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Flashcards in Other Anti-coags Deck (33)
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1

Factor Xa inhibitors (oral), MOA

-Rivaroxaban
-Edoxaban
-Apixaban

-MOA: oral direct factor Xa inhibitor (inhibits free and clot-bound factor Xa)

2

Clinical indications of factor Xa

-Prevention of VTE in pts undergoing THA/TKA (tx for at least 10-14d, preferably 35d)
-Prevention of stroke/systemic embolism in pts with non-valvular AF
-Prevention and tx of VTE

3

Clinical indication for Rivaroxaban

PAD

4

When should you start the oral factor Xa inhibitors? How's the bleeding risk?

-Start after surgery
-Bleeding risk LESS than warfarin (apixaban has the least)

5

What is the reversal agent for the oral Xa inhibitors?

Andexanet-alpha

6

Drug interactions for oral Xa inhibitors

-Most are substrates of P-GP and 3A4
-Don't use with other anticoags

7

LMWH drug and MOA

-Enoxaparin
-MOA: antithrombin mediated inhibition of factors Xa > IIa

8

LMWH clinical indications

-DVT prophylaxis of hip/knee/abd sxs, restricted mobility
-DVT/PE tx
-ACS
(use this unless you can't, lots of advantages)

9

What is a limitation of LMWH?

Harder to dose in CKD and obese pts

10

Drug monitoring for LMWH

-Monitor for anemia/signs of bleeding (H/H)
-No anticoag monitoring necessary, best during tx rather than prophylaxis

11

What is the reversal agent for LMWH?

Protamine sulfate

12

Common ADRs of LMWH

-Injection site pain and hematoma
-Hemorrhage less than UFH
-Thrombocytopenia < UFH
-HIT rarely (<1%)

13

Synthetic analog of Heparin, MOA

Fondaparinux, anti-thrombin mediated inhibition of factor Xa

14

Clinical indications of Fondaparinux

-DVT prophylaxis of hip/knee/abd sxs
-VTE tx

15

What is a unique advantage of Fondaparinux?

Long half life (qd dosing)

16

What is the drug monitoring, drug interactions, and ADRs to be aware of in Fondaparinux?

-Monitor: H/H, SCr, anti-Xa assay
-Interactions: other antiplatelets/anticoags/NSAIDs -> bleeding
-ADRs: hemorrhage

17

What are the direct thrombin inhibitors (oral, IV)

-Oral: Dabigatran
-IV: Argatroban, Bivalirudin

18

MOA of Dabigatran

Synthetic, non-peptide, direct thrombin (IIa) inhibitor, inhibits both clot bound and circulating thrombin -> decreases thrombin-stimulated platelet aggregation

19

Clinical indications of Dabigatran

-Prevention of stroke in pts with non-valvular AF
-Prevention of VTE in pts undergoing THA/TKA
-VTE tx (not initial)

20

What is the reversal agent for Dabigatran?

Idarucizumab

21

What is a unique pearl about the storage of Dabigatran?

Sensitive to moisture, should be kept in original bottle and tightly capped

22

Dabigatran + __________ = increase hemorrhage

Simvastatin

23

ADRs of Dabigatran

-Bleeding
-Dyspepsia/gastritis

24

What is the only approved product for pts with HIT?

Argatroban

25

Argatroban has a very short half life and is safest in a patient with what?

CKD, metabolized by the liver

26

Bivalirudin pearls

-Approved for ACS managed with PCI
-Pts with/at risk of HIT undergoing PCI
-Cannot reverse

27

Old fibrinolytics

-Streptokinase
-Urokinase

28

Older fibrinolytic, MOA

-Alteplase aka recombinant tissue-type plasminogen activator (tPA)
-MOA: initiates local fibrinolysis by binding to fibrin in a thrombus, converts entrapped plasminogen to plasmin

29

Clinical indications of alteplase

-STEMI
-Acute pulm embolism
-Acute ischemic stroke
-Central venous cath clearance
-Acute peripheral arterial occlusive disease

30

Newer fibrinolytic, MOA

-Tenecteplase
-14x more fibrin specific
-MOA: same as alteplase with longer half life (single IV bolus)