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20 Cards in this Set

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When are anticoags indicated?
To prevent VTE

prevent MI

prevent stroke

prevent VTE in afib
What is a D-Dimer test?
a blood test to see if a pt has a blood clot

a (+) test indicates high levels of fibrin and clot formation in body
When are antiplatelets not used?
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
What are the colors of warfarin tablets and their corresponding strengths?
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
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
What does tobacco do to liver enzymes?
tobacco is a liver enzyme INDUCER so if a pt quits smoking they may need dose reduction of warfarin or any chronically used med
What are some specific drugs to watch out for when using warfarin?
* 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
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
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
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
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
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
Retavase (reteplase)

MOA
Indication
Dose
MOA: tPA

Indication: acute MI

Dose:
10 U over 2 min, then repeat 30 min later
What are the three distinct classes of antiplatelet drugs?
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
Why does enteric coated medicine like the small intestine and not the stomach?
The enteric coating will only dissolve in the alkaline (pH 7-9) environment of the SI not the acidic environment of the stomach
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
Persantine (dipyridamole/asa)
Aggrenox (dipyridamole/asa)

MOA
Dose
MOA: platelet aggregator; specifics unknown

Dose 75-100 mg QID

Aggrenox - one cap BID (25mg/200mg)
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
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
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