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www.pharmteacher.com

www.pharmteacher.com Antithrombotics

QuestionAnswer
Adverse effects of Aggrenox include: Aggrenox contains aspirin so obviously can cause all the side effects of aspirin PLUS headache, N/V, diarrhea, dizziness, bleeding.
Adverse effects of aspirin include: stomach upset, GI discomfort, GI ulcers, bleeding, rash/allergic reactions; abrupt aspirin withdrawal is associated with an increased risk of clots.
Adverse effects of clopidogrel and prasugrel include: stomach upset (take with food), diarrhea, dizziness, headache, bleeding
Adverse effects of the heparins include: Major and minor bleeding (hemorrhagic stroke, GI bleeding, nosebleeds, blood in urine).
Adverse effects of warfarin include: loss of appetite, N/V, diarrhea, minor and major bleeding (hemorrhagic stroke, GI bleeding, nosebleeds, blood in urine)
Define “anticoagulants” Medications that prevent blood clots by blocking or inhibiting parts of the coagulation cascade.
Define “antiplatelet drugs” Medications that prevent blood clots by inhibiting platelet aggregation.
Define “thrombolytics” Medications that dissolve or lyse an already formed clot.
Define acute coronary syndrome (ACS) ACS includes myocardial infarction (heart attack) and unstable angina that requires treatment in a hospital setting.
Define cerebrovascular accident (CVA) CVA is a stroke, ischemic or hemorrhagic
Define deep vein thrombosis (DVT) Blood clot in the large veins of the legs. If large enough, can be limb threatening.
Define primary prevention Primary prevention is the prevention of clots in persons who have not yet experienced a clotting event, but who are at risk.
Define pulmonary embolism (PE) Blood clot that lodges in a vessel of the lungs. If large enough, can be life threatening.
Define secondary prevention Secondary prevention is the prevention of clots in persons who have already experienced a clotting event (e.g. MI, ACS, ischemic stroke, TIA)
Define thrombosis Formation of an unwanted clot within a blood vessel or heart.
Define transient ischemic attack (TIA) TIA is sometimes called mini stroke: A transient episode of neurologic dysfunction caused by ischemia. The blood clot forms but quickly resolves on its own.
Define venous thromboembolism (VTE) Umbrella term that includes any blood clot with venous origins (e.g. DVT or PE)
Describe the 2009 USPSTF guidelines regarding primary stroke prevention: Daily aspirin is suggested for men 49-79 y/o and women 55-79 y/o who have cardiac risk factors (diabetes, HTN, high cholesterol, smoker) and are at low risk of GI bleed.
Is AGGRENOX an antiplatelet, anticoagulant or thrombolytic? Antiplatelet
Is ASPIRIN an antiplatelet, anticoagulant or thrombolytic? Antiplatelet
Is CLOPIDOGREL an antiplatelet, anticoagulant or thrombolytic? Antiplatelet
Is ENOXAPARIN an antiplatelet, anticoagulant or thrombolytic? Anticoagulant
Is HEPARIN an antiplatelet, anticoagulant or thrombolytic? Anticoagulant
Is it OK to overlap heparin and warfain? Yes, this is commonly done. The heparin or LMWH product will be continued until the warfarin “kicks-in” and the INR is therapeutic.
Is STREPTOKINASE or RETEPLASE an antiplatelet, anticoagulant or thrombolytic? Thrombolytic
Is WARFARIN an antiplatelet, anticoagulant or thrombolytic? Anticoagulant
List 4 substances that trigger platelet aggregation: collagen, epinephrine, adenosine diphosphate (ADP), thromboxane A2
List key things patients taking warfarin should know: its purpose, how it works, importance of monitoring INR, signs/symptoms of bleeding and clots, foods rich in vitamin K, avoid NSAID/aspirin use, avoid alcohol, avoid pregnancy; importance of adherence, etc.
List some signs/symptoms of bleeding: blood in urine, stools, nosebleed, easy bruising, bleeding gums, cuts that won’t stop bleeding.
List some signs/symptoms of clots: shortness of breath (PE), chest pain (MI), swelling in leg (DVT)
List some therapeutic uses for warfarin: Prevention of DVT, PE, or stroke in patients with recent blood clots, ACS, chronic atrial fibrillation, and prosthetic heart valves.
List the antidote for supratherapeutic warfarin: vitamin K (phytonadione)
List the antiinflammatory/analgesic dose of aspirin: 650mg
List the antiplatelet dose of aspirin: 81mg, 162mg, or 325mg
List the antiplatelet regimen most commonly used following ACS or cardiac stent placement: aspirin plus clopidogrel followed by either aspirin or clopidogrel alone thereafter.
List the OTC analgesic of choice in people taking warfarin? acetaminophen…no aspirin or NSAIDS
Therapeutic uses of the heparins include: acute stroke, ACS, DVT, PE as well as prevention of DVT post orthopedic surgery
These psychiatric medications can increase the risk of bleeding in patients taking antiplatelet drugs: SSRIs (serotonin inhibits platelet aggregation)
This OTC analgesic may block the antiplatelet benefits of aspirin: IBUPROFEN. To avoid this interaction, administer the aspirin at least 2 hr before or 4 hr after an ibuprofen dose or use a different NSAID.
What are some things that can cause a person’s INR to be too low? skipping doses, nonadherence, taking a dose that is too low, taking a medication that interacts with warfarin, eating vitamin K rich foods
What are some things that can elevate a person’s INR? taking too much warfarin, taking a dose that is too high, taking a medication that interacts with warfarin
What does USPSTF say about primary prevention in people > 70 y/o? Not enough evidence to make a specific recommendation either for or against. Risk of stroke is higher but so is the risk of GI bleeding.
What is a good/therapeutic INR for a person taking warfarin? Usually between 2.0 and 3.0
What is a hemorrhagic stroke (intracerebral hemorrhage)? Hemorrhagic strokes are caused by weakened blood vessels or rupture of vessels leaking blood into the brain. This causes cell death.
What is a normal INR for a person NOT taking warfarin? 1.0
What is an ischemic stroke? Ischemic strokes are more common in the US than hemorrhagic strokes. They are caused by interruption of blood supply to the brain, cell necrosis/death.
What is HIT? Heparin Induced Thrombocytopenia; an immune mediated destruction of platelets caused by heparin. The drop in platelets resolves after the heparin is stopped.
What is the MOA of aspirin? Irreversibly inhibits the COX enzyme. By blocking this enyzme, the production of thromboxane A2 is inhibited.
What is the MOA of clopidogrel? Blocks ADP receptors, thus preventing ADP stimulated platelet aggregation.
What is the MOA of prasugrel? Blocks ADP receptors, thus preventing ADP stimulated platelet aggregation.
What is the MOA of the dipyridamole component of Aggrenox? MOA is complex and not fully understood; don’t worry about memorizing it
What is the MOA of warfarin? Blocks production of vitamin K dependent clotting factors by the liver.
What is the onset of action of the heparins? They begin to work almost immediately.
What is the onset of action of vitamin K as a warfarin antidote? Several hours. Vitamin K works by allowing the body to make clotting factors and this takes time. If rapid reversal is needed, use fresh frozen plasma
What is the onset of action of warfarin? Delayed 3 to 5 days. Warfarin only prevents the production of NEW clotting factors; existing clotting factors will remain active for 3 to 5 days.
What kinds of OTC products contain NSAIDs? Lots of them…cough/cold products, analgesics, migraine medications, sinus medications, etc. Patients must read lables carefully.
What laboratory test is monitored for heparin therapy? aPTT or APTT (activated partial thromboplastin time) measured in seconds.
What laboratory test is monitored for warfarin therapy? PT (prothrombin time) or INR (international normalized ratio)
What OTC supplements sometimes contain vitamin K? some multivitamins and in particular some calcium supplements specifically designed for osteoporosis
When is chew and swallow aspirin used? ACS (acute MI or unstable angina)
Which patients should NOT receive heparin? Patients with increased risk of bleeding, uncontrollable bleeding, spinal surgery, spinal epidural, lumbar puncture.
Which patients should not receive warfarin? pregnant, alcoholism, liver disease, vitamin K deficiency, and patients with increased risk of bleeding, uncontrollable bleeding, spinal surgery, spinal epidural, lumbar puncture
Created by: www.pharmteacher.com on 2011-06-23



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