ACS and VTE Treatment Quiz
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Questions and Answers

What is the mechanism of action of direct thrombin inhibitors?

  • Activating the production of antithrombin
  • Binding to the active thrombin site of free and clot-associated thrombin (correct)
  • Breaking down thrombin
  • Inhibiting the production of thrombin

    • What is the indication for Dabigatran?

  • PCI-thrombosis and HIT
  • HIT, PCI-thrombosis and Thromboprophylaxis
  • DVT/PE Prevention and Treatment, Nonvalvular A-Fib, Thromboprophylaxis (correct)
  • Thromboprophylaxis, HIT, and PCI-thrombosis

    • What is the antidote for Dabigatran?

  • Idarucizumab (Praxbind) (correct)
  • Bivalirudin
  • Argatroban
  • Warfarin

    • What is the common side effect of Dabigatran?

    <p>Dyspepsia, Gastritis-like Symptoms, Bleeding</p> Signup and view all the answers

    What is Argatroban indicated for?

    <p>HIT with risk for thrombosis</p> Signup and view all the answers

    What is the route of administration for Argatroban?

    <p>IV</p> Signup and view all the answers

    What is the serious side effect of Argatroban?

    <p>Hemorrhage, cardiac arrest, sepsis</p> Signup and view all the answers

    What is Bivalirudin used for?

    <p>PCI-thrombosis and HIT</p> Signup and view all the answers

    What is the advantage of Bivalirudin?

    <p>Safe to use in HIT</p> Signup and view all the answers

    What is a contraindication for Dabigatran?

    <p>Active Bleeding, Mechanical Heart Valves</p> Signup and view all the answers

    What is the warning for Dabigatran?

    <p>Do not break, chew, or open capsule</p> Signup and view all the answers

    What is a common side effect of Heparin therapy?

    <p>Thrombocytopenia</p> Signup and view all the answers

    What is the mechanism of action of Low Molecular Weight Heparins?

    <p>Binding to Antithrombin to inhibit Factor Xa</p> Signup and view all the answers

    What is the antidote for Heparin overdose?

    <p>Protamine</p> Signup and view all the answers

    What is a contraindication for Heparin therapy?

    <p>Uncontrolled Active Bleeding</p> Signup and view all the answers

    What is a role of Antithrombin in Heparin therapy?

    <p>Binding to Heparin to inhibit Factor Xa</p> Signup and view all the answers

    What is a key consideration in managing the risk of bleeding during Heparin therapy?

    <p>Checking dosage to prevent overdose</p> Signup and view all the answers

    What is the mechanism of action of Unfractioned Heparin?

    <p>It binds to antithrombin (AT) and inactivates thrombin (Factor IIa) and Factor Xa</p> Signup and view all the answers

    What is the recommended dosage adjustment for Apixaban in patients who are 80 years or older and weigh 60 kg or less?

    <p>Reduce the dose to 2.5mg BID</p> Signup and view all the answers

    What is the antidote for Apixaban?

    <p>Andexanet alfa (Andexxa) and Prothrombin complex concentrate (Kcentra)</p> Signup and view all the answers

    What is the most common side effect of Eptifibatide?

    <p>Chest pain</p> Signup and view all the answers

    What is the indication for Rivaroxaban in CAD/PAD?

    <p>Risk reduction of major CVD events</p> Signup and view all the answers

    What should be avoided when taking Apixaban?

    <p>Grapefruit juice</p> Signup and view all the answers

    What is the mechanism of action of Glycoprotein IIb/IIIa Inhibitors?

    <p>Inhibiting platelet aggregation by binding to GPIIb/IIIa</p> Signup and view all the answers

    What is the indication for Eptifibatide?

    <p>Percutaneous coronary intervention</p> Signup and view all the answers

    What is the serious side effect of Rivaroxaban?

    <p>GI bleeding</p> Signup and view all the answers

    What is the alternative IV agent to Eptifibatide?

    <p>Abciximab (no longer in market)</p> Signup and view all the answers

    What is a common side effect of Dabigatran?

    <p>Dyspepsia</p> Signup and view all the answers

    What is a contraindication for Argatroban?

    <p>Active major bleeding</p> Signup and view all the answers

    What is Bivalirudin used for?

    <p>PCI-thrombosis and HIT</p> Signup and view all the answers

    What is the antidote for Dabigatran overdose?

    <p>Idarucizumab (Praxbind)</p> Signup and view all the answers

    What is the route of administration for Dabigatran?

    <p>Oral (PO)</p> Signup and view all the answers

    What is a side effect of Argatroban?

    <p>N/V/D</p> Signup and view all the answers

    What is a contraindication for Bivalirudin?

    <p>Active major bleeding</p> Signup and view all the answers

    What is the mechanism of action of direct thrombin inhibitors?

    <p>Directly inhibiting thrombin</p> Signup and view all the answers

    What is a warning for Dabigatran?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic of Dabigatran capsules?

    <p>Do not break, chew, or open</p> Signup and view all the answers

    What is the mechanism of action of P2Y12 inhibitors?

    <p>Irreversibly inhibit P2Y12 on platelets</p> Signup and view all the answers

    Which platelet aggregation inhibitor is not recommended in patients 75 years and older unless high risk?

    <p>Prasugrel</p> Signup and view all the answers

    What is the common side effect of Ticagrelor?

    <p>Dyspnea</p> Signup and view all the answers

    What is the effect of Aspirin doses greater than 100 on Ticagrelor?

    <p>Reduce effectiveness</p> Signup and view all the answers

    When should Clopidogrel be stopped before elective surgery?

    <p>5 days before</p> Signup and view all the answers

    What is the interaction between grapefruit juice and CYP2C19 inhibitors?

    <p>Avoidance recommended</p> Signup and view all the answers

    What is the indication for Prasugrel?

    <p>ACS patients managed with PCI</p> Signup and view all the answers

    What is the serious side effect of Prasugrel?

    <p>Fatal bleeding</p> Signup and view all the answers

    When should Ticagrelor be stopped before elective surgery?

    <p>7 days before</p> Signup and view all the answers

    What is the mechanism of action of Fibrinolytics?

    <p>Break down clots by binding to fibrin</p> Signup and view all the answers

    What is the consequence of premature discontinuation of Apixaban in patients with Nonvalvular A-Fib?

    <p>Increased risk of stroke</p> Signup and view all the answers

    Which of the following is a contraindication for Eptifibatide?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of Rivaroxaban?

    <p>Reversible and selective active site inhibitor of Factor Xa</p> Signup and view all the answers

    What is the indication for Rivaroxaban in Nonvalvular A-Fib?

    <p>All of the above</p> Signup and view all the answers

    What is the antidote for Apixaban overdose?

    <p>Both A and B</p> Signup and view all the answers

    What is the consequence of taking grapefruit juice with Apixaban?

    <p>Increased risk of drug interactions</p> Signup and view all the answers

    What is the mechanism of action of Unfractioned Heparin?

    <p>Binds to antithrombin, which then inactivates thrombin and Factor Xa</p> Signup and view all the answers

    What is the indication for Eptifibatide?

    <p>Percutaneous coronary intervention</p> Signup and view all the answers

    What is the common side effect of Eptifibatide?

    <p>All of the above</p> Signup and view all the answers

    What is the alternative IV agent to Eptifibatide?

    <p>Abciximab</p> Signup and view all the answers

    What is the indication for Apixaban in Nonvalvular A-Fib patients?

    <p>Stroke Risk Reduction</p> Signup and view all the answers

    What is the antidote for Rivaroxaban overdose?

    <p>Andexanet alfa (Andexxa)</p> Signup and view all the answers

    What is the mechanism of action of Glycoprotein IIb/IIIa Inhibitors?

    <p>Inhibiting platelet aggregation by binding to GPIIb/IIIa</p> Signup and view all the answers

    What is the consequence of premature discontinuation of Apixaban in patients with Nonvalvular A-Fib?

    <p>Increased risk of stroke</p> Signup and view all the answers

    What is the recommended dosage adjustment for Apixaban in patients who are 80 years or older and weigh 60 kg or less?

    <p>Reduce the dose to 2.5mg BID</p> Signup and view all the answers

    What is the indication for Eptifibatide?

    <p>Percutaneous coronary intervention</p> Signup and view all the answers

    What is the serious side effect of Rivaroxaban?

    <p>All of the above</p> Signup and view all the answers

    What is the alternative IV agent to Eptifibatide?

    <p>Abciximab</p> Signup and view all the answers

    What should be avoided when taking Apixaban?

    <p>Grapefruit juice</p> Signup and view all the answers

    What is the mechanism of action of Unfractioned Heparin?

    <p>Binding to antithrombin (AT) to inactivate thrombin (Factor IIa) and Factor Xa</p> Signup and view all the answers

    Which platelet aggregation inhibitor is not recommended in patients 75 years and older unless high risk?

    <p>Ticagrelor</p> Signup and view all the answers

    What is the effect of Aspirin doses greater than 100 on Ticagrelor?

    <p>Reduces effectiveness</p> Signup and view all the answers

    When should Clopidogrel be stopped before elective surgery?

    <p>5 days</p> Signup and view all the answers

    What is the interaction between grapefruit juice and CYP2C19 inhibitors?

    <p>Reduced effectiveness</p> Signup and view all the answers

    What is the indication for Prasugrel?

    <p>ACS patients managed with PCI</p> Signup and view all the answers

    What is the serious side effect of Prasugrel?

    <p>Fatal bleeding</p> Signup and view all the answers

    When should Ticagrelor be stopped before elective surgery?

    <p>7 days</p> Signup and view all the answers

    What is the mechanism of action of Fibrinolytics?

    <p>Break down clots by binding to fibrin in a thrombus</p> Signup and view all the answers

    What is the consequence of premature discontinuation of Apixaban in patients with Nonvalvular A-Fib?

    <p>Increased risk of stroke</p> Signup and view all the answers

    Which of the following is a contraindication for Eptifibatide?

    <p>All of the above</p> Signup and view all the answers

    Which of the following direct thrombin inhibitors is used for thromboprophylaxis?

    <p>Dabigatran</p> Signup and view all the answers

    What is the indication for Dabigatran in patients with non-valvular atrial fibrillation?

    <p>Reducing stroke risk</p> Signup and view all the answers

    What is the consequence of premature discontinuation of Dabigatran in patients with non-valvular atrial fibrillation?

    <p>Increased risk of stroke</p> Signup and view all the answers

    Which of the following is a boxed warning for Dabigatran?

    <p>Risk of bleeding</p> Signup and view all the answers

    What is the antidote for Dabigatran overdose?

    <p>Idarucizumab</p> Signup and view all the answers

    Which of the following direct thrombin inhibitors is safe to use in patients with heparin-induced thrombocytopenia (HIT)?

    <p>Bivalirudin</p> Signup and view all the answers

    What is the route of administration for Argatroban?

    <p>Intravenous</p> Signup and view all the answers

    What is the common side effect of Argatroban?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a contraindication for Argatroban?

    <p>Active major bleeding</p> Signup and view all the answers

    What is the effect of Dabigatran on international normalized ratio (INR)?

    <p>No effect on INR</p> Signup and view all the answers

    What is the dose adjustment for Apixaban in patients who are 80 years or older and weigh 60 kg or less?

    <p>Reduce the dose to 2.5mg BID</p> Signup and view all the answers

    What is the indication for Rivaroxaban in Cardiovascular Disease?

    <p>Risk reduction of major Cardiovascular events in CAD/PAD</p> Signup and view all the answers

    What is the antidote for Apixaban overdose?

    <p>Andexanet alfa (Andexxa)</p> Signup and view all the answers

    What is the mechanism of action of Glycoprotein IIb/IIIa Inhibitors?

    <p>Inhibiting platelet aggregation by binding to GPIIb/IIIa</p> Signup and view all the answers

    What is the common side effect of Eptifibatide?

    <p>All of the above</p> Signup and view all the answers

    What is the consequence of premature discontinuation of Apixaban in patients with Nonvalvular A-Fib?

    <p>Increased risk of stroke</p> Signup and view all the answers

    What is the alternative IV agent to Eptifibatide?

    <p>Abciximab</p> Signup and view all the answers

    What should be avoided when taking Apixaban?

    <p>Grapefruit juice</p> Signup and view all the answers

    What is the mechanism of action of Unfractioned Heparin?

    <p>Binding to antithrombin, which then inactivates thrombin and Factor Xa</p> Signup and view all the answers

    What is the indication for Rivaroxaban in Nonvalvular A-Fib?

    <p>Stroke prevention</p> Signup and view all the answers

    What is the mechanism of action of P2Y12 inhibitors on platelets?

    <p>Irreversibly inhibit P2Y12 on platelets</p> Signup and view all the answers

    Which platelet aggregation inhibitor is not recommended in patients 75 years and older unless high risk?

    <p>Clopidogrel</p> Signup and view all the answers

    What is the effect of Aspirin doses greater than 100 on Ticagrelor?

    <p>Reduces the effectiveness of Ticagrelor</p> Signup and view all the answers

    When should Clopidogrel be stopped before elective surgery?

    <p>5 days before elective surgery</p> Signup and view all the answers

    What is the interaction between grapefruit juice and CYP2C19 inhibitors?

    <p>Grapefruit juice reduces the effectiveness of CYP2C19 inhibitors</p> Signup and view all the answers

    What is the indication for Prasugrel?

    <p>ACS patients managed with PCI</p> Signup and view all the answers

    What is the serious side effect of Prasugrel?

    <p>Fatal bleeding</p> Signup and view all the answers

    When should Ticagrelor be stopped before elective surgery?

    <p>7 days before elective surgery</p> Signup and view all the answers

    What is the mechanism of action of Fibrinolytics?

    <p>Break down clots by binding to fibrin in a thrombus</p> Signup and view all the answers

    What is the common side effect of Ticagrelor?

    <p>Dyspnea</p> Signup and view all the answers

    Which direct thrombin inhibitor is indicated for stroke risk reduction in nonvalvular atrial fibrillation?

    <p>Dabigatran</p> Signup and view all the answers

    What is the consequence of premature discontinuation of Dabigatran in patients with nonvalvular atrial fibrillation?

    <p>Increased risk of stroke</p> Signup and view all the answers

    Which antidote is used to reverse the effects of Dabigatran?

    <p>Idarucizumab</p> Signup and view all the answers

    Which platelet aggregation inhibitor is not recommended in patients 75 years and older unless at high risk?

    <p>Prasugrel</p> Signup and view all the answers

    What is the advantage of Bivalirudin in patients with heparin-induced thrombocytopenia (HIT)?

    <p>Safe use in HIT</p> Signup and view all the answers

    What is the characteristic of Dabigatran capsules that should be noted?

    <p>Should be taken with a full glass of water</p> Signup and view all the answers

    What is the effect of Aspirin doses greater than 100 on Ticagrelor?

    <p>Increased risk of bleeding</p> Signup and view all the answers

    When should Clopidogrel be stopped before elective surgery?

    <p>7 days before</p> Signup and view all the answers

    What is the common side effect of Ticagrelor?

    <p>Bleeding, dyspnea, and bradycardia</p> Signup and view all the answers

    What is the mechanism of action of Fibrinolytics?

    <p>Breakdown of fibrin clots</p> Signup and view all the answers

    What is the effect on Ticagrelor's effectiveness when Aspirin doses are greater than 100?

    <p>Reduced effectiveness</p> Signup and view all the answers

    Which P2Y12 inhibitor is not recommended in patients 75 years and older unless high risk?

    <p>Clopidogrel</p> Signup and view all the answers

    When should Ticagrelor be stopped before elective surgery?

    <p>7 days</p> Signup and view all the answers

    What is the mechanism of action of Fibrinolytics?

    <p>Breaking down clots by binding to fibrin in a thrombus and converting plasminogen to plasmin</p> Signup and view all the answers

    What is a characteristic of P2Y12 inhibitors?

    <p>Irreversibly inhibit P2Y12 on platelets</p> Signup and view all the answers

    What is the interaction between grapefruit juice and CYP2C19 inhibitors?

    <p>Decreased CYP2C19 activity</p> Signup and view all the answers

    When should Clopidogrel be stopped before elective surgery?

    <p>5 days</p> Signup and view all the answers

    What is the indication for Prasugrel?

    <p>ACS patients managed with PCI</p> Signup and view all the answers

    What is the serious side effect of Prasugrel?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of P2Y12 inhibitors?

    <p>Irreversibly inhibit P2Y12 on platelets</p> Signup and view all the answers

    Which of the following direct thrombin inhibitors is used for PCI-thrombosis and has a benefit in patients with a risk of HIT?

    <p>Bivalirudin</p> Signup and view all the answers

    What is a common side effect of Dabigatran that is related to the gastrointestinal system?

    <p>Dyspepsia</p> Signup and view all the answers

    Which of the following anticoagulants has a specific reversal agent?

    <p>Dabigatran</p> Signup and view all the answers

    What is the route of administration for Argatroban?

    <p>IV</p> Signup and view all the answers

    Which of the following direct thrombin inhibitors is used for stroke prevention in patients with nonvalvular atrial fibrillation?

    <p>Dabigatran</p> Signup and view all the answers

    What is a contraindication for Dabigatran?

    <p>Active bleeding</p> Signup and view all the answers

    Which of the following direct thrombin inhibitors has a higher risk of bleeding?

    <p>All of the above</p> Signup and view all the answers

    What is the advantage of using Bivalirudin in patients with a risk of HIT?

    <p>It is safer in patients with a risk of HIT</p> Signup and view all the answers

    Which of the following direct thrombin inhibitors can be used for thromboprophylaxis?

    <p>Dabigatran</p> Signup and view all the answers

    What is the warning for Dabigatran?

    <p>All of the above</p> Signup and view all the answers

    What is the recommended dosage adjustment for Apixaban in patients who are 80 years or older and weigh 60 kg or less?

    <p>Reduce the dose to 2.5mg BID</p> Signup and view all the answers

    What is the mechanism of action of Glycoprotein IIb/IIIa Inhibitors?

    <p>Inhibiting platelet aggregation by specifically binding to GPIIb/IIIa and preventing fibrinogen</p> Signup and view all the answers

    What is the consequence of premature discontinuation of Apixaban in patients with Nonvalvular A-Fib?

    <p>Increased risk of stroke</p> Signup and view all the answers

    What is the antidote for Rivaroxaban overdose?

    <p>Andexanet alfa (Andexxa)</p> Signup and view all the answers

    What is the indication for Rivaroxaban in CAD/PAD?

    <p>Risk reduction of major cardiovascular events</p> Signup and view all the answers

    What is the common side effect of Eptifibatide?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of Unfractioned Heparin?

    <p>Binds to antithrombin (AT), which then inactivates thrombin (Factor IIa) and Factor Xa</p> Signup and view all the answers

    What is the alternative IV agent to Eptifibatide?

    <p>Abciximab</p> Signup and view all the answers

    What is the serious side effect of Rivaroxaban?

    <p>All of the above</p> Signup and view all the answers

    What should be avoided when taking Apixaban?

    <p>Grapefruit juice</p> Signup and view all the answers

    Study Notes

    Heparin

    • Prevents conversion of fibrinogen to fibrin
    • Uses: VTE prophylaxis, treatment of VTE, and ACS
    • Contraindications: History of uncontrolled active bleeding, severe thrombocytopenia
    • Side effects: Bleeding risk, thrombocytopenia, increased LFT's
    • Antidote: Protamine

    Low Molecular Weight Heparin

    • Binds to AT, inhibiting Factor Xa more than Factor IIa
    • Side effects: Vfib, retroperitoneal/intracranial bleeding

    Factor Xa Inhibitors

    • Reversible and selective inhibitor of Factor Xa, decreasing thrombin generation and thrombus formation
    • Examples: Apixaban (Eliquis) and Rivaroxaban (Xarelto)
    • Indications: DVT/PE treatment and prevention, nonvalvular atrial fibrillation (reduce stroke risk)
    • Side effects: Bleeding risk, GI bleeding, hemorrhage, increased LFT's
    • Antidotes: Andexanet alfa (Andexxa) and Prothrombin complex concentrate (Kcentra)

    Glycoprotein IIb/IIIa Inhibitor

    • Inhibits platelet aggregation by binding to GPIIb/IIIa and preventing fibrinogen
    • Example: Eptifibatide (Integrilin)
    • Indications: Percutaneous coronary intervention, adjunct to PCI
    • Contraindications: CVA within 30 days, active abnormal bleeding, surgery/trauma within 6 weeks
    • Side effects: Bleeding risk, thrombocytopenia, anaphylaxis, CVA, intercranial hemorrhage

    Direct Thrombin Inhibitors

    • Directly inhibits thrombin (Factor IIa), binding to the active thrombin site of free and clot-associated thrombin
    • Examples: Dabigatran (Pradaxa) and Argatroban
    • Indications: DVT/PE treatment and prevention, nonvalvular atrial fibrillation (reduce stroke risk), thromboprophylaxis, HIT, PCI-thrombosis
    • Side effects: Bleeding risk, dyspepsia, gastritis-like symptoms, anemia, hypotension, chest pain
    • Antidotes: Idarucizumab (Praxbind) for dabigatran, no specific antidote for argatroban

    Factor Xa Inhibitors

    • Reversible and selective active site inhibitor of Factor Xa, resulting in decreased thrombin generation and thrombus formation.
    • Apixaban (Eliquis) is used for DVT/PE treatment and prevention, and nonvalvular A-Fib stroke risk reduction.
    • Dose reduction to 2.5mg BID for patients 80 years or older, weighing 60 kg or less, and having a SCr of 1.5 or more.
    • Andexanet alfa (Andexxa) and Prothrombin complex concentrate (Kcentra) are antidotes.
    • Avoid grapefruit juice and CYP3A4 inhibitors.

    Glycoprotein IIb/IIIa Inhibitor

    • Inhibits platelet aggregation by specifically binding to GPIIb/IIIa and preventing fibrinogen.
    • Eptifibatide (Integrilin) is used for percutaneous coronary intervention, adjunct to PCI, and acute coronary syndrome.
    • Contraindications include CVA within 30 days, active abnormal bleeding, and severe hypertension.

    Unfractionated Heparin

    • Binds to antithrombin (AT), which then inactivates thrombin (Factor IIa) and Factor Xa.
    • Used for OA, RA, and other conditions.

    P2Y12 Inhibitors

    • Irreversibly inhibit P2Y12 (On ADP Receptors) on platelets, resulting in inhibition of platelet activation and aggregation.
    • Clopidogrel (Plavix) is used for ACS, stroke, and established PAD.
    • Contraindications include active bleeding, history of stroke or TIA.
    • Prasugrel (Effient) is used for ACS patients managed with PCI, and has fatal bleeding as a boxed warning.
    • Ticagrelor (Brilinta) is used for ACS and has fatal bleeding, aspirin doses greater than 100, and severe hepatic impairment as contraindications.

    Fibrinolytics

    • Breaks down clots by binding to fibrin in a thrombus and converting plasminogen to plasmin.
    • 2nd Generation, due to clot-specific binding.

    Direct Thrombin Inhibitors

    • Directly inhibits thrombin (Factor IIa) by binding to the active thrombin site of free and clot-associated thrombin.
    • Dabigatran (Pradaxa) is used for DVT/PE treatment and prevention, nonvalvular A-Fib stroke risk reduction, and thromboprophylaxis.
    • Contraindications include premature discontinuation, spinal/epidural hematoma, and active bleeding.
    • Idarucizumab (Praxbind) is an antidote.
    • Argatroban is used for HIT, PCI - thrombosis and has active major bleeding as a contraindication.
    • Bivalirudin (Angiomax) is used for PCI - thrombosis and has active major bleeding as a contraindication.

    Factor Xa Inhibitors

    • Reversible and selective active site inhibitor of Factor Xa, resulting in decreased thrombin generation and thrombus formation.
    • Apixaban (Eliquis) is used for DVT/PE treatment and prevention, and nonvalvular A-Fib stroke risk reduction.
    • Dose reduction to 2.5mg BID for patients 80 years or older, weighing 60 kg or less, and having a SCr of 1.5 or more.
    • Andexanet alfa (Andexxa) and Prothrombin complex concentrate (Kcentra) are antidotes.
    • Avoid grapefruit juice and CYP3A4 inhibitors.

    Glycoprotein IIb/IIIa Inhibitor

    • Inhibits platelet aggregation by specifically binding to GPIIb/IIIa and preventing fibrinogen.
    • Eptifibatide (Integrilin) is used for percutaneous coronary intervention, adjunct to PCI, and acute coronary syndrome.
    • Contraindications include CVA within 30 days, active abnormal bleeding, and severe hypertension.

    Unfractionated Heparin

    • Binds to antithrombin (AT), which then inactivates thrombin (Factor IIa) and Factor Xa.
    • Used for OA, RA, and other conditions.

    P2Y12 Inhibitors

    • Irreversibly inhibit P2Y12 (On ADP Receptors) on platelets, resulting in inhibition of platelet activation and aggregation.
    • Clopidogrel (Plavix) is used for ACS, stroke, and established PAD.
    • Contraindications include active bleeding, history of stroke or TIA.
    • Prasugrel (Effient) is used for ACS patients managed with PCI, and has fatal bleeding as a boxed warning.
    • Ticagrelor (Brilinta) is used for ACS and has fatal bleeding, aspirin doses greater than 100, and severe hepatic impairment as contraindications.

    Fibrinolytics

    • Breaks down clots by binding to fibrin in a thrombus and converting plasminogen to plasmin.
    • 2nd Generation, due to clot-specific binding.

    Direct Thrombin Inhibitors

    • Directly inhibits thrombin (Factor IIa) by binding to the active thrombin site of free and clot-associated thrombin.
    • Dabigatran (Pradaxa) is used for DVT/PE treatment and prevention, nonvalvular A-Fib stroke risk reduction, and thromboprophylaxis.
    • Contraindications include premature discontinuation, spinal/epidural hematoma, and active bleeding.
    • Idarucizumab (Praxbind) is an antidote.
    • Argatroban is used for HIT, PCI - thrombosis and has active major bleeding as a contraindication.
    • Bivalirudin (Angiomax) is used for PCI - thrombosis and has active major bleeding as a contraindication.

    Factor Xa Inhibitors

    • Reversible and selective active site inhibitor of Factor Xa, resulting in decreased thrombin generation and thrombus formation.
    • Apixaban (Eliquis) is used for DVT/PE treatment and prevention, and nonvalvular A-Fib stroke risk reduction.
    • Dose reduction to 2.5mg BID for patients 80 years or older, weighing 60 kg or less, and having a SCr of 1.5 or more.
    • Andexanet alfa (Andexxa) and Prothrombin complex concentrate (Kcentra) are antidotes.
    • Avoid grapefruit juice and CYP3A4 inhibitors.

    Glycoprotein IIb/IIIa Inhibitor

    • Inhibits platelet aggregation by specifically binding to GPIIb/IIIa and preventing fibrinogen.
    • Eptifibatide (Integrilin) is used for percutaneous coronary intervention, adjunct to PCI, and acute coronary syndrome.
    • Contraindications include CVA within 30 days, active abnormal bleeding, and severe hypertension.

    Unfractionated Heparin

    • Binds to antithrombin (AT), which then inactivates thrombin (Factor IIa) and Factor Xa.
    • Used for OA, RA, and other conditions.

    P2Y12 Inhibitors

    • Irreversibly inhibit P2Y12 (On ADP Receptors) on platelets, resulting in inhibition of platelet activation and aggregation.
    • Clopidogrel (Plavix) is used for ACS, stroke, and established PAD.
    • Contraindications include active bleeding, history of stroke or TIA.
    • Prasugrel (Effient) is used for ACS patients managed with PCI, and has fatal bleeding as a boxed warning.
    • Ticagrelor (Brilinta) is used for ACS and has fatal bleeding, aspirin doses greater than 100, and severe hepatic impairment as contraindications.

    Fibrinolytics

    • Breaks down clots by binding to fibrin in a thrombus and converting plasminogen to plasmin.
    • 2nd Generation, due to clot-specific binding.

    Direct Thrombin Inhibitors

    • Directly inhibits thrombin (Factor IIa) by binding to the active thrombin site of free and clot-associated thrombin.
    • Dabigatran (Pradaxa) is used for DVT/PE treatment and prevention, nonvalvular A-Fib stroke risk reduction, and thromboprophylaxis.
    • Contraindications include premature discontinuation, spinal/epidural hematoma, and active bleeding.
    • Idarucizumab (Praxbind) is an antidote.
    • Argatroban is used for HIT, PCI - thrombosis and has active major bleeding as a contraindication.
    • Bivalirudin (Angiomax) is used for PCI - thrombosis and has active major bleeding as a contraindication.

    Factor Xa Inhibitors

    • Reversible and selective active site inhibitor of Factor Xa, resulting in decreased thrombin generation and thrombus formation.
    • Apixaban (Eliquis) is used for DVT/PE treatment and prevention, and nonvalvular A-Fib stroke risk reduction.
    • Dose reduction to 2.5mg BID for patients 80 years or older, weighing 60 kg or less, and having a SCr of 1.5 or more.
    • Andexanet alfa (Andexxa) and Prothrombin complex concentrate (Kcentra) are antidotes.
    • Avoid grapefruit juice and CYP3A4 inhibitors.

    Glycoprotein IIb/IIIa Inhibitor

    • Inhibits platelet aggregation by specifically binding to GPIIb/IIIa and preventing fibrinogen.
    • Eptifibatide (Integrilin) is used for percutaneous coronary intervention, adjunct to PCI, and acute coronary syndrome.
    • Contraindications include CVA within 30 days, active abnormal bleeding, and severe hypertension.

    Unfractionated Heparin

    • Binds to antithrombin (AT), which then inactivates thrombin (Factor IIa) and Factor Xa.
    • Used for OA, RA, and other conditions.

    P2Y12 Inhibitors

    • Irreversibly inhibit P2Y12 (On ADP Receptors) on platelets, resulting in inhibition of platelet activation and aggregation.
    • Clopidogrel (Plavix) is used for ACS, stroke, and established PAD.
    • Contraindications include active bleeding, history of stroke or TIA.
    • Prasugrel (Effient) is used for ACS patients managed with PCI, and has fatal bleeding as a boxed warning.
    • Ticagrelor (Brilinta) is used for ACS and has fatal bleeding, aspirin doses greater than 100, and severe hepatic impairment as contraindications.

    Fibrinolytics

    • Breaks down clots by binding to fibrin in a thrombus and converting plasminogen to plasmin.
    • 2nd Generation, due to clot-specific binding.

    Direct Thrombin Inhibitors

    • Directly inhibits thrombin (Factor IIa) by binding to the active thrombin site of free and clot-associated thrombin.
    • Dabigatran (Pradaxa) is used for DVT/PE treatment and prevention, nonvalvular A-Fib stroke risk reduction, and thromboprophylaxis.
    • Contraindications include premature discontinuation, spinal/epidural hematoma, and active bleeding.
    • Idarucizumab (Praxbind) is an antidote.
    • Argatroban is used for HIT, PCI - thrombosis and has active major bleeding as a contraindication.
    • Bivalirudin (Angiomax) is used for PCI - thrombosis and has active major bleeding as a contraindication.

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    Description

    This quiz covers the treatment of Acute Coronary Syndrome (ACS) and Venous Thromboembolism (VTE), including prophylaxis and management of related complications such as thrombocytopenia and HIT.

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