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Definition
bind to P2Y (12) ADP receptor on platelet surface, inhibiting platelet activation |
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Definition
irriversible inhibits COX1 within platelet, blocking production of thromboxane A2 and platelet aggregation |
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Definition
inhibit the enzyme VKOR; only affects synthesis of new factors |
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Definition
reduces oxidized Vitamin K for reuse |
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Definition
is coupled to carboxylation of inactive forms of factors VII, IX |
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Definition
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Definition
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Definition
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Definition
following oral and rectal is nearly complete |
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Definition
detectable in plasma within 1 hour, peak 2-8 hours, 98% protein bound |
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Definition
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Definition
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Definition
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Definition
primarily hepatic, metabolites primarily excreted in urine |
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Definition
decreased ability to metabolize S-warfarin (increasing risk of bleeding) |
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Term
carried by 25% European Americans |
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Definition
CYP2C9 variability (*2 and *3) |
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Term
heterozygosity (*2 and *3 on CYP2C9) |
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Definition
decrease dose requirement of 20-30% |
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Term
homozygosity (*2 and *3 on CYP2C9) |
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Definition
decrease dose requirement of 50-70% |
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Term
"FAB 4" warfarin interactions |
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Definition
fluconazole, amiodarone, bactrim, metronidazole |
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Term
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Definition
warfarin causes discoloration on toes within 3-8 weeks, color fades with elevation of leg, thought to be due to cholesterol emboli |
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Definition
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Term
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Definition
Oral Vitamin K preferred; FFP or prothrombin complex can be used |
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Definition
faster but risk of anaphylaxis |
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Term
direct thrombin inhibitors |
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Definition
bind directly to and inhibit free and clot-bound thrombin (factor IIa), prevents conversion of fibrinogen to fibrin, and inhibits thrombin mediated platelet activation |
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Term
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Definition
oral direct thrombin inhibitor, first FDA approved oral DTI for thromboprophylaxis and non-valvular AFib |
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Term
dabigatran bioavailability |
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Definition
poor (3-7%), food slows absorption but does not affect bioavail |
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Definition
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Term
peak plasma concentration of dabigatran achieved |
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Definition
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Definition
50-70L and is 35% protein bound |
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Term
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Definition
prodrug that is rapidly converted to active form by serine esterase |
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Term
interactions with P-glycoprotein subrates |
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Definition
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Term
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Definition
12-17 hours, excreted primarily unchanged in the urine |
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Term
dose adjustments for dabigatran |
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Definition
CrCl 30 (150 mg BID), CrCl 15-30 (75 mg BID), CrCl of 30-50 with use of dronedarone or systemic ketoconazole (75 mg BID) |
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Term
converting warfarin to dabigatran |
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Definition
discontinue warf and start when INR is <2 |
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Term
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Definition
provides qalitative estimate of antocoagulant effect |
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Term
monitoring for dabigatran |
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Definition
monitor renal function and S/Sx of bleeding |
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Term
adverse affects of dabigatran |
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Definition
bleeding, dyspepsia reported in pre-marketing studies |
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Term
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Definition
discontinue drug, supportive care (blood products), 60% removed by dialysis |
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Term
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Definition
directly inhibits Xa preventing the conversion of II to IIa |
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Term
factor X activated by intrinsic and extrinsic pathways |
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Definition
activating factor Xa which converts II to IIa and promotes the clotting cascade |
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Term
bioavalability of rivaroxiban |
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Definition
66-100%, dose dependent decreases with larger doses, food increases availability of 20 mg doses |
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Term
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Definition
50L, 92-95% protein bound to albumin |
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Term
metabolism of rivaroxaban |
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Definition
primarily hepatic via CYP3A4/5 and 2J2, also a p-glycoprotein substrate, inactive metabolites excreted in urine |
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Term
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Definition
VTE prophylaxis (post-op), VTE treatment and secondary prophylaxis, non-valvular AFib |
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Term
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Definition
renal function, S/Sx of bleeding, may increase INR but is not definitive test |
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Term
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Definition
abrupt discontinuation may increase risk of thrombolic events, risk of spinal/ epidural hematoma in PTs receiving neuraxial anesthesia or spinal puncture |
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Term
rivaroxaban and hepatic impairment |
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Definition
child-pugh class B and C associated with increased risk of coagulopathy |
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Term
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Definition
strong CYP3A4 and P glycoprotein inducers should be avoided |
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Term
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Definition
no specific or reliable reversal agent; discontinue drug, supportive care, activated charcoal may be used and Prothrombin Complex Concentrates may be an option |
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Term
bioavailability of apixaban ADME |
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Definition
50%, food slows absorption, but no affect on Cmax or AUC |
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Term
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Definition
21-61L with 87% protein binding and also P-glycoprotein binding |
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Term
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Definition
primarily hepatic via CYP3A4, excretion primarily fecal with 7-12 hour half-life |
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Term
apixaban dose adjustment to 2.5 mg PO BID |
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Definition
with concomitant use of strong CYP3A4 and P-glycoprotein substrates, age >80 yr, weight < 60kg and SCr >1.5 |
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Term
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Definition
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Term
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Definition
abrupt discontinuation increases risk of thrombotic events |
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Definition
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Term
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Definition
50L, 92-95% protein bound to albumin |
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Term
metabolism of rivaroxaban |
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Definition
primarily hepatic via CYP3A4/5 and 2J2, also a p-glycoprotein substrate, inactive metabolites excreted in urine |
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Term
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Definition
VTE prophylaxis (post-op), VTE treatment and secondary prophylaxis, non-valvular AFib |
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Term
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Definition
renal function, S/Sx of bleeding, may increase INR but is not definitive test |
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Term
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Definition
abrupt discontinuation may increase risk of thrombolic events, risk of spinal/ epidural hematoma in PTs receiving neuraxial anesthesia or spinal puncture |
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Term
rivaroxaban and hepatic impairment |
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Definition
child-pugh class B and C associated with increased risk of coagulopathy |
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Term
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Definition
strong CYP3A4 and P glycoprotein inducers should be avoided |
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Term
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Definition
no specific or reliable reversal agent; discontinue drug, supportive care, activated charcoal may be used and Prothrombin Complex Concentrates may be an option |
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Term
bioavailability of apixaban ADME |
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Definition
50%, food slows absorption, but no affect on Cmax or AUC |
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Term
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Definition
21-61L with 87% protein binding and also P-glycoprotein binding |
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Term
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Definition
primarily hepatic via CYP3A4, excretion primarily fecal with 7-12 hour half-life |
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Term
apixaban dose adjustment to 2.5 mg PO BID |
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Definition
with concomitant use of strong CYP3A4 and P-glycoprotein substrates, age >80 yr, weight < 60kg and SCr >1.5 |
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Term
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Definition
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Term
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Definition
abrupt discontinuation increases risk of thrombotic events |
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Term
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Definition
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