Pharmacology

Question 1

What is the mechanism of action for ASA

Answer 1

Anti platelet - cyclooxygenase inhibitor, prevents synthesis of TXA2 to inhibit platelet aggregation

Question 2

What are the primary indications for ASA

Answer 2

prevention of thrombosis, MI, thrombotic stroke

Question 3

What monitoring is required for ASA

Answer 3

none

Question 4

Does ASA have an antidote? If so what?

Answer 4

no - effect is irreversible for life of platelet (7-10days)

Question 5

What is the mechanism of action for unfragmented Heparin

Answer 5

Antithrombin activator - QUICKLY helps antithrombin inactivate clotting factors thrombin & Xa to prevent formation of fibrin

Question 6

What route can Heparin be administered

Answer 6

Sub q or IV

Question 7

What are the major AEs associated with Heparin

Answer 7

Hemorrhage, Heparin-induced thrombocytopenia

Question 8

Which anticoagulant is safe in pregnancy?

Answer 8

Heparin

Question 9

What monitoring is required for patients on Heparin

Answer 9

platelet counts, aPTT, anti-Xa

Question 10

What is the antidote for Heparin?

Answer 10

Protamine sulfate - 1mg for every 100mg of heparin in the last 2hrs

Question 11

What is the mechanism of action for fragmented Heparin (LMW Heparin)

Answer 11

antithrombin activator - helps antithrombin inactivate Xa (segments too small to also inactivate thrombin)

Question 12

What route can LMW Heparin be administered

Answer 12

ONLY sub q

Question 13

What the the common AEs associated with LMW Heparin?

Answer 13

Bleeding, immune-mediated thrombocytopenia

Question 14

What are the common indications for use of LMW Heparin

Answer 14

prevention of DVT, prevention of ischemic complications due to unstable angina

Question 15

When should a provider adjust the standard dose of LMW Heparin

Answer 15

Dose should be adjusted in pts with Cr clearance of <30ml/min

Question 16

What monitoring is required for LMW Heparin

Answer 16

None required, may do anti-Xa

Question 17

What is the antidote for LMW Heparin

Answer 17

Protamine sulfate - not fast reversal because cannot reverse antiXa activity & half life of LMW Hep is 3-6hrs

Question 18

What is the mechanism of action for Warfarin

Answer 18

Anticoagulation via inhibition of the enzyme that activates Vitamin K (VKORC1). This in turn decreases production of Vit K dependent clotting factors (VII, IX, X & prothrombin)

Question 19

What the the common AEs associated with Warfarin

Answer 19

hemorrhage, fetal hemorrhage & teratogenesis/death

Question 20

What is the indication for Warfarin (Coumadin)

Answer 20

long term prevention of thrombus

Question 21

What tests are required for pts on Warfarin

Answer 21

INR 2-3 (2.5-3.5 if artificial valve), PT (11-13s)

Question 22

What is the antidote for warfarin

Answer 22

Vit K (if doesn’t work may give blood/blood concentrate transfusion)

Question 23

What is the mechanism of action for Apixaban

Answer 23

Direct inhibition of factor Xa

Question 24

What are common AEs associated with Apixaban

Answer 24

bleeding, spinal/epidural hematoma

Question 25

what are the common indications for apixaban

Answer 25

atrial fibrillation, knee/hip replacement

Question 26

When are dose adjustments needed for Apixaban

Answer 26

Reduce in mild/mod renal impairment. Stop in use of severe renal or any hepatic impairment.

Question 27

What monitoring is required for Apixaban

Answer 27

none

Question 28

What is the antidote for Apixaban

Answer 28

Andexnet alfa

Question 29

What is the mechanism of action for Dabigatran

Answer 29

Direct, reversible inhibition of thrombin (prevents conversion of fibrinogen into fibrin & factor XIII activation which prevents soluble fibrin converting to insoluble fibrin

Question 30

What are the common AEs related to Dabigatran

Answer 30

Bleeding, GI distrubance (dispepsia gastritis)

Question 31

What are indications for use of Dabigatran

Answer 31

atrial fibrillation, knee/hip replacement, treat/prevent DVTs&PEs

Question 32

When is dabigatran contraindicated

Answer 32

Renal failure, Cr. clearance <30ml/min

Question 33

What monitoring is required for Dabigatran

Answer 33

none

Question 34

What is the antidote for Dabigatran

Answer 34

Idarucuzumab

Question 35

What factors require vit K for synthesis

Answer 35

10, 9, 7 &2