Exam (elaborations)
Pharm 895 Antiplatelet & Anticoagulant (1)
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Pharm 895 Antiplatelet & Anticoagulant (1)
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Pharm 895 Antiplatelet & AnticoagulantDrugs that are monitored via PTT - CORRECT ANSWER--Heparin.
-Angiomax: bivalirudin.
-Argatroban.
Drugs that are monitored via factor Xa - CORRECT ANSWER--LMWH.
-Arixtra: fondaparinux.
Drugs that are monitored via PT/INR - CORRECT ANSWER--Coumadin: warfarin.
Asprin - CORRECT ANSWER--MOA: Antiplatelet, inhibits prostaglandin synthesis
through irreversible COX inhibition.
-AE: Dyspepsia, bleeding, asthma exacerbation, rare rash, hepatotoxicity (in OD),
thrombocytopenia.
-Reye's Syndrome.
-Recommended in pts with unprovoked proximal DVT/PE who are stopping
anticoagulation
Platelet P2Y12 inhibitors - CORRECT ANSWER--AE: Bleeding, dyspepsia, rare
rash, HA.
-Clopidogrel: prodrug, must be enterically & hepatically metabolized.
-Prasugrel: prodrug, must be enterically metabolized.
-Ticagrelor: taken in active form.
Plavix: clopidogrel - CORRECT ANSWER--Platelet P2Y12 inhibitor.
-Increased risk of thromboembolic events when taken with certain PPIs.
Effient: prasugrel - CORRECT ANSWER--Platelet P2Y12 inhibitor.
-3A4 substrate.
-Contraindicated after TIA or stroke
Brilinta: ticagrelor - CORRECT ANSWER--Platelet P2Y12 inhibitor, reversible.
-AE: Dyspnea.
-3A4 substrate, 2C9 inhibitor.
Kengreal: cagrelor - CORRECT ANSWER--Platelet P2Y12 inhibitor.
-IV only. Do not administer clopidogrel or prasugrel during infusion.
PAR-1 Antagonist - CORRECT ANSWER--Zontivity: vorapaxar, w/ aspirin or
clopidogrel.
-Effectively irreversible because of long half-life.
-Indicated for patients with prior MI or PAD.
-AE: bleeding, anemia, rash, depression.
, -Avoid in h/o stroke, TIA, intracranial hemorrhage, or severe hepatic impairment.
-Monitor CBC
Aggrenox: dipyridamole - CORRECT ANSWER--ONLY used in combination therapy
with aspirin.
-Vasodilator, prevents platelet aggregation by inhibiting adenosine uptake and cGMP
activity.
-Indication: stroke prevention after TIA.
-AE: bleed, HA (from vasodilation), abd pain, diarrhea, nausea, dyspepsia
Aggrenox: dipyridamole how to avoid headaches - CORRECT ANSWER--For first
several weeks, dose only q HS.
-Then move to BID, typically headaches from vasodilation decrease over time.
Aspirin nonadherence - CORRECT ANSWER--Very common for patients to stop
taking aspirin, because it's OTC and seen as less important.
-Aspirin has been proven to be one of the most effective medicines to prevent an
acute ischemic attack.
-Write a prescription for aspirin to convey its importance to patients.
Fibrinolytics - CORRECT ANSWER--Alteplase, aka tPA, Activase, Cathflo, is most
commonly used.
-Converts plasminogen to plasmin, causes fibrinolysis through proteolytic digestions
of fibrin.
-Dose </= 100mg.
-Indications: acute ischemic stroke, PE, acute MI, catheter clearance, others.
-AE: bleeding, rare angioedema.
Fibrinolysis inhibitors - CORRECT ANSWER--Aminocaproic acid, tranexamic acid.
-AE: thrombosis. Rare AE: myopathy, hypotension, abdominal discomfort, diarrhea,
blood dyscrasias.
-Monitor: CBC, fibrinogen, BUN, Cr.
Unfractionated Heparin - CORRECT ANSWER--Mixture of molecules of different
weights & activity.
-Prophylactic dose: 5000 U q 12/8.
-Treatment dose: 10 to 20 U/kg/hr on average, titrated to PTT or anti-Xa units.
-Binds to antithrombin III which inhibits factors IIa, IXa, and Xa.
Unfractionated Heparin AE, monitoring, antidote - CORRECT ANSWER--AE:
bleeding, rare thrombocytopenia, alopecia, hepatotoxicity, very rare hypersensitivity
rxn.
-Monitoring: PTT most common, most variable. Anti-Xa level much more predictable
between labs, but more expensive. CBC, platelets, potassium.
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