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Thrombotics Flashcards

1
Q

Indirect thrombin inhibitors?

A

Unfractioned heparin, Dalteparin, Enoxaparin, Tinzaparin, Fondaparinux

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2
Q

Unfractionated heparin class and mxn?

A

Indirect thrombin inhibitor; Bind antithrombin and potentiate formation of antithrombin-coagulation factor complex (Xa, IIa)

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3
Q

Unfractionated for?

A

Prevention and tx of venous thromboembolism

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4
Q

Unfractionated heparin side effects?

A

Heparin-induced thrombocytopenia, bleeding, osteoporosis

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5
Q

How is unfractionated heparin monitored?

A

PTT: wasnt 2-2.5 normal value

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6
Q

How is unfractionated heparin given?

A

Parenterally

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7
Q

Reversal of unfractionated heparin effects?

A

Protamine

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8
Q

Protamine is an antidote for?

A

Unfractionated heparin, Dalteparin, Enoxaparin, Tinzaparin

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9
Q

Dalteparin class and mxn?

A

LMWH that inhibits thrombin less effectively than Xa

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10
Q

Dalteparin for?

A

Prevent thrombosis and embolism from clots

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11
Q

Dalteparin side effect?

A

Bleeding

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12
Q

How is dalteparin monitored?

A

Heparin assay (anti-factor Xa)

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13
Q

Dalteparin half-life?

A

Longer than heparin (1-2/day)

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14
Q

Reversal of dalteparin effects?

A

Protamine

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15
Q

Enoxaparin class and mxn?

A

LMWH that inhibits thrombin less effectively than Xa

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16
Q

Tinzaparin class and mxn?

A

LMWH that inhibits thrombin less effectively than Xa

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17
Q

Enoxaparin for?

A

Drug of choice in pregnancy for prevention and tx of venous thromboembolism

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18
Q

Side effects of enoxaparin?

A

HIT, bleeding. Osteoporosis and thrombocytopenia are uncommon

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19
Q

Enoxapain half-life?

A

Longer than heparin (1-2/day)

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20
Q

Tinzaparin half-life?

A

Longer than heparin (1-2/day)

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21
Q

How is enoxaparin monitored?

A

Heparin assay (anti-factor Xa)

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22
Q

How is tinzaparin monitored?

A

Heparin assay (anti-factor Xa)

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23
Q

Tinzaparin side effects?

A

HIT, bleeding. Osteoporosis and thrombocytopenia are uncommon

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24
Q

Fondaparinux class and mxn?

A

Indirect thrombin inhibitor; Synthetic polysaccharide that binds active site of antithrombin and inhibits Xa

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25
Indirect thrombin inhibitor without an antidote?
Fondaparinux
26
Reversal of fondararinux effects?
No antidote
27
Fondaparinux for?
HIT
28
Fondaparinux side effect?
Bleeding
29
Warfarin class and mxn?
Vitamin K antagonist; Blocks Vit K-dependent gamma-carboxylaton of factors II, VII, IX, X, Protein C and S (does not affect already synthesized factors)
30
Warfarin for?
Long term anticoagulation
31
Warfarin side effects?
Thrombosis and warfarin skin necrosis (Relative Protein C depression); Bleeding
32
How is warfarin monitored?
PT/INR
33
Monitor ___ with PTT?
Heparin, Bivalirudin, Argatroban
34
Monitor ___ with PT/INR?
Warfarin
35
Warfarin contraindicate in who?
Pregnancy (teratogen)
36
Warfarin can be reversed how?
Vitamin K, factor concentrates
37
Special note about warfarin metabolism?
Enhanced by drugs that induce P450 activity (barbiturates)
38
Direct thrombin inhibitors?
Bivalirudin, Argatroban, Dabigatran
39
Bivalirudin class and mxn?
Direct thrombin inhibitor; Irreversibly inactivate fibrinogen-bound and unbound thrombin
40
Argatroban class and mxn?
Direct thrombin inhibitor; binds to catalytic site of thrombin and inactivates fibrinogen-bound and unbound thrombin
41
Dabigatran class and mxn?
Direct thrombin inhibitor; Reversibly (competitively) inactivate fibrinogen-bound and unbound thrombin
42
Reversible (Competitive) direct thrombin inhibitor?
Dabigatran
43
Irreversible direct thrombin inhibitors?
Bivalirudin, Argatroban
44
Bivalirudin for?
Percutaneous coronary intervention
45
Argatroban for?
Percutaneous coronary intervention + HIT
46
Dabigatran for?
DVT, PE, AFib
47
Bivalirudin side effect?
Bleeding
48
Argatroban side effect?
Bleeding
49
Dabigatran side effect?
Bleeding
50
Reversal of direct thrombin inhibitors?
No antidote
51
How is bivalirudin administered?
Parenterally
52
How is argatroban administered?
Parenterally
53
How is dabigatran administered?
Orally
54
Note about dabigatran clearance?
Renal fixed dose clearance
55
How is bivalirudin monitored?
PTT
56
How is argatroban monitored?
PTT
57
Direct Xa inhibitors?
Rivaroxaban, Apixaban
58
Rivaroxaban class and mxn?
Direct Xa inhibitor; reversibly bind active site of Xa
59
Apixaban class and mxn?
Direct Xa inhibitor; reversibly bind active site of Xa
60
Rivaroxaban for?
DVT PE prophylaxis
61
Apixaban for?
DVT PE prophylaxis
62
How are direct xa inhibitors administered?
Rivaroxaban and apixaban: Orally
63
Reversal of rivaroxaban and apixaban effects?
No antidote
64
Note on direct xa inhibitor clearance?
Rivaroxaban and apixaban: Renal fixed dose clearance
65
Fibrinolytic drugs?
Alteplase, Reteplase, Tenecteplase
66
Alteplase class and mxn?
Fibrinolytic, Lyse already formed clots by activating circulating plasminogen
67
Reteplase class and mxn?
Fibrinolytic, Lyse already formed clots by activating circulating plasminogen
68
Tenecteplase class and mxn?
Fibrinolytic, Lyse already formed clots by activating circulating plasminogen
69
Alteplase, reteplase, tenecteplase for?
Acute MI, acute stroke, central DVT, multiple PE
70
Antiplatelet drugs?
Aspirin, Dipyridamidole, Cloidogrel, Abciximab, Eptifibatide, Tirofiban
71
Remind me of aspirin class and mxn.
Antiplately; Irreversible inhibitor of platelets and prevent thromboxane A2 formation
72
Aspirin for?
Often as "baby" to prevent and treat MI and strok
73
Dipyridamole class and mxn?
Antiplatelet; PDE inhibitor --> Increase platelet cAMP
74
Dipyridamole for?
Weak antiplatelet effect
75
How is dipyridamole administered?
Parenterally
76
Clopidogrel class and mxn?
Antiplatelet; Inhibit platelet ADP receptor
77
Clopidogrel for?
Prevent and treat ACS, stroke, peripheral vascular disease, angina, stent
78
Reversal of clopidogrel?
Platelet transufion
79
Clopidogrel side effects?
Bleeding, TTP
80
Abciximab class and mxn?
Antiplatelet; mab against GPIIb/IIIa
81
How is abciximab given?
Parenterally
82
How is eptifibatide given?
Parenterally
83
How is tirofiban given?
Parenterally for an immediate effect
84
Abciximab side effect?
Immune response
85
Eptifibatide class and mxn?
antiplatelet; fibrinogen analog which competes with endogenous fibrinogen for IIb/IIIa
86
Tirofiban class and mxn?
antiplatelet; fibrinogen analog which competes with endogenous fibrinogen for IIb/IIIa
87
Eptifibatide side effect?
Bleeding, ACS, PCI, thrombocytopenia
88
Tirofiban side effects?
Bleeding, NSTE-ACS
89
Fibrinogen analogs?
Eptifibatide, Tirofiban
90
PDE inhibitor?
Dipyridamole
91
Monoclonal antiplatelet antibody?
Abciximab
92
Inhibits plately ADP receptors?
Clopidogrel
93
LMWH reversal with protamine is ______?
Less-effective
94
The risk of HIT with LMWH is _____?
Less than with unfractionated heparin
95
Is there a need for monitoring with LMWH?
No, there is a predictable dose response.
96
Similar to Fondaparinux but with 5-6 day half-life?
Idraparinux
97
Half-life of Fondaparinux?
17-21 hours
98
Why is warfarin dosing difficult?
Competes with VitK, >99% bound to albumin, hepatic metabolism, fluctuation of the cascade, has a very narrow therapeutic index
99
Are direct thrombin inhibitors active in clots?
yes!
100
Bivalirudin half-life?
Very short
101
Argatroban clearance?
Hepatic
102
Dabigatran clearance?
Renal
103
Dabigatran is?
Serine-protease inhibitor
104
Dabigatran a predrug?
Yes
105
Need for monitoring with dabigatran?
No, safe over a large range of doses
106
2 generalizations of oral direct inhibitors of Xa and IIa (thrombin)?
No antidote, no methods to assess levels
107
Fibrinolytic timing?
Effective if within 3-12 hours; Given for 1-2 days
108
Is alteplase clot specific?
No
109
Is tenecteplase clot specific?
Yes
110
Is reteplase clot specific?
Somewhat
111
Does a high or low dose of aspirin provide greater antiplatelet effect?
Low dose! High dose will increasingly affect endothelial cell COX1 which can be re-made
112
PDE inhibitors aside from dipyramidole?
Cilostazol, Pentoxifylline
113
Is clopidogrel reversible
NO
114
Onset of clopidogrel?
Slow, and offset is slow as well and can last up to 10 days
115
Other ADP receptor blockers?
Prasugrel, Ticagrelor
116
Abciximab lasts?
24-48 hours
117
Eptifibatide timing?
Rapid onset, short half-life

Pharmacology (46 decks)

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