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Pharm BMED 575


Name three drugs that inhibit thrombogenesis Aspirin Clopidogrel (Plavix) Abciximab (ReoPro)
What is the MOA of aspirin? inhibits thromboxane A2 synthesis
What patient group is aspirin used for? Those at risk for embolism
What drug is used to treat unstable angina not responding to conventional therapy? abciximab
Hemophiliacs are best treated with heparin FALSE
Heparin should be used as an adjunct treatment for infective endocarditis? FALSE
A threatened abortion is a contraindication for heparin TRUE
What procedures are contraindicated for patients on aspirin? Dental or surgical
What procedures are treated with abciximab? Angioplasty, atherectomy, and stent placement
What side effect does clopidogrel have less than aspirin? Less GI effect because clopidogrel does not effect prostaglandin
Can abciximab be used to treat AMI? Yes
Heparin and what drug is used for patients undergoing percutaneous coronary intervention? abciximab
What drug dosing needs to be adjusted with aspirin therapy? Warfarin
What activated clotting factors does ATIII work on (with the enhancing effect of heparin) XIIa, XIa, IXa, Xa and especially IIa (thrombin)
What is the recommended dose of aspirin therapy? 325 mg per day for primary prevention of MI
Heparin should be used in patients that are actively bleeding. FALSE
Thrombocytopenia purpura is a contraindication for using heparin. TRUE
Why is abciximab given IV Because it is a peptide
Heparin sodium (Liquaemin) and LMW Heparins such as enoxaprin (Lovenox) have what MOA? enhance ATIII
Can clopidogrel be given during an acute MI? Yes
Patients with active tuberculosis should not use heparin. TRUE
What are the side effects of heparin? Hemorrhage, osteoporosis, allergic reactions, decreased platelets (thrombocytopenia)
Heparin aids in the treatment of visceral carcinoma. FALSE
Advanced renal or hepatic disease is a contraindication for using heparin TRUE
Surgery of what body parts is the use of heparin contraindicated for? During or after surgery of the brain, spinal cord, or eye. Lumbar puncture or regional anesthetic
What is eptifibatide a cyclic peptide like abciximab
LMWH enoxaprin (Lovenox) can be used as an intraoperative anticoagulant TRUE
Acetylsalicylic acid (Aspirin) MOA Inhibits the synthesis of the thromboxane A2
What are the effects of inhibiting thromboxane A2? Irreversible platelet dysfunction lasting the lifespan of the platelet (7-10 days)
Heparin is good for patients with severe hypertension or intracranial hemorrhage. FALSE
What is the MOA of abciximab (ReoPro)? inhibits GPIIb/IIIa receptors
What inhibits binding of fibrinogen and von Willebrand factor? abciximab
Why does tirofiban last longer than abciximab? It is not a peptide, so it lasts longer in circulation.
What is the MOA for clopidogrel (Plavix)? Inhibits platelets aggregation by blocking the ADP receptor
For patients allergic to aspirin what is an alternative treatment Clopidogrel (Plavix)
What are the toxicities of abciximab? Bleeding, thrombocytopenia
Enoxaprin can be used for thrombosis prophylaxis, catheters and bypass anticoagulation TRUE
Heparin should not be used to anticoagulate collected blood FALSE
Heparin is dangerous to use in pregnancy FALSE
What effects will protamine sulfate have is given when not heparin is present? Produces an anticoagulant effect on platelets and fibrinogen
What is the antagonist for heparin Protamine sulfate
Enoxoprin (Lovenox) is an appropriate prophylactic antithrombotic TRUE
Can enoxoprin (Lovenox) be used to keep catheters from clotting? YES
While ACD is used to anti-coagulate homologous blood when collected, heparin and what else can be used for autologous intraoperative shed blood collection? Enoxoprin (Lovenox)
If a patient has been treated with warfarin and becomes pregnant it is okay to switch to enoxoprin (Lovenox). TRUE
What are the toxicity's of protamine sulfate? Hypotension due to histamine release, pulmonary hypertension and anaphylactic allergic reaction
Lepirudin (Refludan) is made by recombinant amplification, what is original source genetics for lepirudin? Leeches produce hirudin
What is the target of recombinant hirudin? Lepirudin is a direct thrombin inhibitor (specifically inactivates IIa without ATIII)
Is it okay to give lepirudin orally? No, it is an IV formulation like heparin
What is the MOA of ancrod (Viprinex)? Ancrod (Viprinex) is a primary fibrinolytic. It is able to degrade fibrinogen into soluble fibrin fragments that cannot participate in clot formation
Name two clinical circumstances where ancrod (Viprinex) is used HIT and stroke
What is a significant side effect of ancrod (Viprinex)? intracranial bleeding
What is warfarin a structural analog of ? Vitamin K
What factors does warfarin affect the synthesis of? II, VII, IX and X (2,7,9, and 10)
Can warfarin achieve activity in stored blood? No, since warfarin affects the synthesis of clotting factors 2, 7, 9, and 10 it can act only in vivo.
What is there a time lag in the effectiveness of warfarin? The existing factors have to be depleted
What test is used to measure warfarin? The PT or protime test
How is protime measured? In seconds
What calculated value is derived from the protime? INR, international normalizing ratio is a calculated value based on the PT in seconds
What is a target INR of patients on warfarin An INR between 2 and 3
If warfarin is taken and the patients is also taking aspirin what side effect can occur? Bleeding
Why do we care about other drugs that affect liver function (such as cimetidine [Tagamet])? Because clotting factors are produced in the liver, if a vitamin K antagonist such as warfarin is given, it will decrease the production of clotting factors significantly (could throw patient into bleeding instead of just prevently clotting)
What other activity affects liver function? Chronic alcoholics will have a lower rate of clotting factor synthesis
Why are oral contraceptives a concern for some patients? They cause clots to form in some patients
What is the concern with barbiturates and warfarin? Barbiturates decrease the anticoagulant effect of warfarin
Is warfarin safe to use in pregnancy? No it is embryotoxic
What two diseases increase the anticoagulant effect of warfarin? Hyperthyroidism and hepatic disease
What it the main result of warfarin overdose and how is it treated? hemorrhage, treat with a vitamin K antidote
Is warfarin effective against existing thromboembolism? No, it is a preventative medication
What is the primary clotting problem warfarin is given to patients to prevent? DVT
Is warfarin given just as needed or is it a long term medication? Is is used long term (chronically)
What is the MOA of cilostazol (Pletal) a phosphodiesterase inhibitor
Can cilostazol be taken orally? yes
What are the effects of taking cilostazol (Pletal) promotes vasodilation and inhibits platelet aggregation
A patient complains of muscle cramps and fatigue when walking, what medication can treat them? cilostazol (Pletal)
What patient group is contraindicated for taking cilostazol (Pletal) CHF
In addition to lepirudan (Refludan) what other drug is a direct inhibitor of thrombin? bivalirudin (Angiomax) and argatroban (Novastan)
Bivalirudin (Angiomax) has two mechanisms for anticoagulation, what are they? directly inhibits IIa and also in inhibit platelet activation (prevents them from releasing their granules)
How much bivalirudin is cleared renally? 20%
How much bivalirudin is cleared by metabolic pathways? 80%
What treatment is bivalirudin approved for? Percutaneous coronary angioplasty
What is the MOA of argatroban (Novastan) direct inhibitor of thrombin
What two drugs can be used for patients with HIT? Argatroban (Novastan) and lepirudin (Refludan)
Where is agratroban cleared from? the liver
Can argatroban (Novastan) be given to patients orally? No, warfarin is the only oral anticoagulant
What is the experimental (now withdrawn) pro-drug that can also be given orally? ximelagatran (Exanta)
melagatran acts on what to achieve anticoagulation? it is a direct inhibitor of IIa (thrombin)
Why was ximelagatran (Exanta) an attractive alternative to warfarin? unlike warfarin, ximelagatran (Exanta) has a predictable bioavailability and kinetics, also is has a rapid onset and offset, no p450 interactions to worry about
The extended length of time it takes for ximelagatran (Exanta) to work is why it was not approved for use FALSE, it acts as a direct thrombin inhibitor, therefor a rapid onset and offset of action
As warfarin acts on synthesis of clotting enzymes, so does ximelagatran (Exanta) that is why liver function is important to consider FALSE, only warfarin acts as an inhibitor of factor production, ximelagatran (Exanta) acts directly on IIa
Created by: lisamccunesSS