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20 Cards in this Set
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- Back
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When are anticoags indicated?
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To prevent VTE
prevent MI prevent stroke prevent VTE in afib |
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What is a D-Dimer test?
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a blood test to see if a pt has a blood clot
a (+) test indicates high levels of fibrin and clot formation in body |
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When are antiplatelets not used?
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When trying to prevent venous thromboembolitic complications since it is believed that platelets play less of a role in blood clotting in veins compared to arteries
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What are the colors of warfarin tablets and their corresponding strengths?
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Please Let Greg Tanner Bring Peaches To Your Wedding
1 mg - Pink 2 mg - Lavender 2.5 mg - Green 3 mg - Tan 4 mg - Blue 5 mg - Peach 6 mg - Teal 7.5 mg - Yellow 10 mg - White |
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Coumadin (Warfarin)
t1/2 MOA Indication Dose Metabolism Monitor Side Effects Drug interactions Antidote Pregnancy |
MOA: interferes with VitK dependent clotting factors, 2,7,9,10
Takes 3-5 days to become therapeutic t1/2: 36-42 hr Indications prevent DVT from afib prevent PE post MI - prevents systemic embolism post MI - prevents stroke Metabolism: 3A4 - major 2C9; lost of minors Monitor: PT and INR Preg category *X* - causes fetal bleeding Drug Interactions: liver enzyme inducers/inhibitors bile acid sequesterants, antacids, antibiotics Antidote: Vit K: 1-2mg to revers INR of > 5-9 Can also use FFP |
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What does tobacco do to liver enzymes?
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tobacco is a liver enzyme INDUCER so if a pt quits smoking they may need dose reduction of warfarin or any chronically used med
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What are some specific drugs to watch out for when using warfarin?
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* Classic group of CYP inhibitors
I Cum During Coitus Always Isoniazid Chloramphenicol Disulfiram Cimetidine Allopurinol Other Big Ones Antibiotics Erythromycin Cipro Clarithromycin TMP/SMX Metronidazole Antifungals Fluconazole Itraconazole Ketoconazole Asthma Drugs Zafirlukast - Accolate Zileuton - Zyflo HIV drugs Ritonavir Indinavir all protease inhibitors Delavirdine Misc Drugs nefazadone amiodarone |
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Pradaxa (dabigatran)
MOA t1/2 Indication Dose Most common ADR Converting warfarin to dabigatran Converting dabigatran to warfarin |
MOA: direct thrombin inhibitor
t1/2: 12-17 hr Indication: Reduce risk of stroke and systemic embolisms in pts w/ non-valvular afib Most common side effects: gastritis like symptoms and bleeding Dose: CrCl > 30 - 150 mg BID CrCl < 15-30 - 75 mg BID ADR gastritis-like symptoms bleeding Converting W to D: DC warfarin and start dabigatran when INR < 2 Converting D to W CrCl > 50 - start warfarin 3 days before stopping dabigatran CrCl 31-50 - start warfarin 2 days before stopping dabigatran CrCl 15-30 - start warfarin 1 day before stopping dabigatran CrCl < 15 - no recs |
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Heprin
MOA t1/2 Indication Dose w symptoms of acute PE Dose age forms Antidote |
MOA: complexes with AT-III making it a more potent anticoagulant
t1/2: 1-2 hrs Indication: pt going into labor (does not cross placenta) and/or surgery Dose: 5,000-15,000 U bolus and then 1000 U/hr ONLY available SC IM Antidote: Protamine 1mg/100 U of heparin |
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Lovenox (enoxaparin)
Dalteparin (Fragmin) MOA Indication/dose Fragmin Lovenox Dose Monitor |
MOA: factor Xa inhibitor
Indication Fragmin: used as anticoag during dialysis - 500 U IV via arterial line Lovenox Dose: DVT proph - 30 mg q 12 hr increased to 40 mg q 12 hr if BMI > 40 Monitor: anti Xa levels |
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TNKase (tenecteplase)
MOA Indication Contraindication |
MOA: tPA - tissue plasminogen activator; bind fibrin and converts plasminogen to plasmin
Indication: after acute MI to dissolve clot Contraindication Internal bleeding Hx CVA Surgery w/in 2 months neoplasms uncontrolled HTN Current anticoag therapy |
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Activase (alteplase)
MOA Indication |
MOA: tPA
Indication thrombolytic agent given post MI to lyse thrombi *give w/in 3 hrs of stroke *more bleeding problems than with tenecteplase |
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Retavase (reteplase)
MOA Indication Dose |
MOA: tPA
Indication: acute MI Dose: 10 U over 2 min, then repeat 30 min later |
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What are the three distinct classes of antiplatelet drugs?
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1. Inhibition of prostaglandin synthesis
Aspirin - ASA inhibits synthesis of Thromboxane A2 by inhibiting cyclooxygenase 2. Inhibition of ADP-induced platelet aggregation Plavix - clopidogrel Ticlid - ticlopidine Brilinta - ticagrelor 3. Blockage of GP IIb/IIIa receptors on platelets TEA-AIR Tirofiban - Aggrastat Eptifibatide - Integrilin Abciximab - ReoPro |
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Why does enteric coated medicine like the small intestine and not the stomach?
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The enteric coating will only dissolve in the alkaline (pH 7-9) environment of the SI not the acidic environment of the stomach
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Plavix - Clopidogrel
MOA Indication Dose Black Box Warning Liver Enzyme inhibitor |
MOA: inhibits platelet aggregation by blocking ADP receptors
Indication/Dose: Recent Transient MI, Stroke, PAD - 75mg qd w/out ASA NSTEMI: loading 300mg then 75 daily with ASA w/STEMI: 75mg daily with ASA Black Box Warning: may not be as effective in pts who are 2C19 deficient - GENOTYPING in high conc Plavix is a 2C9 inhibitor; unpredictable effect though |
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Persantine (dipyridamole/asa)
Aggrenox (dipyridamole/asa) MOA Dose |
MOA: platelet aggregator; specifics unknown
Dose 75-100 mg QID Aggrenox - one cap BID (25mg/200mg) |
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Ticlid (ticlopidine)
MOA Dose Black Box Warning ADR Monitor |
MOA: inhibits ADP induced platelet aggregation
Dose: 250mg bid w/ food BBW: neutropenia and Thrombotic thrombocytopenic purpura (TTP) ADR: diarrhea, hemorrhage, leukopenia Monitor: WBC q 2 wks for first 3 months |
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Effient (prasugrel)
MOA Indication Dose Black Box Warning Side Effects |
MOA: P2Y12 platelet inhibitor - P2Y12 is a receptor essential for platelet aggregation
Indication: MI Dose: after heart attack 60mg loading dose then 10 mg daily; ASA at physician discretion BBW: do not use if actively bleeding or hx of TIA; not recommended for pt over 75 |
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Xarelto (rivaroxaban)
MOA Indication Dose BBW: DI Switching from warf to riva |
MOA: factor Xa inhibitor
Indication: reduce risk of stroke and blood clot in pts w nonvalvular afib proh of DVT in pts undergoing knee or hip replacement Dose: CrCl > 50 - 20mg daily w dinner CrCl 15-50 - 15mg daily w dinner DVT proph - 10mg daily with or w/out food Black Box Warning: epidural or spinal hematomas have occured in pts treated with rivaroxaban who are receiving neuraxial anesthesia or under going spinal punture. DI: avoid with drugs that are potent Pgp and strong 3a4 inducers such as St. John's Wort, carbamazepine, phytoin Monitor patients fq for S/Sx of neurological impairment DI - avoid in combo with strong 3A4 inducers Switching - wait till INR is < 3 |
