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Pharm > Anticoagulation > Flashcards

Anticoagulation Flashcards

1
Q

Atrial Fibrillation: Common type of

A

arrhythmia

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2
Q

Atrial Fibrillation: Incidence increase with

A

age

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3
Q

Atrial Fibrillation: AF increases the risk of

A

stroke

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4
Q

Atrial Fibrillation: Responsible for 5-20% of all

A

strokes

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5
Q

Atrial Fibrillation: Stroke risk even in ____ AF

A

asymptomatic

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6
Q

Paroxysmal AF

A
  • AF that stops within 7 days

- Episodes can happen at random frequencies

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7
Q

Persistent AF

A

continuous AF that lasts longer than 7 days

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8
Q

Long-standing persistent AF

A

continuous AF that lasts longer than a year

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9
Q

Permanent AF

A

This is when you decide you’re not even gonna bother trying to fix it anymore.
Accepting that you have AF can actually help your symptoms

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10
Q

Nonvalvular AF

A

When you have AF but no rheumatic mitral stenosis, no prosthetic heart valve, no valve repair

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11
Q

The CHA2DS2-VASc score

A

Used to assess the risk of stroke in patients with AF

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12
Q

How do you decide to do anticoagulation therapy

A

the risk of thromboembolism will determine anticoagulation therapy, not the presentation of the AF

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13
Q

What do you recomend for CHA2DS2-VASc score ≥ 2 (men)

A

Oral anticoagulants

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14
Q

What do you recomend for CHA2DS2-VASc score ≥ 3 (women)

A

Oral anticoagulants

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15
Q

What do you recomend for CHA2DS2-VASc score 1 (men)

A

Oral anticoagulant to reduce thromboembolic stroke may be considered

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16
Q

What do you recomend for CHA2DS2-VASc score 2 (women)

A

Oral anticoagulant to reduce thromboembolic stroke may be considered

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17
Q

What do you recomend for CHA2DS2-VASc score 0 (men)

A

It is reasonable to omit anticoagulant therapy

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18
Q

What do you recomend for CHA2DS2-VASc score 1 (women)

A

It is reasonable to omit anticoagulant therapy

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19
Q

Except in AF with moderate- to -severe mitral stenosis or a mechanical heart valve
what does this mean, its on slide 7 of the anticoagulant

A

email her

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20
Q

___ ___ score has been validated as having the best predictive value for intracranial bleeding

A

HAS BLED

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21
Q

HAS BLED score: A score of ≥ 3 indicates

A

high risk and alerts the provider that close monitoring is warranted

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22
Q

HAS BLED score: The score also takes other risk factors into account and may

A

offer opportunity for modification of reversible risks

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23
Q

HAS BLED stands for

A 
Hypertension 
Abnormal renal or liver function 
Stroke 
Bleeding 
Labile INRs
Elderly 
Drugs or alcohol in excess
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24
Q

HAS BLED: hypertension criteria

A

SBP over 160

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25
Q

the HAS BLED system identifies hypertension of SBP over 160 to be

A

a risk factor that we want to improve

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26
Q

HAS BLED: Labile INRs criteria

A

therapeutic INRs less than 60% of the time

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27
Q

Direct Oral Anticoagulant (DOAC) examples

A

Dabigatran
Rivaroxaban
Apixaban
Endoxaban

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28
Q

Vitamin K Antagonist (VKA) example

A

Warfarin

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29
Q

DOACs are recommended over warfarin in DOAC-eligible patients with

A

AF

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30
Q

For patients with AF, who have mechanical heart valves, ____ is recommended

A

warfarin

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31
Q

For patients with AF, who have ___ ____ valves, warfarin is recommended

A

mechanical heart valves

32
Q

For patients with AF (except ____ or ____) who are unable to maintain a therapeutic INR with warfarin, a DOAC is recommended

A

mod-severe mitral stenosis or a mechanical heart valve

33
Q

For patients with AF (except mod-severe mitral stenosis or a mechanical heart valve) who are unable to maintain a therapeutic INR with

A

warfarin, a DOAC is recommended

34
Q

For patients with nonvalvular AF with a CHA2DS2-VASc score of 2 or greater and who have end-stage CKD (CrCl < 15 mL/min) or are on HD, it is reasonable to prescribe

A

warfarin or another oral anticoagulant

35
Q

In patients who are eligible for oral anticoagulation therapy, we recommend

A

DOACs over VKA

36
Q

In patients on warfarin with consistently low time in INR therapeutic range (<65%) we recommend

A

considering interventions to improve or switching to DOACs

37
Q

Dabigatran

A

Direct thrombin inhibitor
Poor bioavailability
Renal excretion, not hepatic

38
Q

Rivaroxaban, Apixaban, Edoxaban

A
  • Factor Xa inhibitors
  • Hepatic metabolism
  • Rivar and Edoxa need renal dosing, Apixa does not
  • Edoxa has no antidote
39
Q

Even though Apixa might not need renal dosing,

A

Apixa and the other 3 DOACs all need the patient to have their renal function tested and hepatic function tested. Then get them re-tested yearly.

40
Q

DOACs in Atrial Fibrillation: Their primary efficacy is for

A

stroke or systemic embolism

41
Q

DOACs compared to warfarin for treating AF

A

All DOACs are at least as good as warfarin, Dabig and Apixa are even better than warfarin

42
Q

DOACs compared to warfarin for treating

A

All DOACs are way better than warfarin

43
Q

DOACs compared to warfarin for treating

A

Only Dabig is better than warfarin

44
Q

DOACs compared to warfarin for treating

A

Apixa and Edoxa are better than warfarin

45
Q

DOACs compared to warfarin for mortality in general

A

All DOACs have 10% less mortality, only Apixa is significantly lower than warfarin

46
Q

What are the 4 reasons to reduce the dose of Apixa

A

If they’re 80 years old or older
If SCr is 1.5 or more
If the weigh 60 kg or less
IF you’re giving it with P-gp/CYP inhibitors

47
Q

What are the 2 reasons to reduce the dose of Dabig

A

CrCl is 15-30

CrCl is 30-50 while using dronedarone or ketoconazole

48
Q

What is the reason that would tell you that you need to reduce the dose of Edoxa

A

CeCL 15-50

49
Q

Why would you need to reduce the dose of Rivar

A

CrCl equal to or less than 50

50
Q

Warfarin facts

A

100% bioavailability
Highly protein bound
long half life
You have to monitor INR

51
Q

What does these mean on slide 18?

  • Racemic mixture S-warfarin 5x > than R-warfarin
  • Small Vd
A

email her

52
Q

Warfarin patient teaching

A

Keep your diet consistent and avoid vitamin K

53
Q

What are the 3 Warfarin antidotes

A

Vitamin K
fresh frozen plasma
Prothrombin concentrates

54
Q

Virchow’s triad

A

Hypercoagulable state
Endothelial injury
Venous stasis

55
Q

How does the DVT Wells Score work?

A

There’s a bunch of risk factors, they get 1 point for each factor
1-2 is moderate risk, 3 or more is high risk

56
Q

DVT/PE: All Parenteral medication

A 
Unfractionated heparin 
Low molecular weight heparin
Fondaparinux 
Bivalirudin
Argatroban 
Thrombolytics
57
Q

DVT/PE: Parenteral medication that are indirect thrombin inhibitors

A

Unfractionated heparin
Low molecular weight heparin
Fondaparinux

58
Q

DVT/PE: Parenteral medication that are direct thrombin inhibitors

A

Bivalirudin
Argatroban
Thrombolytics

59
Q

DVT/PE: Oral medication

A 
Apixaban
Betrixaban
Dabigatran
Edoxaban
Rivaroxaban
Warfarin
60
Q

What do you recommend for a proximal DVT of PE

A

Long term (3 months) anticoagulant therapy

61
Q

What do you recommend for DVT of the leg or PE when they don’t have cancer

A

DOAC for 3 months (long term treatment) (Dabig, rivar, apixa, or edoxa). 2nd line treatment is vitamin K antagonist

62
Q

What do you recommend for DVT of the leg or PE if they have cancer

A

LMWH for 3 months (long term). DOACs and VKA are 2nd line

63
Q

DOAC dosing for VTE: Switching to oral after 5-10 days of IV anticoagulant therapy

A
  1. Give Dabig (but not if they’re on a P-gp inhibitor and have CRCL less than 50, or just CrCl less than 30)
  2. Or you can give Edoxa
64
Q

is slide 27 saying you should give Edoxa if they meet the criteria like CrCl 30-50 etc?

A

email her

65
Q

DOACs that are approved as meds you can use to begin therapy

A

Apixaban and rivaroxaban are approved to initiate therapy. Dabigatran and Edoxaban are not.

66
Q

initiate oral monotherapy: Avoid Apixa if

A

SCr is more than 2.5

67
Q

Initiate oral monotherapy: Avoid Rivar if

A

CrCl is less than 30

68
Q

Fondaparinux for VTE is dosed based on

A

body weight

69
Q

To reverse Dabig,

A

give Idaruc

70
Q

To reverse Apixa and Rivar,

A

give Andexxa

71
Q

Andexxa

A

It’s given to reverse Apixa and Rivar
It works in about 2 hours
You should restart anticoagulation therapy asap
ADRs are UTI and peneumonia

72
Q

Andexxa dose is based on

A

the FXa inhibitor (Rivar or Apixa)
the dose of the inhibitor
and the time since the last dose of the inhibitor

73
Q

Antidotes: Indirect Thrombin Inhibitors

A

Protamine sulfate

74
Q

Antidotes: Vitamin K antagonist

A

Vitamin K

75
Q

Antidotes: Dabigatran

A

Idaruizumab

76
Q

Antidotes: Apixaban

A

Andexxa

77
Q

Antidotes: Rivaroxaban

A

Andexxa

Pharm (23 decks)

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