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Diseases of the Blood BDS2 > Anticoagulation and Antiplatelet Drugs > Flashcards

Anticoagulation and Antiplatelet Drugs Flashcards

1
Q

what are the injectable anticoagulants?

A

heparins

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2
Q

what are the oral anticoagulants?

A

coumarin/non-coumarin

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3
Q

what are the antiplatelet medications?

A

aspirin/clopidogrel/new drugs

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4
Q

what are he two types of heparins?

A

unfractionated and low molecular weight

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5
Q

how is unfractionated heparin given?

A

by infusion and only active for a few minutes

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6
Q

what does unfractionated heparin allow?

A

rapid control - rapid onset and quick to end

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7
Q

what does unfractionated heparin do?

A

inhibits antithrombin 3 preventing its action

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8
Q

where is unfractionated heparin given?

A

hospitals for operations

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9
Q

how is low molecular weight heparin given?

A

subcutaneously daily

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10
Q

what does low molecular heparin do?

A

stops low level excess clotting without increasing bleeding risk

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11
Q

list some oral anticoagulants

A

warfarin, apixaban, edoxaban, rivaroxaban, dabigatran

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12
Q

list some oral antiplatelets

A

low dose aspirin, clopidogrel, dipyridamole

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13
Q

what are the safe dental procedures for all drugs?

A

hygiene therapy, removable pros, restorative dentistry, endodontics, orthodontic treatment

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14
Q

what dental procedures should you treat with caution?

A

extractions, minor oral surgery, implants, periodontal surgery, biopsies

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15
Q

what are the indications for anticoagulation?

A

conditions where blood clots will form too readily on or in the circulation - atrial fibrillation, deep venous thrombosis, heart valve disease, mechanical heart valves, thrombophilia

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16
Q

what is the common type of coumarin?

A

warfarin

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17
Q

name an indanediones

A

phenindione

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18
Q

name a direct thrombin inhibitor

A

dabigatran

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19
Q

name factor Xa inhibitors

A

apixaban, ravaroxaban, edoxaban

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20
Q

what does warfarin do?

A

inhibit production of vitamin K dependent clotting factors - 2,7,9,10

21
Q

describe the onset of warfarin?

A

slow onset over 3 days as existing factor have to be consumed

22
Q

why do warfarin takers have to take heparin?

A

due to the initial hypercoagulability

23
Q

how is warfarin response measured?

A

INR

24
Q

what is the normal INR value for warfarin patients?

A

2-3 or 3-4 with prosthetic valves

25
Q

how often should INR be checked for warfarin patients?

A

every 4-8 weeks

26
Q

what must warfarin patients have done within 72 hours of dental procedures with risk of haemorrhage?

A

INR and FBC blood tests

27
Q

when should you treat patients on warfarin?

A

early in the day and early in the week

28
Q

which drugs increase INR?

A

amiodarone, antibiotics, alcohol, NSAIDs

29
Q

what drugs reduce INR?

A

carbamazepine, barbiturates, cholestyramine, griseofulvin, alcohol

30
Q

what medications should you avoid prescribing for dental patients on warfarin?

A

aspirin as analgesic, NSAIDs including ibuprofen, azole antifungal drugs (fluconazole)

31
Q

what are the hazards from taking warfarin?

A

haemorrhage

32
Q

what can you take if a person of warfarin has a haemorrhage?

A

vitamin K injection for reversal of anticoagulation

33
Q

how can haemorrhage occur?

A

trauma such as hip/bone fracture following a fall or soft tissue injury leading to bleeding muscles

34
Q

what is the advantages of NOACs

A

predictable bioavailability, rapid onset of action within an hour of dose, short duration of action so the effect is lost within a day

35
Q

how do NOACs work?

A

by preventing the effect of factor X

36
Q

give examples of NOACs

A

rivaroxiban, apixaban given twice daily

37
Q

when should you treat patients on NOACs

A

early in day early in week

38
Q

what must happen if you are performing a high risk procedure on a NOAC patient?

A

miss/delay morning dose of NOACs then restart immediately after treatment

39
Q

what planning procedures for NOAC patients are important with regards to dental treatment?

A

IDB needed? local haemostatic measures in place, extraction at beginning of day at beginning of week, keep 20mins post extraction to assess bleeding

40
Q

what dental drugs are safe for use with NOACs?

A

dental antibiotics (except fluconazole), antifungals, LA, antivirals

41
Q

what dental drugs should be avoided with NOAC patients?

A

NSAIDs and carbamazepine

42
Q

what is the standard therapy of antiplatelet medicines given?

A

low dose aspirin, clopidogrel, dipyridamole

43
Q

what is the advanced cardiac therapy antiplatelet medicines given?

A

prasugrel + aspirin, abciximab, eptifibate + aspirin, ticagrelor, tirofaban

44
Q

what do antiplatelet drugs do?

A

inhibit platelet aggregation, inhibit thrombus formation in the arterial circulation

45
Q

what are the dental considerations with a patient on aspirin alone?

A

treat without interrupting medication, local haemostatic measures, consider limiting initial treatment area

46
Q

what should the dental considerations be for patients on non-aspirin therapy or dual therapy with aspirin?

A

do not interrupt treatment, expect prolonged bleeding, local haemostasis essential

47
Q

what should the dental considerations be if two antiplatelet drugs are taken but without aspirin?

A

discuss with doctor to stop one of the drugs 7 days before surgery, if not possible then refer to hospital unit

48
Q

what must post-operative instructions contain?

A

include emergency contact details

49
Q

what drugs should you be careful with for patients on antiplatelets?

A

NSAIDs, erythromycin, fluconazole, clarithromycin, carbamazepine/omeprazole

Diseases of the Blood BDS2 (8 decks)

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