Pharmacology Anticoagulation - Test 2

Front 1

Antithrombotic Therapy
Anticoagulants

Back 1

Antithrombotic Therapy
Anticoagulants
A- Unfractionated heparin (UFH)
B- Low molecular weight heparins (LMWH)
Enoxaparin (Lovenox)
C- Fondaparinux (Arixtra)
D- Argatroban
E- Warfarin (Coumadin)

Front 2

Anticoagulants- mechanism
Heparin

Back 2

Anticoagulants- mechanism
Heparin
activates antithrombin which inhibits factors IIa (thrombin), Xa, others

Front 3

Anticoagulants- mechanism Low molecular weight heparin

Back 3

Low molecular weight heparin
enoxaparin (Lovenox)
fragments of UFH which strongly inhibit factor Xa greater than factor IIa

Front 4

Fondaparinux (Arixtra)Anticoagulants- mechanism

Back 4

Fondaparinux (Arixtra)
synthetic, directly inhibits factor Xa

Front 5

Anticoagulants- mechanism
Argatroban

Back 5

Anticoagulants- mechanism
Argatroban
synthetic, direct thrombin inhibitor

Front 6

Anticoagulants- mechanism
Warfarin (Coumadin)

Back 6

Warfarin (Coumadin)
interferes with the hepatic synthesis of vitamin-K dependent clotting factors (II, VII, IX, X)

Front 7

Anticoagulants- Indication, Dose, Monitoring (IDM)
Heparin

Back 7

(I)acute MI, thromboembolism, ischemic stroke. (D)treatment dose- infusion on heparin protocol.(SE)bleeding, TCP, HIT. (M)labs-aPTT, stool guaiac, UA, H/H, platelets, S&S of bleeding

Front 8

Heparin propylaxis of thromboembolism

Back 8

prophylaxis dose-5000 units SC every 8-12 hrs. (SE)bleeding, TCP, HIT. (M) labs, aPTT, stool, UA, H/H, platelets, S&S of bleeding

Front 9

Lovenox (IDM)

Back 9

acute MI, ACS, thromboembolism. (D)treatment dose- img/fg SC every 12 hrs or 1.5 mg/kg SC every 24 hrs. (SE) bleeding. (M) labs, stool, UA, H/H, platelets, S&S of bleeding

Front 10

Lovenox prophhylaxis of thromboembolism

Back 10

propholaxis dose- 30mg SC every 12hrs or 40mg SC every 24. (SE)bleeding. (M) labs, stool, UA, H/H, platelets, S&S of bleeding

Front 11

Arixtra

Back 11

treatment of thromboembolism. (D)5-10mg (based on body wt. range)SC once daily. (SE) bleeding, thrombocytopenia. (M)labs, stool, UA, H/H, platelets, S&S bleeding

Front 12

Arixtra prophylaxis of thromboembolism

Back 12

(D)2.5mg once daily. (SE) bleeding, thrombocytopenia(M)labs, stool, UA, H/H, platelets, S&S bleeding

Front 13

Agratroban

Back 13

(I)heparine-induces thrombocytopenia, ischemic stroke, acute MI. (D)completely different dosing according to indication. (SE) bleeding. (M)labs, stool, UA, H/H, platelets, S&S bleeding

Front 14

Couamadin

Back 14

(I)throboembolism (Afib, post-MI, venous TE, heart valves). (D)loading dose of 5mg then adjust according to PT/INR, goal is 2.5-3.5 , (M) S&S of bleeding

Front 15

Antithrombotic Therapy

Back 15

Antithrombotic Therapy
Antiplatelets
Aspirin
Clopidogrel (Plavix)
Dipyridamole (Persantine)
Dipyridamole/aspirin (Aggrenox)

Front 16

Antithrombotic- mechanism
Aspirin

Back 16

Antithrombotic- mechanism
Aspirin- irreversibly inhibits platelet cyclooxygenase
Clopidogrel (Plavix)- selectively, irreversibly inhibits adenosine diphosphate (ADP)-induced platelet aggregation
Dipyridamole (Persantine)- inhibits adenosine and phosphodiesterase resulting in accumulation of adenosine, adenine and cyclic AMP in the platelet which in turn inhibit platelet aggregation
Dipyridamole/aspirin (Aggrenox)- combination mechanism

Front 17

AM Clopidogrel (Plavix)-

Back 17

Clopidogrel (Plavix)- selectively, irreversibly inhibits adenosine diphosphate (ADP)-induced platelet aggregation

Front 18

AM Dipyridamole (Persantine)-

Back 18

Dipyridamole (Persantine)- inhibits adenosine and phosphodiesterase resulting in accumulation of adenosine, adenine and cyclic AMP in the platelet which in turn inhibit platelet aggregation

Front 19

Dipyridamole/aspirin (Aggrenox)-

Back 19

Dipyridamole/aspirin (Aggrenox)- combination mechanism

Front 20

Antiplatelets- Indication, Dose, Monitoring (IDM)
aspirin

Back 20

(I)ACS, acute MI, ischemic stroke, etc.(D)75-325mg once daily.(SE)all GI intolerance, bleeding, allergy (ASA), BMS(plavix)(M)labs-CBC, stool, S&S of bleeding

Front 21

Plavix

Back 21

I)ACS, acute MI, ischemic stroke, PAD. (D)75mg once daily (SE)all GI intolerance, bleeding, allergy (ASA), BMS(plavix)(M)labs-CBC, stool, S&S of bleeding

Front 22

Dipyridamole

Back 22

(I)thromboembolism prophylaxis in cardiac valve replacement and CABG. (D)75-100mg four times daily.(SE)all GI intolerance, bleeding, allergy (ASA), BMS(plavix)(M)labs-CBC, stool, S&S of bleeding

Front 23

Aggrenox

Back 23

(I)stroke prophylaxis. (D)1 capsule twice daily - do not crush.(SE)all GI intolerance, bleeding, allergy (ASA), BMS(plavix)(M)labs-CBC, stool, S&S of bleeding

Front 24

Combination Therapy

Back 24

Combination Therapy
Anticoagulants
Thromboembolism
Initially anticoagulated with
Heparin or
Lovenox or
Arixtra or
Argatroban
Overlap with warfarin until therapeutic INR

Front 25

Combination Therapy
Antiplatelets
Post-MI, ACS-

Back 25

Combination Therapy
Antiplatelets
Post-MI, ACS- DOC is aspirin, alternative is Plavix. But can use aspirin + Plavix in stent placement or for medical management (no PCI)

Front 26

Ischemic stroke-
Primary prevention

Back 26

Ischemic stroke-
Primary prevention: aspirin
unless pt w/ risk factors, then use Coumadin

Front 27

Ischemic stroke- Secondary prevention

Back 27

Secondary prevention: aspirin
alternatives:
Aggrenox
Plavix or Coumadin in aspirin intolerance or failed aspirin or in Afib (use warfarin)