Pulm: Drugs used for PE/DVT

Question 1

MOA of Heparin

Answer 1

Long polysaccharine that binds and activates ATIII to inhibit Factors Xa and IIa

Rapid onset in treating Red Clots in PE, stroke, DVT, DIC

Question 2

Which is rapid onset: Heparin or Warfarin?

Answer 2

Heparin

Question 3

Is heparin safe in pregnancy?

Answer 3

Yes, “Keep your baby Heppy with Heparin”

Question 4

What is the antidote to heparin or Low Molecular Weight Heparin (LMWH) OD?

Answer 4

Protamine

Question 5

What do you monitor with heparin and warfarin?

Answer 5

Heparin: PTT

Warfarin: PT
-war takes place outside, extrinsic

Question 6

What are contrainidcations for all the drugs used for DVT?

Answer 6

Bleeding (hemophilia/thrombocytopenia) and stroke

Question 7

What drugs are LMWH?

Answer 7

Enoxaparin, Delteparin, tinazeparin

Question 8

MOA of LMWH?

Answer 8

Inhibits Xa, prevents red clots

-little effect on existing thrombin

Question 9

Clinical use of LMWH

Answer 9

Prevention of DCT after knee/hip surgery
Treatment of DVT w/ or w/o PE history
Prevention of ischemic events in ACS

Question 10

Is enoxaparin safe in pregnancy?

Answer 10

Yes

Question 11

Which is more reliable, LMWH or heparin?

Answer 11

LMWH is easier to use, has a longer half life, and is now the first choice to prevent DVT

Question 12

MOA of fondaparinux

Answer 12

Binds Xa, preventing II->IIa

Question 13

Which one is more effective, fondaparinux or LMWH?

Answer 13

Fondaparinux is more effective, but bleeding risk is higher

Question 14

How do you administer fondaparinux?

Answer 14

SubQ Everyday

-long half life (too long?)

Question 15

Clinical applications of fondaparinux

Answer 15

Prevention of DVT
Acute PE with warfarin
Acute DVT with warfarin

Question 16

Is fondaparinux reversible with protamine?

Answer 16

No

Question 17

Does fondaparinux cause HIT?

Answer 17

No

-only Heparin and LMWH

Question 18

What are the Hirudin analogs?

Answer 18

Bivalirudin

-not used much; second line for dual therapy w asparin

Question 19

Route of entry for bivalirudin?

Answer 19

Must be given IV

-parenteral

Question 20

MOA of argatroban

Answer 20

Prophylaxis and treatment of HIT

-monitored w PTT

Question 21

Route of entry for argatroban

Answer 21

IV, short half life

Question 22

MOA of Warfarin

Answer 22

Oral Inhibitor of vitamin K y-epoxide reductase

-decreases factors II, VII, IX, X and protein C/S

Question 23

Clinical applications of Warfarin

Answer 23

Long term prophylaxis of thrombosis

-especially in those with a-fib and mechanical heart valves

Question 24

How do you monitor warfarin?

Answer 24

PT/INR (eliminated by liver)

-goal=between 2-3

Question 25

Is warfarin safe in pregnancy?

Answer 25

No, crosses the placenta and disrupts bone formation

Question 26

What are the first two factors/proteins affected in warfarin?

Answer 26

Factor VII and Protein C

Question 27

Why does warfarin cause skin necrosis?

Answer 27

Protein C has a shorter half-life, so it creates a hypercoagulable state

Question 28

MOA of Rivaroxaban (and other xabans)

Answer 28

direct (oral) inhibitor of Factor Xa (activated factor X)

Question 29

What are the advantages of Rivaroxaban over Heparin?

Answer 29

``` Rapid, Fixed dose, less bleeding, Fewer interactions, No need to monitor INR ```

Question 30

Clinical applications of rivaroxaban?

Answer 30

Prevention of DVT after knee/hip replacement | Prevention of stroke in a-fib

Question 31

What is important when taking rivaroxaban?

Answer 31

Must dose on time (short half life)

Question 32

Contraindications to rivaroxaban?

Answer 32

Bleeds Renal/hepatic impairment Pregnancy

Question 33

MOA of dabigatran

Answer 33

direct (oral) thrombin inhibitor

Question 34

Clinical application of dabigatran

Answer 34

Prevention of stroke in those with non-valvular A-fib

Question 35

If dabigatran safe in those with mechanical heart valves?

Answer 35

Nope, recently contrainidcated

Question 36

Antidote to dabigatran toxicity?

Answer 36

Idarucizumab

Question 37

Antidote to Xa inhibitors?

Answer 37

Andexanet alfa

Question 38

What is important to remember when storing dabigatran?

Answer 38

Must keep it in the manufacturer bottle | -pills are unstable==keep dry and room temp

Question 39

What are the thrombolytic drugs?

Answer 39

``` TPA drugs (end in -plase) -alteplase, reteplase, and tenecteplase ``` Streptokinase

Question 40

Adverse effects of thrombolytics?

Answer 40

Bleeding and allergic rxns (streptokinase mainly)

Question 41

How do you reverse the thrombolytic agents?

Answer 41

tranexamic acid and aminocaproic acid

Question 42

What should you do with subsegmental PE?

Answer 42

Just watch and wait, unless at high risk for reoccurance then anti-coagulate

Question 43

Can you send someone home with a PE

Answer 43

Yes if they are stable

Question 44

When would systemic thrombolytic therapy for PE be done?

Answer 44

If SBP <90 and low risk for bleed or if pt deteriorates | -no if SBP >90

Question 45

What is prefered for PE: Catheter or Fibrolytic therapy?

Answer 45

Fibrolytic therapy