PHCY 502: Cardio Test 4 VTE
questions well answered to pass
white thrombi - correct answer ✔✔arterial thrombi; rich in platelets but scarce in RBCs
NSTEMI
red thrombi - correct answer ✔✔fibrin rich, lost of red blood cells
Most common thrombi found in STEMI
deep venous thrombosis
pulmonary embolism
venous thromboembolism - correct answer ✔✔a blood clot that originates in a vein
DVT and PE
last and most effective defense against bleeding - correct answer ✔✔coagulation (clotting)
clotting factors in plasma - correct answer ✔✔from liver/platelets mostly
activated in a reaction cascade
anticoagulants - correct answer ✔✔drugs that prevent clotting by inhibiting clotting factors -->
prevention and treatment of thrombosis
fibrinolytics - correct answer ✔✔act by dissolving existing thrombi or emboli (acute treatment
of thrombosis)
,direct thrombin inhibitors MOA - correct answer ✔✔Directly bind to the active site of thrombin,
inhibiting downstream effects
only oral direct thrombin inhibitor - correct answer ✔✔Dabigatran (Pradaxa)
monovalent direct thrombin inhibitor - correct answer ✔✔dabigatran, bind only at active site
Bivalent Direct Thrombin Inhibitors - correct answer ✔✔Hirudin and Bivalirudin
bind active site + substrate recognition site
argatroban - correct answer ✔✔smaller molecule than bivalirudin
short 1/2 life, IV infusion
clinical applications of argatroban - correct answer ✔✔HIT or risk of HIT
PCI
dabigatran - correct answer ✔✔prodrug
no monitoring
half-life 12-24 hours
dabigatran AE - correct answer ✔✔bleeding, dyspepsia
dabigatran clinical applications - correct answer ✔✔prevention and treatment of VTE
prevention of stroke and systemic embolism in non-valvular A-fib
reversal agent for dabigatran - correct answer ✔✔Idarucizumab (Praxbind)
, Idarucizumab (Praxbind) - correct answer ✔✔humanized mouse mAb fragment
infused as two IV boluses
for emergyncy situations or need for urgent surgical intervention
Idarucizumab (Praxbind) MOA - correct answer ✔✔binds dabigatran with an affinity 350 fold
higher than that of dabigatran for thrombin --> irreversible complex cleared by the kidney
DOACs - correct answer ✔✔ALL ORAL
Dabigatran
Rivaroxaban
Apixaban
Edoxaban
betrixaban
Oral direct factor Xa inhibitors - correct answer ✔✔oral
no monitoring
short half lifes
oral direct factor xa inhibitors DDI - correct answer ✔✔cyp3a4 and PgP
Oral direct factor Xa inhibitors CI - correct answer ✔✔renal/hepatic impairment
betrixaban - correct answer ✔✔minimal hepatic metabolism, but still P-gp substrate
less renal excretion
longest half life
questions well answered to pass
white thrombi - correct answer ✔✔arterial thrombi; rich in platelets but scarce in RBCs
NSTEMI
red thrombi - correct answer ✔✔fibrin rich, lost of red blood cells
Most common thrombi found in STEMI
deep venous thrombosis
pulmonary embolism
venous thromboembolism - correct answer ✔✔a blood clot that originates in a vein
DVT and PE
last and most effective defense against bleeding - correct answer ✔✔coagulation (clotting)
clotting factors in plasma - correct answer ✔✔from liver/platelets mostly
activated in a reaction cascade
anticoagulants - correct answer ✔✔drugs that prevent clotting by inhibiting clotting factors -->
prevention and treatment of thrombosis
fibrinolytics - correct answer ✔✔act by dissolving existing thrombi or emboli (acute treatment
of thrombosis)
,direct thrombin inhibitors MOA - correct answer ✔✔Directly bind to the active site of thrombin,
inhibiting downstream effects
only oral direct thrombin inhibitor - correct answer ✔✔Dabigatran (Pradaxa)
monovalent direct thrombin inhibitor - correct answer ✔✔dabigatran, bind only at active site
Bivalent Direct Thrombin Inhibitors - correct answer ✔✔Hirudin and Bivalirudin
bind active site + substrate recognition site
argatroban - correct answer ✔✔smaller molecule than bivalirudin
short 1/2 life, IV infusion
clinical applications of argatroban - correct answer ✔✔HIT or risk of HIT
PCI
dabigatran - correct answer ✔✔prodrug
no monitoring
half-life 12-24 hours
dabigatran AE - correct answer ✔✔bleeding, dyspepsia
dabigatran clinical applications - correct answer ✔✔prevention and treatment of VTE
prevention of stroke and systemic embolism in non-valvular A-fib
reversal agent for dabigatran - correct answer ✔✔Idarucizumab (Praxbind)
, Idarucizumab (Praxbind) - correct answer ✔✔humanized mouse mAb fragment
infused as two IV boluses
for emergyncy situations or need for urgent surgical intervention
Idarucizumab (Praxbind) MOA - correct answer ✔✔binds dabigatran with an affinity 350 fold
higher than that of dabigatran for thrombin --> irreversible complex cleared by the kidney
DOACs - correct answer ✔✔ALL ORAL
Dabigatran
Rivaroxaban
Apixaban
Edoxaban
betrixaban
Oral direct factor Xa inhibitors - correct answer ✔✔oral
no monitoring
short half lifes
oral direct factor xa inhibitors DDI - correct answer ✔✔cyp3a4 and PgP
Oral direct factor Xa inhibitors CI - correct answer ✔✔renal/hepatic impairment
betrixaban - correct answer ✔✔minimal hepatic metabolism, but still P-gp substrate
less renal excretion
longest half life
