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PDAT5 CV > 25 - Oral Anticoagulants > Flashcards

25 - Oral Anticoagulants Flashcards

1
Q

Rivaroxaban
Xarelto

DOSING:
DVT Following Hip or Knee Replacement Surgery

A
  • *CrCL <30 mL/min**
  • *AVOID**
  • *10mg QD**
  • with or without food*
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2
Q

DABIGATRAN = Pradaxa

  • *Treatment / Reduction in risk of DVT & PE**
  • *DOSING**
A

Treatment / Reduction in risk of DVT & PE

CrCl >30:
150mg BID after 5-10 days of Parenteral AC “Bridge”

CrCl < 30 or Dialysis
dosing not provided

CrCl <50 + P-gp Inhibitor
AVOID co-admin

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3
Q

Rivaroxaban
Xarelto

DOSING:
DVT or PE Treatment

A

15mg wf BID x 21 days
then
20mg wf QD

  • *CrCl < 30 ml/min**
  • *AVOID**
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4
Q

Which AC drug is

CONTRAINDICATED w/ CrCL > 95?

A

EDOXABAN = Savaysa

Non-Valvular AFIB w/ CrCL > 95
Is
CONTRAINDICATED

Also CrCl < 15

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5
Q

Which AC drug inhibits

Factor Xa?

A

Rivaroxaban** / **Apixaban** / **Edoxaban
Xarelto / Eliquis / Savaysa

Betrixaban

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6
Q

Which AC drugs require

BRIDGING / Parenteral Lead-In

A

DABIGATRAN
DVT/PE Treatment –> 5-10 days of Bridge
then 150mg BID (reg dose)

EDOXABAN
DVT/PE Treatment –> 5-10 days LMWH/UFH
then 30mg QD (normal is 60mg)

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7
Q

Dabigatran
Pradaxa

DRUG INTERACTIONS

A
  • *AVOID with Pg-p INDUCERS**
  • *Rifampin / Carbamazepine / Phenytoin**

Pg-P Inhibitors
↑Drug Concentration –> ↑Risk of Bleeding
DRONEDERONE** or **KETOKONAZOLE

AFIB:
CrCl 30-50 = 75mg BID, CrCl <30: Avoid

Ortho VTE Prophylaxis:
CrCl >50 = seperate doses by hours, <50 = AVOID

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8
Q

Apixaban
Eliquis

DOSING:
Reduction in risk of recurrent DVT & PE following initial therapy

A
  • *2.5mg BID**
  • same as prophylaxis of DVT following hip/knee replacement*
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9
Q

DABIGATRAN = Pradaxa

  • *Reduction in STROKE risk & Systemic Embolism in Non-Vascular AF**
  • *DOSING**
A

Reduction in STROKE risk & Systemic Embolism in Non-Vascular AF

CrCl > 30:
150mg BID

CrCl: 15 - 30
75mg BID

CrCl <15 or Dialysis
no dosing rec

CrCl 30 - 50 + P-gp Inhibitor
if Dronedarone or Ketoconazole –> 75mg BID

CrCl <30 + P-gp Inhibitor
AVOID co-admin

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10
Q

Apixaban
Eliquis

DOSING:
↓Risk of Stroke + PEinNonvalvular AFIB

A

5mg BID

2.5mg BID –> if 2 of the following:
> 80 y/o
Weight < 60kg
Scr > 1.5mg/dL

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11
Q

Apixaban
Eliquis

DRUG INTERACTIONS

P-gp + Strong CYP3A4 INDUCERS

A

P-gp + Strong CYP3A4 INDUCERS

RIFAMPIN / Carbamazepine / Phenytoin

BARBITURATES / St. Johns Wort

AVOID WITH APIXABAN
decrease apixaban exposure
same as DABIGATRAN

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12
Q

Which AC drug should you AVOID/CONTRAINDICATED
with
P-gp INDUCERS

Rifampin / Carbamazepine / Phenytoin

St. John’s Wort / Ritonavir / Avasimibe

A

DABIGATRAN

APIXABAN** + **EDOXABAN
+barbiturates

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13
Q

Edoxaban
Savaysa

Contraindications

A

P-gp INDUCERS
Rifampin / Carbamazepine / Phenytoin

  • *CrCl > 95** for AFIB
  • still 60mg qd for VTE/PE treatment*

CrCl < 15

Weight <60 kg

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14
Q

Edoxaban
Savaysa

DOSING:
Non-valvular AFib

A
  • *CrCl 50-95**
  • *60mg QD**
  • *CrCL 15-50**
  • 30mg QD**, no clinical data*
  • CrCL > 95* or wt <60kg _or CrCL < 15_
  • CONTRAINDICATED*
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15
Q

Apixaban
Eliquis

DOSING:
TREATMENT of DVT + PE

A

5mg BID

2.5mg BID –> if 2 of the following:
> 80 y/o
Weight < 60kg
Scr > 1.5mg/dL

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16
Q

Which AC drug(s) inhibit

IIa?

A

DABIGATRAN (Pradaxa)

DIRECT THROMBIN INHIBITOR

17
Q

Indications for

DABIGATRAN = Pradaxa

A

Treatment of DVT & PE
150mg BID after 5-10 days of Parenteral AC

Prophylaxis of DVT & PE** **following HIP REPLACEMENT
110mg first day –> 220mg QD

Reduction in Stroke Risk & Systemic Embolism
150mg BID

18
Q

Which AntiCoagulant can NOT be CRUSHED?

A

DABIGATRAN = Pradaxa

Capsule w/ small pellets, preserves gut absorption even when HIGH pH

19
Q

Apixaban
Eliquis

DOSING:
Prophylaxis of DVTfollowing Hip/Knee replacement

A
  • *2.5mg BID**
  • same as reduction in risk for recurrent DVT & PE*
20
Q

Which AC drug requires

HEPATIC DOSE ADJUSTMENT?

And What is recommended?

A

APIXABAN

Mild = Okay

Moderate = limited data

Severe = NOT RECOMMENDED

Dabigatran
has limited data in Hepatic Impairment + Obesity

21
Q

Edoxaban
Savayasa

DVT/PE Treatment Dosing

no Indication for VTE prophylaxis

A

DVT/PE Treatment
TREAT FIRST WITH 5-10 DAYS of LMWH or UFH

CrCl >95 or 50-95
60mg qd

  • *CrCl >15-50** or Weight < 60kg** or **With Pg-P INHIBITOR
  • *30mg qd**
  • *CrCl < 15_ or _w/ Pg-P Inducer**
  • CONTRAINDICATED*
22
Q

Which AC drugs are

DAILY DOSING?

A

Warfarin

EDOXABAN = SAVAYSA

Rivaroxaban
BID for 21 days –> then once Daily

23
Q

Rivaroxaban
Xarelto

DOSING:
NonValvular AFIB

A

CrCl >50 mL/min:
20mg QD + evening meal

CrCl <50 mL/min:
15mg QD + evening meal

24
Q

DABIGATRAN = Pradaxa

Prophylaxis of DVT & PE following
HIP REPLACEMENT SURGERY
DOSING

A

Prophylaxis of DVT & PE following
HIP REPLACEMENT SURGERY

CrCl >30:
110mg for first day –> 220mg QD

CrCl < 30 or Dialysis
dosing not provided

CrCl <50 + P-gp Inhibitor
AVOID co-admin

25
Q

Apixaban
Eliquis

Metabolism

A
  • *CYP3A4**
  • not affected by food*

Prolongs:
PT/INR+aPTT

26
Q

Which DOAC is a Prodrug?

A

DABIGATRAN = Pradaxa

After PO admin:
rapid absorption & CONVERSION by esterase-catalyzed hydrolysis in LIVER

2-3 Hour onset

27
Q

Rivaroxaban = Xarelto

Metabolism / Drug Interactions

A

92-95% protein binding
metablolized by:
CYP3A4

Prolongs INR

Renally Dosed

28
Q

Betrixaban
Bevyxxa

Indications

A

ONLY 1 INDICATION

  • *HOSPITILIZED**
  • *Acute medical illness who are AT RISK for VTE**

still a Factor Xa inhibtor –> ORAL instead of enoxaparin?

29
Q

Rivaroxaban
Xarelto

DOSING:
Reduction in Risk of DVT +/- PE
in patients at risk for DVT/ PE

A

CrCl >50 mL/min:
20mg QD + evening meal

CrCl <50 mL/min:
15mg QD + evening meal

30
Q

Dabigatran = Pradaxa

Metabolism / Elimination

A

RENALLY EXCRETED
moderate / severe renal impairment –> reduce dose
no CYP450 metabolism

LOW PROTEIN BINDING
can be removed by hemodialysis

Prolongs Clotting Time of:
PT / aPTT / ECT / TCT

31
Q

Dabigatran = Pradaxa

ADR

A
  • *DYSPEPSIA**
  • *GI Side Effects**

Bleeding –> BEERS Criteria
(>75 yo)

Dispense in original bottle / blister package

32
Q

Apixaban
Eliquis

DRUG INTERACTIONS

P-gp + Strong CYP4A4 Inhibitors

A

P-gp + Strong CYP4A4 Inhibitors

Ketoconazole / Itraconazole / Ritonavir

↓Dose by 50% if taking 5mg or 10mg BID

AVOID if taking 2.5mg BID

PDAT5 CV (30 decks)

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