PAD

Question 1

What is the main cause for PAD?

Answer 1

Smoking or DM have greatest risk

Question 2

What are the 2 complications of PAD?

Answer 2

1. Critical limb ischemia

2. Stroke and Heart Attack

Question 3

What can pseudoephedrine and OTC meds predispose you to?

Answer 3

Vasoconstrict so bad in PAD

Question 4

What is found on physical exam of PAD?

Answer 4

ABI < 0.9
Weak or absent pedal pulses with bruit
Poor wound healing
Tredmill test is positive to assess severity while walking

Note that with DVT we will see swelling, pain, red/discolored skin, warmth

Question 5

What are the tests to check PAD dx?

Answer 5

1. Ultrasound = identify blocked arteries
2. Angiography = view blood flow
3. Blood tests = lipid, fasting glucose

Question 6

This med is a type 3 PDE inhibitor that prolongs the life of cAMP in platelets and cells to promote aggregation and vasodilate

Answer 6

Cilostazol

Question 7

When is Cilostazol contraindicated?

Answer 7

Heart failure patients - especially Class III and IV patients

Question 8

What imaging can be done for DVT dx?

Answer 8

Ultrasound
Blood Test = D-dimer
Venography = visualize via Xray
CT/MRI

Question 9

What are the only 3 oral drugs for DVT treatment? Rest are parenteral

Answer 9

Warfarin, thrombin inhibitor, factor Xa inhibitor

Can also treat with compression stockings, stents, and vena cava filter

Question 10

Antiplatelet drugs break up

Answer 10

white clots

Question 11

Anticoagulant drugs block. Complication?

Answer 11

red clots (fibrin)

Spinal or epidural hematoma

Question 12

Intrinsic pathway is represented by:

Answer 12

aPTT - we mix phospholipids, activator, and Ca2+ in the patient’s plasma and evaluate serine protease factors (2, 9, 10, 11, 12)

HEPARIN

WAR IS OUTSIDE SO HEPARIN MUST BE INSIDE

Question 13

Extrinsic pathway is represented by:

Answer 13

PT - time to coagulation after addition of tissue factor - then normalized to INR

WARFARIN you lose lots of tissue

Question 14

Use this drug to treat RAPIDLY for PE, Stroke, DVT, DIC, acute MI

Answer 14

Heparin

Question 15

MOA of heparin?

Answer 15

Binds to and activates antithrombin III to inhibit factor Xa then thrombin

Question 16

This drug prevents formation of red clots

Answer 16

Heparin

Question 17

Can heparin be used in pregnancy?

Answer 17

yes

Question 18

When is heparin contraindicated?

Answer 18

• Thrombocytopenia
• Uncontrollable bleeding
• Avoid using during any surgery or procedure involving CNS or eyes (also enoxaparin)
• BLEEDING IS HUGEST CONCERN

Question 19

What does enoxaparin and fondiparinaux inhibit?

Answer 19

LMWH - inhibits Factor Xa

Question 20

This drug is used for prevention DVT after abdominal surgery or hip/knee replacement

Answer 20

Enoxaparin

Question 21

This drug is used for ischemic pcomplications in unstable angina or STEMI

Answer 21

Enoxaparin

Question 22

What is the first choice for treatment and prevention of DVT?

Answer 22

Enoxaparin, much longer half lives and dosing is predictable

Question 23

What is the antidote to enoxaparin?

Answer 23

Protamine

Question 24

This drug is used to treat PE or DVT with warfarin

Answer 24

Fondiparinaux

Question 25

This is an anticoagulant that must be stopped 4-5 days before surgery

Answer 25

Fondiparinaux

Question 26

What anticoagulant is not reversible by protamine?

Answer 26

Fondiparinaux

Question 27

This drug does not cause heparin induced thrombocytopenia

Answer 27

Fondiparinaux

Question 28

The benefit to using bivalirudin over heparin?

Answer 28

Doesn't need antithrombin and causes less bleeding, but there's no antidote

Question 29

This drug is given in combination with aspirin for angioplasty patients

Answer 29

Bivalirudin

Question 30

What's the difference in MOA of bivalirudin and trobin?

Answer 30

``` Bivalirudin = directly blocks thrombin Argatroban = directly binds catalytic site of thrombin ```

Question 31

How do we monitor if argatroban is working?

Answer 31

Monitor aPTT

Question 32

What is the challenge associated with warfarin dosing?

Answer 32

Genetic variability | Note that the CYP2C9 substrate is S-warfarin and polymorphisms of this in whites lead to lower clearance rates

Question 33

What makes warfarin resistant in blacks but sensitive in asians?

Answer 33

VKORC1 haplotype

Question 34

This drug is used for long-term prophylaxis of thrombosis in mechanical heart valves, PE, atrial fibrillation, but cannot be used in emergencies

Answer 34

Warfarin

Question 35

How do we monitor warfarin?

Answer 35

It's 100% bioavailable orally but it is eliminated by liver in bile, has slow onset and slow offset We monitor with PT, INR = 2-3, and check more frequently if you add or subtract a drug

Question 36

What happens when bleeding occurs with warfarin?

Answer 36

Discontinue warfarin immediately and administer Vitamin K to reverse

Question 37

Why do we get cutaneous necrosis with warfarin?

Answer 37

Protein C has a shorter half life than several other clotting factors so pro-coagulant state initially

Question 38

This drug can be used to prevent DVT and PE after hip/knee replacement and prevent stroke in patients with nonvalvular atrial fibrillation

Answer 38

Rivaroxaban Note that mechanical heart valves are contraindicated in Dabigatran

Question 39

What can we use as an antidote to rivaroxaban?

Answer 39

Andaxanet alfa

Question 40

What drug must be kept in a supplied dessicator bottle?

Answer 40

Dabigatran

Question 41

General concern with all anticoagulants in terms of adverse effects

Answer 41

Bleeding and cranial issues