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Cardiovascular > Anticoagulants > Flashcards

Anticoagulants Flashcards

1
Q

What are anticoagulants used for

A

To prevent thrombus formation in veins

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2
Q

Anticoagulants include

A

Coumarins - phenindione and warfarin

DOACs

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3
Q

Can you use coumarins in pregnancy

A

No because it crosses the placenta- teratogenic - avoid!

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4
Q

Coumarins MOA

A

Antagonise vitamin K

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5
Q

Onset of coumarins is (how long they take to give full anticoagulation)

A

2-3 days

48-72 hours

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6
Q

A patient requires immediate effect of anticoagulation, what option would you give?

A

LMHW or unfractionated heparins have a quicker onset

Coumarins onset is 48-72 hours hence theyre not preferred in immediate onset requirement

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7
Q

Coumarins is required in a patient - drug of choice is ….

A

Warfarin

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8
Q

What are the different strengths of warfarin, what colours are their boxes

A

0.5 mg - white

1mg - brown

3mg - blue

5mg - pink

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9
Q

What colour box is 3mg warfarin

A

Blue

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10
Q

What colour box is 0.5 mg warfarin

A

White

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11
Q

What colour box is 1mg warfarin

A

Brown

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12
Q

What colour box is 5mg warfarin

A

Pink

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13
Q

Warfarin MHRA advice includes

A

Calciphylaxis

Miconazole interaction - daktarin oral gel

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14
Q

Describe miconazole (daktarin oral gel) and warfarin interaction.

Can you give them together?

A

Causes bleeding - seek medical advice if nose bleeds, blood in urine or unexplained bruising

Avoid unless patients INR is monitored closely

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15
Q

Describe calciphylaxis - where is this seen?

What action would you take if a patient presents to the pharmacy with this?

A

Painful rash

Its seen in patients taking warfarin especially if they are renally impaired

Refer to the GP

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16
Q

Warfarin antidote

A

Phytomenadiaone / vitamin K1

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17
Q

What foods are avoided with warfarin?

A

Cranberry juice
Pomegranate juice
Heavy alcohol - decreases effect of warfarin - inducer

Avoid diet change (liver, sprouts, broccoli, green tea, salads, leafy greens)

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18
Q

Cranberry and warfarin interaction

A

Cranberry juice increases anticoagulation affect of warfarin

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19
Q

Heavy alcohol interaction with warfarin

A

Heavy alcohol decreases the anticoagulation affect of warfarin

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20
Q

Warfarin in pregnancy, can it be given?

A

Avoid especially in 1st and 3rd trimester- risk if haemorrhage

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21
Q

What would you give a pregnant lady instead of warfarin?

A

LMWH

Tinazaparin, deltaparin, enoxeparin

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22
Q

INR can be within ……. Of target values when on warfarin

A

0.5

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23
Q

When is the required INR 3.5

A

Patients with recurrent DVT or PE

Patients with mechanical prosthetic heart valves

INR can be within 0.5 of target hence 3 or 4

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24
Q

Patient on warfarin for treatment of DVT or PE INR target

A

2.5

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25
Q

Patient on warfarin for recurrent DVT or PE target

A

3.5

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26
Q

Patient on warfarin for AF INR target

A

2.5

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27
Q

Patient on warfarin for Cardioversion INR target

A

2.5

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28
Q

Patient on warfarin for Mechanical prosthetic heart valve INR target

A

3.5

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29
Q

Patient on warfarin for Dilated cardiomyopathy INR target

A

2.5

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30
Q

Patient on warfarin for Mitral stenosis or regurgitation INR target

A

2.5

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31
Q

Patient on warfarin for Myocardial infarction INR target

A

2.5

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32
Q

Patient on warfarin for Acute arterial embolism INR target

A

2.5

33
Q

A patient is on warfarin and has an INR of 5-8 with no bleeding, what do you do?

A

Withhold 1 or 2 doses of warfarin

Reduce subsequent maintenance dose

34
Q

A patient on warfarin has an INR 5-8 with minor bleeding

A

Stop warfarin

Give phytomenadione/vit K1 slow IV injection

Restart when INR <5

35
Q

A patient on warfarin with an INR >8 with no bleeding

A

Stop warfarin

IV phytomenadione by mouth orally
Repeat dose of vit K if INR still too high after 24hours

Restart when INR <5

36
Q

A patient on warfarin with an INR of >8 with minor bleeding

A

Stop warfarin

Give phytomenadione/vit K1 by slow IV injection
Repeat dose of vit K if INR still too high after 24hrs

Restart INR <5

37
Q

A patient on warfarin with major bleeding

A

Stop warfarin

Give phytomenadione/ Vit K by slow IV injection and or dried prothrombin complex/ fresh frozen plasma (less effective)

38
Q

When would you use dried prothrombin complex/frozen plasma in warfarin patients

A

When a warfarin patient has major bleeding, you add if if IV vitmain K isnt effective alone

39
Q

Which is more effective fresh plasma or dried plasma

A

Dried

40
Q

Warfarin drug interactions

A

Miconazole, fluconazole, itraconazole
St johns wart
Heavy alcohol
Amiodarone
Aspirin
Bezafibrate
Carbamazepine
Ciprofloxacin

41
Q

Warfarin and ciprofloxacin interaction

A

Increases warfarin anticoagulation effect

42
Q

Amiodarone and warfarin interaction

A

Increases anticoagulant effect

43
Q

Aspirin and warfarin interaction

A

Increased bleeding risk

44
Q

Carbamazepine and warfarin interaction

A

Decreases the effects of warfarin

45
Q

Clotrimozole and warfarin interaction

A

No interaction

46
Q

Fluconazole and warfarin interaction

A

Increases anticoagulant effect

47
Q

Warfarin and clarithromycin interaction

A

Increases anticoagulant effect of warfarin

48
Q

Greeny leafy veg/green tea and warfarin interaction

A

Affects anticoagulant control

49
Q

Theres a higher risk of bleeds with warfarin and

Aspirin or clopidogrel

A

Clopidogrel

50
Q

A patient is on antiplatelet therapy - aspirin and requires warfarin, what do you do

A

Withhold aspirin until if possible or only use it short term

51
Q

Heparin (unfractionated) onset and duration of action

A

Rapid onset but short duration of action

52
Q

In high risks of bleeding patients taking warfarin, which is preferred, warfarin or heparin and why

A

Heparin because it has a short duration of action hence if bleeds occur and you withhold/ stop heparin the effect will be removed quicker

53
Q

Can heparins be used in pregnancy and why

A

Yes because they dont cross the placenta

54
Q

LMWH indications

A

DVT, PE, MI

55
Q

Which is preferred, LMWH or standard heparin (unfractionated) and why

A

LMWH because of lower risks of osteoporosis and heparin induced thrombocytopenia

56
Q

Monitoring requirements for LMWH

A

Doesnt require any

57
Q

Which has a longer duration of action

Heparin
LMWH

A

LMWH hence can be given OD subcutaneously

58
Q

What medications are licensed for extended treatment and prophylaxis in VTE patients with solid tumours

How many units/ml

A

Deltaparin and tinzaparin
20,000units/ml syringe

59
Q

Are anti platelets given for primary or secondary prevention

A

Secondary prevention

60
Q

Examples of antiplatelets

A

Ticagrelor
Aspirin
Dipyridamole
Clopidogrel

61
Q

Prasugrel class

A

Antiplatelet

62
Q

Cangrelor class

A

Antiplatelet

63
Q

Antiplatelet MOA

A

Glycoprotein IIb/IIIa inhibitors such as tirofiban, eptifibatide, abciximab

64
Q

Why isnt aspirin used in primary prevention

A

No benefit in patients with or without diabetes

65
Q

If a patient is on an antiplatelet and is at a high risk of bleed you can give ….

A

PPI

66
Q

dipyridamole dose for secondary prevention of ischaemic stroke and TIA

A

200mg BD with food

67
Q

Dipyridamole dispensing information

A

It should be dispensed in original container- dont split because pack contains desiccant.

Any remaining caps should be discarded after 6 weeks of opening

68
Q

Discard dipyridamole………… after opening

A

6 weeks

69
Q

Aspirin secondary prevention dose

A

75mg OD

70
Q

Aspirin secondary prevention in deep vein thrombosis or pulmonary embolism dose

A

75mg OD or 150mg

71
Q

Aspirin dose in Suspected TIA

A

300mg once daily until diagnosis established

72
Q

Long term management of TIA and ischaemic stroke not associated with AF aspirin dose

A

75mg OD with or without dipyridamole

73
Q

Acute ischaemic stroke aspirin dose

A

300mg daily for 14 days
24hrs after alteplase (thrombolysis) or 48hrs within symptom onset in patients not receiving alteplase

74
Q

AF following disabling ischaemic stroke aspirin dose

A

300mg daily for 14 days whilst being considered for anticoagulant treatment

75
Q

Warfarin dose

A

Initially 5-10mg (adjusted to INR later) - day 1
Maintenance dose 3-9mg same time each day

76
Q

Is warfarin preferred in valvular or non valvular AF

A

Valvular

77
Q

Warfarin interaction with green tea

A

Reduces warfarin affect

78
Q

Does warfarin interact with smoking

A

Yes

If a person taking warfarin stops smoking, their INR might increase

Cardiovascular (9 decks)

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