www.pharmteacher.com Antithrombotics
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| 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.
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| 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.
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| Adverse effects of clopidogrel and prasugrel include: | stomach upset (take with food), diarrhea, dizziness, headache, bleeding
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| Adverse effects of the heparins include: | Major and minor bleeding (hemorrhagic stroke, GI bleeding, nosebleeds, blood in urine).
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| Adverse effects of warfarin include: | loss of appetite, N/V, diarrhea, minor and major bleeding (hemorrhagic stroke, GI bleeding, nosebleeds, blood in urine)
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| Define “anticoagulants” | Medications that prevent blood clots by blocking or inhibiting parts of the coagulation cascade.
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| Define “antiplatelet drugs” | Medications that prevent blood clots by inhibiting platelet aggregation.
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| Define “thrombolytics” | Medications that dissolve or lyse an already formed clot.
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| Define acute coronary syndrome (ACS) | ACS includes myocardial infarction (heart attack) and unstable angina that requires treatment in a hospital setting.
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| Define cerebrovascular accident (CVA) | CVA is a stroke, ischemic or hemorrhagic
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| Define deep vein thrombosis (DVT) | Blood clot in the large veins of the legs. If large enough, can be limb threatening.
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| 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.
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| Define pulmonary embolism (PE) | Blood clot that lodges in a vessel of the lungs. If large enough, can be life threatening.
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| 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)
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| Define thrombosis | Formation of an unwanted clot within a blood vessel or heart.
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| 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.
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| Define venous thromboembolism (VTE) | Umbrella term that includes any blood clot with venous origins (e.g. DVT or PE)
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| 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.
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| Is AGGRENOX an antiplatelet, anticoagulant or thrombolytic? | Antiplatelet
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| Is ASPIRIN an antiplatelet, anticoagulant or thrombolytic? | Antiplatelet
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| Is CLOPIDOGREL an antiplatelet, anticoagulant or thrombolytic? | Antiplatelet
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| Is ENOXAPARIN an antiplatelet, anticoagulant or thrombolytic? | Anticoagulant
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| Is HEPARIN an antiplatelet, anticoagulant or thrombolytic? | Anticoagulant
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| 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.
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| Is STREPTOKINASE or RETEPLASE an antiplatelet, anticoagulant or thrombolytic? | Thrombolytic
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| Is WARFARIN an antiplatelet, anticoagulant or thrombolytic? | Anticoagulant
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| List 4 substances that trigger platelet aggregation: | collagen, epinephrine, adenosine diphosphate (ADP), thromboxane A2
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| 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.
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| List some signs/symptoms of bleeding: | blood in urine, stools, nosebleed, easy bruising, bleeding gums, cuts that won’t stop bleeding.
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| List some signs/symptoms of clots: | shortness of breath (PE), chest pain (MI), swelling in leg (DVT)
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| 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.
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| List the antidote for supratherapeutic warfarin: | vitamin K (phytonadione)
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| List the antiinflammatory/analgesic dose of aspirin: | 650mg
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| List the antiplatelet dose of aspirin: | 81mg, 162mg, or 325mg
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| List the antiplatelet regimen most commonly used following ACS or cardiac stent placement: | aspirin plus clopidogrel followed by either aspirin or clopidogrel alone thereafter.
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| List the OTC analgesic of choice in people taking warfarin? | acetaminophen…no aspirin or NSAIDS
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| Therapeutic uses of the heparins include: | acute stroke, ACS, DVT, PE as well as prevention of DVT post orthopedic surgery
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| These psychiatric medications can increase the risk of bleeding in patients taking antiplatelet drugs: | SSRIs (serotonin inhibits platelet aggregation)
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| 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.
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| 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
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| 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
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| 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.
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| What is a good/therapeutic INR for a person taking warfarin? | Usually between 2.0 and 3.0
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| 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.
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| What is a normal INR for a person NOT taking warfarin? | 1.0
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| 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.
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| 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.
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| What is the MOA of aspirin? | Irreversibly inhibits the COX enzyme. By blocking this enyzme, the production of thromboxane A2 is inhibited.
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| What is the MOA of clopidogrel? | Blocks ADP receptors, thus preventing ADP stimulated platelet aggregation.
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| What is the MOA of prasugrel? | Blocks ADP receptors, thus preventing ADP stimulated platelet aggregation.
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| What is the MOA of the dipyridamole component of Aggrenox? | MOA is complex and not fully understood; don’t worry about memorizing it
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| What is the MOA of warfarin? | Blocks production of vitamin K dependent clotting factors by the liver.
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| What is the onset of action of the heparins? | They begin to work almost immediately.
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| 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
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| 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.
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| What kinds of OTC products contain NSAIDs? | Lots of them…cough/cold products, analgesics, migraine medications, sinus medications, etc. Patients must read lables carefully.
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| What laboratory test is monitored for heparin therapy? | aPTT or APTT (activated partial thromboplastin time) measured in seconds.
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| What laboratory test is monitored for warfarin therapy? | PT (prothrombin time) or INR (international normalized ratio)
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| What OTC supplements sometimes contain vitamin K? | some multivitamins and in particular some calcium supplements specifically designed for osteoporosis
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| When is chew and swallow aspirin used? | ACS (acute MI or unstable angina)
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| Which patients should NOT receive heparin? | Patients with increased risk of bleeding, uncontrollable bleeding, spinal surgery, spinal epidural, lumbar puncture.
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| 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
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