Anticoags

Question 1

venous thrombotic events

Answer 1

dvt
pe

Question 2

arterial thrombotic events

Answer 2

coronary
cerebral
peripheral

Question 3

indications for anti coags

Answer 3

venous thrombosis
afib

Question 4

MOA of heparin

Answer 4

potentiates anti thrombin
enhances effect of it (inhibits clotting factors)
binds to thrombin/ factor 10, complex switches it off, heparin wraps around and keeps it secure so they dont associate again

LMWH and unfractioned-

Question 5

how long does heparin take to act

Answer 5

immediate efffect

Question 6

how to monitor heparin

Answer 6

activated partial thromboplastin time for unfractioned

anti-xa assay for LMWH but usually not required to monitor lmwh as more predictable response

Question 7

complications of heparin

Answer 7

bleeding

heparin induced thrombocytopenia - monitor FBC

Question 8

what can heparin cause long term

Answer 8

osteoporosis

Question 9

what to do if a patient is bleeding on heparin

Answer 9

stop the heparin
gone out the ssystem within 30 minutes usually

Question 10

what does unfractioned heparin inhibit

Answer 10

factor xa and and thrombin

Question 11

what does lmwh inhibit

Answer 11

greater effect on factor xa than on thrombin

Question 12

coumarin anticoags

Answer 12

warfarin
phenindione
acenocoumarin
phenprocoumon

Question 13

MOA of warfarin

Answer 13

inhibits vitamin k

Blocks ability of vitamin k to carboxylate vit k dependant clotting factors so reducing their coagulant activity

Question 14

what reaction is vitamin k involved in

Answer 14

carboxylation

Question 15

what is vitamin k

Answer 15

fat soluble vitamin absorbed in upper intestine
requires bile slats to for absorption

Question 16

vitamin k dependant fcators

Answer 16

factors II , VII, IX & X
PROTEIN C AND S

Question 17

monitoring of warfarin

Answer 17

international normalised ratio - INR

Question 18

major adverse effect of warfarin

Answer 18

haemorrhage

Question 19

factors that may influence bleeding risk

Answer 19

Intensity of anticoagulation

Concomitant clinical disorders

Concomitant use of other medications

BEWARE DRUG INTERACTIONS

Quality of management

Question 20

what is warfarin metabolised by and where

Answer 20

cytochrome p450 in the liver - same which metabolises alcohol

Question 21

bleeding complications of warfarin

Answer 21

Mild
skin bruising
epistaxis
haematuria
Severe
gastro-intestinal
intracerebral
significant drop in Hb

Question 22

what to give for warfarin reversal

Answer 22

vit k - inr will come down in 6 hours
or clotting factors - immediate affect

Question 23

new anticoags use

Answer 23

initially used instead of lmwh as prohylaxis in elective hip and knee replacement surgery

used for dvt and pe

introduced for stroke prevention in afib for new patients

Question 24

examples of new anticoags

Answer 24

Direct activated factor X inhibitors (eg edoxaban, rivaroxaban, apixaban)

Direct thrombin inhibitors (dabigatran)

Question 25

benefits of new anticoags

Answer 25

Oral and no monitoring required
Less drug interactions