Podcast
Questions and Answers
A patient is prescribed aspirin for secondary prevention of cardiovascular events. What is the primary mechanism of action of aspirin in preventing platelet aggregation?
A patient is prescribed aspirin for secondary prevention of cardiovascular events. What is the primary mechanism of action of aspirin in preventing platelet aggregation?
- Blocking the ADP receptor on platelets.
- Inhibiting the activity of phosphodiesterase to increase cAMP levels.
- Inhibiting the synthesis of thromboxane A2. (correct)
- Blocking the binding of fibrinogen to GP IIb/IIIa receptors.
A patient with a history of MI is currently on aspirin, a beta-blocker, and an ACE inhibitor. He now requires additional antiplatelet therapy to reduce his risk of another thrombotic event. Which of the following medications would be most appropriate to add to his regimen?
A patient with a history of MI is currently on aspirin, a beta-blocker, and an ACE inhibitor. He now requires additional antiplatelet therapy to reduce his risk of another thrombotic event. Which of the following medications would be most appropriate to add to his regimen?
- Dipyridamole
- Eptifibatide
- Clopidogrel (correct)
- Cilostazol
A patient develops heparin-induced thrombocytopenia (HIT). What is the most appropriate next step in managing this patient's anticoagulation?
A patient develops heparin-induced thrombocytopenia (HIT). What is the most appropriate next step in managing this patient's anticoagulation?
- Discontinue heparin and initiate a direct thrombin inhibitor like argatroban. (correct)
- Administer a platelet transfusion to correct the thrombocytopenia.
- Start warfarin therapy while continuing the heparin infusion.
- Immediately administer protamine sulfate to reverse the heparin.
A pregnant patient requires anticoagulation for a deep vein thrombosis (DVT). Which of the following is the preferred anticoagulant for use during pregnancy?
A pregnant patient requires anticoagulation for a deep vein thrombosis (DVT). Which of the following is the preferred anticoagulant for use during pregnancy?
A cardiologist is deciding on antithrombotic therapy for a patient with a mechanical heart valve. Which of the following agents is contraindicated in this patient population?
A cardiologist is deciding on antithrombotic therapy for a patient with a mechanical heart valve. Which of the following agents is contraindicated in this patient population?
Which of the following medications is a prodrug that requires activation by CYP2C19?
Which of the following medications is a prodrug that requires activation by CYP2C19?
A patient on heparin develops severe bleeding. Which of the following medications is the most appropriate antidote?
A patient on heparin develops severe bleeding. Which of the following medications is the most appropriate antidote?
A patient taking warfarin is started on amiodarone for atrial fibrillation. What potential side effect is most important to monitor for, and what adjustment to the warfarin dosage is typically necessary?
A patient taking warfarin is started on amiodarone for atrial fibrillation. What potential side effect is most important to monitor for, and what adjustment to the warfarin dosage is typically necessary?
A hospitalized patient is being transitioned from intravenous heparin to oral warfarin for long-term anticoagulation. Which of the following strategies is most appropriate for this transition?
A hospitalized patient is being transitioned from intravenous heparin to oral warfarin for long-term anticoagulation. Which of the following strategies is most appropriate for this transition?
What drug class does fondaparinux belong to?
What drug class does fondaparinux belong to?
A patient with known heart failure and atrial fibrillation requires anticoagulation. Which agent is contraindicated?
A patient with known heart failure and atrial fibrillation requires anticoagulation. Which agent is contraindicated?
A patient on warfarin has been consistently stabilized at an INR of 2.5. They are going to have a tooth extraction. What is your next step?
A patient on warfarin has been consistently stabilized at an INR of 2.5. They are going to have a tooth extraction. What is your next step?
A patient on warfarin has an unstable INR and has been experiencing significant fluctuations. What is your next step?
A patient on warfarin has an unstable INR and has been experiencing significant fluctuations. What is your next step?
A patient is diagnosed with atrial fibrillation (AFib) and has a history of stroke. Which medication is appropriate for preventing future thromboembolic events?
A patient is diagnosed with atrial fibrillation (AFib) and has a history of stroke. Which medication is appropriate for preventing future thromboembolic events?
Concurrent intake of which of the following substances would cause a decreased effectiveness of warfarin?
Concurrent intake of which of the following substances would cause a decreased effectiveness of warfarin?
What is the mechanism of action of heparin?
What is the mechanism of action of heparin?
What is the antidote for dabigatran?
What is the antidote for dabigatran?
A patient taking clopidogrel requires treatment for acid reflux. Which of the following medications should be avoided due to potential drug interaction that could reduce the effectiveness of clopidogrel?
A patient taking clopidogrel requires treatment for acid reflux. Which of the following medications should be avoided due to potential drug interaction that could reduce the effectiveness of clopidogrel?
A patient develops angioedema while receiving alteplase. What is the most appropriate course of action?
A patient develops angioedema while receiving alteplase. What is the most appropriate course of action?
Which medication is most appropriate for prevention and treatment of DVT and PE in a patient with a confirmed HIT?
Which medication is most appropriate for prevention and treatment of DVT and PE in a patient with a confirmed HIT?
A patient with DVT is prescribed oral medication for treatment. Which of the following factors affect the stability of warfarin?
A patient with DVT is prescribed oral medication for treatment. Which of the following factors affect the stability of warfarin?
A patient has been admitted with DVT/PE and has been initiated on a heparin drip. What is the next best step after confirmed Heparin-Induced Thrombocytopenia?
A patient has been admitted with DVT/PE and has been initiated on a heparin drip. What is the next best step after confirmed Heparin-Induced Thrombocytopenia?
Which antiplatelet agent irreversibly inhibits COX-1?
Which antiplatelet agent irreversibly inhibits COX-1?
What is the antidote for heparin toxicity?
What is the antidote for heparin toxicity?
A patient is prescribed cilostazol. What is the expected outcome for this patient?
A patient is prescribed cilostazol. What is the expected outcome for this patient?
Which of the following drugs is a direct thrombin inhibitor?
Which of the following drugs is a direct thrombin inhibitor?
What is the mechanism of action of alteplase?
What is the mechanism of action of alteplase?
Which of the following medications requires monitoring of aPTT?
Which of the following medications requires monitoring of aPTT?
Which of the following agents is contraindicated in pregnancy?
Which of the following agents is contraindicated in pregnancy?
Which of the following best describes the mechanism of action of Aspirin (ASA)?
Which of the following best describes the mechanism of action of Aspirin (ASA)?
A patient with acute coronary syndrome (ACS) is currently on aspirin and clopidogrel. Which of the following medications should be added for percutaneous coronary intervention (PCI)?
A patient with acute coronary syndrome (ACS) is currently on aspirin and clopidogrel. Which of the following medications should be added for percutaneous coronary intervention (PCI)?
A hospitalized patient receiving heparin develops heparin-induced thrombocytopenia (HIT). What is the next step in management?
A hospitalized patient receiving heparin develops heparin-induced thrombocytopenia (HIT). What is the next step in management?
Which anticoagulant is preferred for a pregnant patient requiring anticoagulation therapy?
Which anticoagulant is preferred for a pregnant patient requiring anticoagulation therapy?
Which medication is contraindicated in a patient with a history of stroke or transient ischemic attack (TIA)?
Which medication is contraindicated in a patient with a history of stroke or transient ischemic attack (TIA)?
Which of the following is a prodrug that requires activation by CYP2C19?
Which of the following is a prodrug that requires activation by CYP2C19?
What is the reversal agent for dabigatran in cases of severe bleeding?
What is the reversal agent for dabigatran in cases of severe bleeding?
Which of the following is the antidote for heparin overdose?
Which of the following is the antidote for heparin overdose?
A patient taking clopidogrel is also prescribed omeprazole for GERD. What is the main concern with this combination?
A patient taking clopidogrel is also prescribed omeprazole for GERD. What is the main concern with this combination?
A patient on warfarin has an INR of 1.3 and requires increased anticoagulation. Which of the following should be considered?
A patient on warfarin has an INR of 1.3 and requires increased anticoagulation. Which of the following should be considered?
A patient on warfarin with an INR of 4.8 has no active bleeding. What is the next step?
A patient on warfarin with an INR of 4.8 has no active bleeding. What is the next step?
Which of the following is the correct approach for transitioning from IV heparin to warfarin?
Which of the following is the correct approach for transitioning from IV heparin to warfarin?
A patient with atrial fibrillation and valvular heart disease needs long-term anticoagulation. Which is the preferred agent?
A patient with atrial fibrillation and valvular heart disease needs long-term anticoagulation. Which is the preferred agent?
A patient with atrial fibrillation and normal renal function is started on a direct oral anticoagulant (DOAC). Which of the following is an appropriate choice?
A patient with atrial fibrillation and normal renal function is started on a direct oral anticoagulant (DOAC). Which of the following is an appropriate choice?
A 65-year-old male with heart failure is prescribed cilostazol for intermittent claudication. What is the next step?
A 65-year-old male with heart failure is prescribed cilostazol for intermittent claudication. What is the next step?
A 70-year-old patient with severe renal impairment requires anticoagulation for DVT prevention. Which drug is contraindicated?
A 70-year-old patient with severe renal impairment requires anticoagulation for DVT prevention. Which drug is contraindicated?
A patient on warfarin is started on rifampin. What effect will this have on INR?
A patient on warfarin is started on rifampin. What effect will this have on INR?
Which of the following medications can increase the effectiveness of warfarin and raise INR?
Which of the following medications can increase the effectiveness of warfarin and raise INR?
A patient on warfarin for atrial fibrillation has a stable INR of 2.5 over the past six months. What is the next step in monitoring?
A patient on warfarin for atrial fibrillation has a stable INR of 2.5 over the past six months. What is the next step in monitoring?
A patient on warfarin has fluctuating INR levels despite consistent dosing. What should be considered?
A patient on warfarin has fluctuating INR levels despite consistent dosing. What should be considered?
A 72-year-old male with atrial fibrillation and chronic kidney disease (eGFR < 30 mL/min) needs anticoagulation for stroke prevention. What is the preferred option?
A 72-year-old male with atrial fibrillation and chronic kidney disease (eGFR < 30 mL/min) needs anticoagulation for stroke prevention. What is the preferred option?
A 58-year-old female with non-valvular atrial fibrillation and no other risk factors is started on anticoagulation. What is the best option?
A 58-year-old female with non-valvular atrial fibrillation and no other risk factors is started on anticoagulation. What is the best option?
A patient is started on IV heparin for a deep vein thrombosis (DVT). When transitioning to warfarin, how should this be done?
A patient is started on IV heparin for a deep vein thrombosis (DVT). When transitioning to warfarin, how should this be done?
A patient on IV heparin is switched to rivaroxaban. When should the first dose of rivaroxaban be given?
A patient on IV heparin is switched to rivaroxaban. When should the first dose of rivaroxaban be given?
A patient on SSRIs and an antiplatelet (e.g., aspirin or clopidogrel) is at increased risk for which complication?
A patient on SSRIs and an antiplatelet (e.g., aspirin or clopidogrel) is at increased risk for which complication?
A patient on ticagrelor is prescribed aspirin 325 mg daily. What is the concern with this combination?
A patient on ticagrelor is prescribed aspirin 325 mg daily. What is the concern with this combination?
A patient with peripheral artery disease (PAD) is started on dual antiplatelet therapy (DAPT). Which of the following is appropriate?
A patient with peripheral artery disease (PAD) is started on dual antiplatelet therapy (DAPT). Which of the following is appropriate?
A patient with a mechanical heart valve needs lifelong anticoagulation. Which agent is preferred?
A patient with a mechanical heart valve needs lifelong anticoagulation. Which agent is preferred?
Flashcards
ASA Mechanism of Action
ASA Mechanism of Action
Inhibits cyclooxygenase-1 (COX-1), preventing thromboxane A2 formation and thus platelet aggregation.
Next step after Heparin-Induced Thrombocytopenia (HIT)
Next step after Heparin-Induced Thrombocytopenia (HIT)
Stop heparin immediately and switch to a direct thrombin inhibitor like argatroban.
Anticoagulation in Pregnancy
Anticoagulation in Pregnancy
LMWH is DOC during pregnancy, coumadin is teratogenic.
Clopidogrel: A Prodrug
Clopidogrel: A Prodrug
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Antidote for Heparin
Antidote for Heparin
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Antidote for Dabigatran
Antidote for Dabigatran
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Antidote for Warfarin
Antidote for Warfarin
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Factors that Potentiate Warfarin
Factors that Potentiate Warfarin
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Factors that Stimulate Warfarin
Factors that Stimulate Warfarin
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Dabigatran as a Prodrug
Dabigatran as a Prodrug
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Heparin Administration
Heparin Administration
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LMWH Administration
LMWH Administration
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Argatroban use and monitoring
Argatroban use and monitoring
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Platelet Aggregation Inhibitors
Platelet Aggregation Inhibitors
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Heparin Mechanism
Heparin Mechanism
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Warfarin Mechanism
Warfarin Mechanism
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Dabigatran and Apixaban Uses
Dabigatran and Apixaban Uses
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Direct Xa Inhibitor characteristics
Direct Xa Inhibitor characteristics
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Thrombolytics Mechanism
Thrombolytics Mechanism
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CYP2C19 Inhibitors Impact on Antiplatelet
CYP2C19 Inhibitors Impact on Antiplatelet
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Heparin Contraindications
Heparin Contraindications
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Parenteral to Oral Anticoagulant Transition
Parenteral to Oral Anticoagulant Transition
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Direct Xa Inhibitors ADEs
Direct Xa Inhibitors ADEs
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Dipyridamole use
Dipyridamole use
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Abciximab Use
Abciximab Use
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Prasugrel Contraindication
Prasugrel Contraindication
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Warfarin & INR of 1.3
Warfarin & INR of 1.3
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Warfarin and INR 4.8
Warfarin and INR 4.8
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Warfarin Transition
Warfarin Transition
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Apixaban Use
Apixaban Use
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Clopidogrel and Omeprazole
Clopidogrel and Omeprazole
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Warfarin in patients with AFib
Warfarin in patients with AFib
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Cilostazol C/I
Cilostazol C/I
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Stable INR Frequency
Stable INR Frequency
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Study Notes
- Aspirin (ASA) mechanism of action is the irreversible inhibition of cyclooxygenase-1 (COX-1).
- Abciximab should be added for percutaneous coronary intervention (PCI) in a patient with acute coronary syndrome (ACS) already on aspirin and clopidogrel; it is a GP IIb/IIIa inhibitor used adjunctively with heparin and aspirin during PCI.
- Discontinue heparin and initiate argatroban to manage Heparin-Induced Thrombocytopenia (HIT); Argatroban is a direct thrombin inhibitor.
- Low molecular weight heparin (LMWH) is preferred for a pregnant patient requiring anticoagulation therapy since Warfarin is contraindicated.
- Prasugrel is contraindicated in patients with a history of stroke or transient ischemic attack (TIA) or age > 75 years.
- Clopidogrel requires CYP2C19 for activation, making it a prodrug, caution should be taken in poor metabolizers.
- Idarucizumab specifically reverses the effects of dabigatran in cases of severe bleeding.
- Protamine sulfate binds to heparin to neutralize its effects, acts as the antidote for Heparin overdose.
- Reduced effectiveness of clopidogrel is the main concern when combined with omeprazole for GERD, because omeprazole inhibits CYP2C19 (reducing clopidogrel activation.)
- Increase the warfarin dose if a patient on warfarin has a subtherapeutic INR requiring increased anticoagulation.
- Hold warfarin and monitor INR in a patient on warfarin with an INR of 4.8 and no active bleeding (if INR > 4.5 but < 10 without bleeding).
- When transitioning from IV heparin to warfarin, overlap heparin with warfarin for at least 5 days because warfarin takes 72-96 hours for peak effect.
- Warfarin is the only approved agent for AFib with valvular disease requiring long-term anticoagulation
- Apixaban is appropriate for a patient with atrial fibrillation and normal renal function started on a direct oral anticoagulant (DOAC); this is preferred for non-valvular AFib due to predictable dosing and no routine monitoring.
- Discontinue cilostazol in a 65-year-old male with heart failure prescribed cilostazol for intermittent claudication because cilostazol is contraindicated in heart failure and can exacerbate it via phosphodiesterase III inhibition.
- Fondaparinux is contraindicated in a 70-year-old patient with severe renal impairment requiring anticoagulation for DVT prevention because it's accumulation in severe renal impairment leads to increased bleeding risk.
- Starting a patient on warfarin on rifampin will decrease INR because rifampin is a CYP450 inducer that increases warfarin metabolism, reducing its anticoagulant effect.
- Amiodarone can increase the effectiveness of warfarin and raise INR by inhibiting warfarin metabolism, increasing INR and bleeding risk.
- Check INR every 4 weeks in a patient on warfarin for atrial fibrillation has a stable INR of 2.5 over the past six months, stable patients can have INR checks spaced every 4 weeks.
- Dietary vitamin K intake should be considered in a patient on warfarin has fluctuating INR levels despite consistent dosing because Vitamin K-rich foods can impact warfarin's effectiveness, leading to INR fluctuations.
- Apixaban is preferred in CKD (eGFR < 30 mL/min) needing anticoagulation for stroke prevention in atrial fibrillation with chronic kidney disease due to its lower renal excretion compared to other DOACs.
- Rivaroxaban is often the best option for a 58-year-old female with non-valvular atrial fibrillation and no other risk factors started on anticoagulation because DOACs like rivaroxaban are first-line for non-valvular AFib.
- Overlap heparin and warfarin for at least 5 days until INR is therapeutic is the strategy to transition to warfarin since warfarin takes time to inhibit clotting factors, must continue heparin until INR is stable.
- For direct Xa inhibitors like rivaroxaban, start at heparin discontinuation to maintain anticoagulation.
- Give the first dose of rivaroxaban at the time of heparin discontinuation in a patient on IV heparin is switched to rivaroxaban.
- A patient on SSRIs and an antiplatelet (e.g., aspirin or clopidogrel) is at increased bleeding risk because SSRIs can inhibit platelet aggregation, increasing bleeding risk when combined with antiplatelets.
- The concern for a patient on ticagrelor prescribed aspirin 325 mg daily is decreased effectiveness of ticagrelor because Ticagrelor loses effectiveness when taken with >100 mg daily of aspirin.
- Aspirin + Clopidogrel is an appropriate dual antiplatelet therapy (DAPT) as DAPT is used for PAD to prevent thrombotic events in a patient with peripheral artery disease (PAD) started on dual antiplatelet therapy (DAPT).
- Warfarin is the only anticoagulant approved for mechanical heart valves which is the agent preferred in a patient with a mechanical heart valve needing lifelong anticoagulation.
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