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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
**_Apixaban_** Eliquis ## Footnote **Metabolism**
* *_CYP3A4_** * not affected by food* **Prolongs: PT/INR**+**aPTT**
26
**Which DOAC is a Prodrug?**
**_DABIGATRAN_** = **Pradaxa** After PO admin: **rapid absorption** & **CONVERSION** by **esterase-catalyzed hydrolysis in LIVER** **2-3 Hour onset**
27
**Rivaroxaban = Xarelto** **Metabolism / Drug Interactions**
**92-95% protein binding** metablolized by: **_CYP3A4_** ## Footnote **Prolongs INR** **_Renally Dosed_**
28
**_Betrixaban_** Bevyxxa **Indications**
ONLY 1 INDICATION * *_HOSPITILIZED_** * *Acute medical illness who are _AT RISK for VTE_** still a **Factor Xa inhibtor** --\> **ORAL instead of enoxaparin?**
29
**_Rivaroxaban_** Xarelto **DOSING: Reduction in Risk of DVT +/- PE** in patients at risk for DVT/ PE
_CrCl \>50 mL/min:_ **20mg** **QD** + **evening meal** _CrCl \<50 mL/min:_ **15mg QD** + **evening meal**
30
**_Dabigatran_** = Pradaxa ## Footnote **Metabolism / Elimination**
**_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
**Dabigatran = Pradaxa** **ADR**
* *_DYSPEPSIA_** * *GI Side Effects** **Bleeding --\> _BEERS Criteria_** (\>75 yo) Dispense in **original bottle / blister package**
32
**_Apixaban_** Eliquis ## Footnote **DRUG INTERACTIONS** **_P-gp + Strong CYP4A4 Inhibitors_**
_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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