3 Anticoagulants HH Oral Flashcards

1
Q

Check baseline ……(3)…… when starting warfarin

A

INR
FBC
LFT

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2
Q

Usual loading dose for warfarin:

reduce this in…. and …

A

10mg od for 2 days

reduce in elderly and liver impaired

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3
Q

2 reasons warfarin interactions are so common?

A
  1. metabolised by cyp

2. highly bound to plasma - other protein bound drugs compete

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4
Q

What factors does Warfarin inhibit synthesis of?

A

clotting factors: II, VII, Ix, X

regulatory factors: protein C and protein S

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5
Q

What are the actions of
protein C
protein S

A

vitamin K dependent anticoagulant proteins

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6
Q

Why do we overlap Warfarin and Heparin

A

Warfarin initially decreases protein C and S faster than coagulation factors - therefor it can increase blood’s tendency to coagulate when first begun

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7
Q

Baseline monitoring for NOACs

A

Prothrombin time
Liver function
Renal function
BP

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8
Q

Do we use TED stockings from stroke patients?

A

No they do worse with them

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9
Q

UFH is rarely used now except in (2)

A

high bleed risk or renal failure

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10
Q

Why is depression risky with Warfarin?

A

Risk of self harm?

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11
Q

Why is illicit drug use risky with Warfarin?

A

Risk of infection and bleed

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12
Q

Why is uncontrolled hypertension risky with NOACs?

A

Bleeding

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13
Q

How to change from Warfarin to apixiban

A
  • you would consult product literature

- Wait for the INR to drop below a certain level (~2.5)

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14
Q

Monitor NOACs for (5)

A

Bleeding & anaemia

Adherence
Liver func
Renal func

Pregnancy and BF - avoid!

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15
Q

What do we try to use for managing NOAC overdose

A

Activated charcoal
Stop drug
Supportive therapy and fluid replacement to insure excretion
Consider factors, tranexamic acid, dialysis

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16
Q

Contraindications for NOACs

A
  • recent GI ulceration
  • neoplasm at risk bleeding
  • recent brain or spinal injury
  • recent brain, spinal or ophthalmic surgery
  • recent intercraneal haemorrage
  • oesophageal varices
  • arteriovenous malformation
  • cocomitant other anticoagulants
17
Q

Caution - check NOAC doses in what patients?

A

elderly