Questions and Answers
What is the primary purpose of administering fresh-frozen plasma or clotting factor concentrates in life-threatening bleeding?
Which of the following is NOT a characteristic of direct oral anticoagulants compared to warfarin?
Which direct oral anticoagulant requires prior subcutaneous anticoagulation for at least 5 days before its administration?
What is the role of idarucizumab in anticoagulation therapy?
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What is a common advantage of using fondaparinux over low molecular weight heparin (LMWH)?
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Which of the following is true regarding parenteral direct thrombin inhibitors (DTIs)?
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Which of the following anticoagulants does NOT require any routine monitoring?
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Which characteristic helps differentiate direct oral anticoagulants from traditional anticoagulants like warfarin?
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What does andexanet alfa do?
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Which anticoagulant is categorized as a direct thrombin inhibitor?
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Study Notes
Calcium Channel Blockers (CCBs)
- Non-dihydropyridine CCBs, such as diltiazem and verapamil, are more selective for cardiac tissues compared to vascular smooth muscle.
- Verapamil significantly decreases heart rate; diltiazem has a lesser effect.
- CCBs are primarily used for managing angina pectoris and hypertension, with non-dihydropyridines also treating cardiac arrhythmias.
- Effective in treating angina linked to coronary vasospasm.
- Nimodipine, related to nifedipine, specifically targets cerebral arteries for vascular spasms post-aneurysmal subarachnoid hemorrhage.
- Verapamil is indicated for cluster headache and migraine prophylaxis; nifedipine treats Raynaud’s syndrome and chronic anal fissure.
- Amlodipine and felodipine allow once-daily dosing due to their extended duration of action.
- Common side effects include flushing, headache, and ankle swelling; verapamil is known for causing constipation.
- Amlodipine and other CCBs should generally be avoided in patients with heart failure as they may worsen cardiac function.
Lipid-Regulating Drugs
- Designed to modify blood lipid levels, helping manage dyslipidemias and reduce cardiovascular risks.
- Main classes of lipid-regulating drugs include:
- Statins (e.g., atorvastatin, rosuvastatin)
- Fibrates (e.g., fenofibrate, gemfibrozil)
- Nicotinic acid (e.g., acipimox)
- Bile acid sequestrants (e.g., colesevelam)
- Absorption inhibitors (e.g., ezetimibe)
- Others (e.g., alirocumab, evolocumab)
- Statins block HMG-CoA reductase, crucial in cholesterol synthesis, effectively lowering LDL but less effective than fibrates for triglycerides.
- Statins are used for primary and secondary prevention in dyslipidemia with documented coronary artery disease.
- Rosuvastatin and atorvastatin have the longest half-lives and are preferred due to lower hepatotoxicity risks.
- Omega-3 fatty acids can reduce triglyceride levels significantly and are utilized as adjunct therapy in hypertriglyceridemia.
- PCSK9 inhibitors (alirocumab, evolocumab) can reduce LDL-C by up to 60% in combination with statins, administered subcutaneously.
- Lomitapide and mipomersen are for homozygous familial hypercholesterolemia and have black box warnings for hepatotoxicity.
- Bempedoic acid lowers LDL-cholesterol and is indicated for inadequate responses to other therapies.
Nitrates
- Nitrates are vasodilators used for angina pectoris, heart failure, myocardial infarction, and anal fissures.
- Sublingual Glyceryl Trinitrate (GTN) offers rapid relief from angina; aerosol sprays are alternatives for ease of use.
- Proper usage involves placement under the tongue without swallowing or inhaling.
- Patient instructions for managing acute angina include rest, GTN administration, and seeking medical help if pain persists after three doses in 15 minutes.
Direct Oral Anticoagulants (DOACs)
- Categories include direct thrombin inhibitors (e.g., dabigatran) and direct factor Xa inhibitors (e.g., rivaroxaban, apixaban).
- DOACs provide rapid onset, predictable pharmacokinetics, and eliminate the need for routine monitoring compared to warfarin.
- For treating or preventing recurrent VTE, edoxaban and dabigatran require initial treatment with parenteral anticoagulants for five days.
- Lower risks of intracranial hemorrhage are associated with target-specific anticoagulants.
- Idarucizumab reverses dabigatran effects, while andexanet alfa reverses apixaban and rivaroxaban effects.
Parenteral Anticoagulants
- Injectable direct thrombin inhibitors include lepirudin, bivalirudin, argatroban, and desirudin; they are preferred in patients with a history of heparin-induced thrombocytopenia (HIT).
- Fondaparinux serves as an effective alternative to low molecular weight heparin (LMWH) for VTE treatment and prevention after surgery without routine coagulation testing requirements.
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Description
This quiz explores the pharmacological properties and clinical uses of non-dihydropyridine calcium channel blockers (CCBs), specifically diltiazem and verapamil. Learn how these medications affect heart rate and their applications in conditions like angina pectoris and hypertension.
