Kingdom of Saudi Arabia

Ministry of Education
Taif University
College of Pharmacy
Pharmacology and Toxicology Department

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Tutorial on anticoagulant drugs

Problem solving 1
A 56-year-old man with a history only mild hypertension presents to the
hospital with calf discomfort and left lower extremity swelling. One day
.earlier he returned to Washington, DC on a long flight from Tokyo, Japan
Left lower extremity ultrasound is consistent with deep venous thrombosis.
Appropriate management at this time includes Starting once daily low
.molecular weight heparin and initiate warfarin as an outpatient

:compare between heparin and warfarin as regards -1

Route of administration, mechanism of action, Onset of action, Monitoring
And Antidote
Kingdom of Saudi Arabia
Ministry of Education
Taif University
College of Pharmacy
Pharmacology and Toxicology Department

?mention adverse effects of heparin -2

?discuss benefits of LMWH over unfractionated heparin -3

Kingdom of Saudi Arabia
Ministry of Education
Taif University
College of Pharmacy
Pharmacology and Toxicology Department

mention alternatives to heparin if the patient develops Heparin -4

?induced thrombocytopenia

Problem solving 2
A 45 year-old woman with a history of atrial fibrillation seen for routine
follow-up asks if she can switch to one of the new oral anticoagulants
that does not require monitoring for adjustment. She is currently on
.warfarin. Her INR values over the past year have ranged from 1.8 to 2.7
compare oral Anticoagulants warfarin, rivaroxaban and -1
:dabigatran as regards
Mechanism of action , Onset, Duration, Monitoring , Antidote, Interaction, Liver
failure, Renal impairment ,Pregnancy
Kingdom of Saudi Arabia
Ministry of Education
Taif University
College of Pharmacy
Pharmacology and Toxicology Department

?mention the contraindications of anticoagulants in general -2

Choose the correct answer

Kingdom of Saudi Arabia
Ministry of Education
Taif University
College of Pharmacy
Pharmacology and Toxicology Department

1-Low molecular weight heparins differ from unfractionated heparin in

that:
A. They selectively inhibit factor Xa
B. They do not significantly prolong clotting time
C. They are metabolized slowly and have longer duration of action
D. All of the above are correct

2- You are treating a patient of deep vein thrombosis with warfarin.

What value of International normalized ratio (INR) will you attempt by
adjusting dose of the anticoagulant for an adequate therapeutic effect:
A. 1.2 – 1.5
B. 1.3 – 1.7
C. 1.5 – 2.5
D. 3.0 – 4.0

3- Unfractionated heparin binds to antithrombin III and inactivates

clotting factor(s).
(a) Xa
(b) IXa
(c) IIa
(d) All of the above
(e) None of these