fibrin and plasminogen converting plasminogen to plasmin (fibrin specific)
64
Aminocaproic acid moa
Competitive inhibition of plasminogen activation by binding to plasminogen At higher concentrations non-competitive inhibition of plasmin
65
tranexaminic acid moa
Competitive inhibition of plasminogen activation by binding to plasminogen At higher concentrations non-competitive inhibition of plasmin

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