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learning from past papers > Anticoagulants > Flashcards

Anticoagulants Flashcards

1
Q

which anticoagulants carry a risk of epidural haematoma (collection of blood in between skull and dura mater)

A
  • NOACs and DOACs

e.g (rivaroxaban, dabigatran
apixaban, edoxaban)

note: no evidence of risk with lmwh eg dalteparin

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2
Q

name the 2 types of juice that interact with warfarin

A

Cranberry + pomegranate juice

both increase INR so increase warfarins anticoagulant effect

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3
Q

which anticoagulants can be used in pregnancy (e.g for DVT/VTE)

A

LMWH (low molecular weight heparins):
Dalteparin
Enoxaparin
Tinzaparin

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4
Q

how long is rivaroxaban given for to prevent VTE after a KNEE replacement surgery

A

2 weeks

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5
Q

how long is rivaroxaban given for to prevent VTE after a HIP replacement surgery

A

5 weeks

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6
Q

what do you do if: INR 5.0–8.0, no bleeding

A

withhold 1 or 2 doses of warfarin sodium and reduce subsequent maintenance dose

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7
Q

what do you do if: INR 5.0–8.0, minor bleeding

A

stop warfarin sodium; give phytomenadione (vitamin K1) by slow intravenous injection; restart warfarin sodium when INR <5.0

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8
Q

what do you do if: INR >8.0, no bleeding

A

stop warfarin sodium; give phytomenadione (vitamin K1) by mouth using the intravenous preparation orally [unlicensed use]; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin when INR <5.0

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9
Q

what do you do if: INR >8.0, minor bleeding

A

stop warfarin sodium; give phytomenadione (vitamin K1) by slow intravenous injection; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin sodium when INR <5.0

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10
Q

what do you do if: a patient taking warfarin has a major bleed

A

stop warfarin sodium; give phytomenadione (vitamin K1) by slow intravenous injection; give dried prothrombin complex (factors II, VII, IX, and X); if dried prothrombin complex unavailable, fresh frozen plasma can be given but is less effective

note: recombinant factor VIIa is not recommended for emergency anticoagulation reversal

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11
Q

what should a patients INR ideally be if they are switch from warfarin to a DOAC straight away

A

<2

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12
Q

which PPIs decrease the efficacy of clopidogrel

A

omeprazole + esomeprazole

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13
Q

why should patients on warfarin report if they get a painful skin rash

A

warfarin use may lead to calciphylaxis ( calcium accumulates in small blood vessels of the fat and skin tissues)

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14
Q

what colour is the warfarin 1mg tablet

A

brown

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15
Q

what colour is the warfarin 3mg tablet

A

blue

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16
Q

what colour is the warfarin 5mg tablet

A

pink

17
Q

how long should a patient take warfarin for isolated calf-vein deep-vein thrombosis

A

6 weeks

18
Q

how long should a patient take warfarin for VTE provoked by surgery or other transient factors

A

3 months

19
Q

how long should a patient take warfarin for unprovoked proximal DVT or PE

A

at least 3 months

20
Q

how long should a patient take warfarin for AF (atrial fibrillation)

A

lifelong

21
Q

how long should a patient take warfarin for prosthetic heart valve

A

lifelong

22
Q

what are the contraindications for NOACs (apixaban, dabigatran + rivaroxaban)

A
  • a lesion or condition that is a risk of major bleeding

- concomitant treatment with any other anticoagulant agent

23
Q

which anticoagulant should not be used for thromboprophylaxis in patients with prosthetic heart valves, including patients who have undergone TAVR (transcatheter aortic valve replacement)

A

rivaroxaban (MHRA warning)

24
Q

which anticoagulants are not recommended in patients with antiphospholipid syndrome

A

DOACS

note: particularly high-risk patients who test positive for all three antiphospholipid tests—lupus anticoagulant, anticardiolipin antibodies, and anti-beta2 glycoprotein I antibodies. consider switching to warfarin

25
Q

describe how rivaroxaban 15mg + 20mg tablets should be taken (counselling points)

A
  • take with food
  • on those who have difficulty swallowing, these tablets can be crushed and mixed with water or apple puree immediately before, and followed by food immediately after, ingestion
26
Q

which anticoagulants are contraindicated in patients with a heart valve

A

DOACs

learning from past papers (21 decks)

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