Blood and Electrolytes Flashcards
Name 8 classes of Blood and Electrolyte Drugs
- anticoagulants
- antiplatelet drugs
- thrombolytics
- other drugs affecting haemostasis
- drugs for reversing anticoagulation
- drugs for anaemias
- drugs that chelate iron
- drugs for electrolyte imbalance
Name 4 classes of anticoagulants
- heparins
- direct thrombin inhibitors
- factor xa inhibitors
- other anticoagulants
Name 5 heparins
- dalteparin
- danaparoid
- enoxaparin
- heparin
- nadroparin
Name 3 direct thrombin inhibitors
- argatroban
- bivalirudin
- dabigatran
Name 3 factor Xa inhibitors
- apixaban
- fondaparinux
- rivaroxaban
Name 1 miscellaneous anticoagulant
warfarin
Name 3 classes of antiplatelet drugs
- glycoprotein IIb/IIIa inhibitors
- P2Y12 antagonists
- other antiplatelet drugs
Name 2 glycoprotein IIb/IIIa inhibitors
- eptifibatide
- tirofiban
Name 4 P2Y12 antagonists
- clopidogrel
- clopidogrel with aspirin
- prasugrel
- ticagrelor
Name 3 miscellaneous antiplatelet drugs
- Aspirin
- diPYRIDAMOLe
- diPYRIDAMOLe with aspirin
Name 3 thrombolytics
- alteplase
- tenecteplase
Name 2 miscellaneous drugs affecting haemostasis
- tranexamic acid
- Vitamin K
Name 3 drugs for reversing anticoagulation
- idarucizumab
- protamine
- Vitamin K
Name 2 classes of drugs for anaemias
- Erythropoietin agonists
- Other drugs for anaemias
Name 4 erythropoietin agonists
- Darbepoetin alfa
- Epoetin alfa
- Epoetin beta
- Methoxy pegpoetin beta
Name 3 miscellaneous drugs for anaemia
- Folic acid
- Iron
- Vitamin B12
Name 3 drugs that collate iron
- deferasirox
- deferiprone
- desferrioxamine
Name 3 classes of drugs for electrolyte imbalance
- drugs for potassium imbalance
- phosphate binders
- other drugs for electrolyte imbalance
Name 2 drugs for potassium imbalance
- patiromer
- polystyrene sulfonate resins
Name 5 phosphate binders
- aluminium hydroxide
- calcium carbonate
- lanthanum
- sevelamer
- sucroferric oxyhydroxide
What should you always remember when IV electrolytes are charted?
IV correction of electrolytes is transient. Maintenance oral therapy should always be charted even if the patient is within normal range.
Describe the use of VTE prophylaxis around surgery.
VTE prophylaxis is commonly held the day before surgery but this is ultimately up to the surgeon.
Is enoxaparin dosing in VTE prophylaxis weight based?
No
If you see a dose for 40 to 60 mg enoxaparin twice daily, what is usually the indication?
This is usually a prophylactic dose for obese patients.
How does obesity affect the dosing of DOACs?
There may be reduced drug exposure to DOACs in obesity.
What is argatroban used for?
Heparin-induced thrombocytopaenia.
What are the 4 reasons you would reduce a patient’s dose of enoxaparin for VTE prophylaxis?
- Renal impairment (<30 mL per minute)
- Severe hepatic impairment
- Spinal/epidural anaesthesia or lumbar puncture
- Weight < 50 kg
What is the oral anticoagulant of choice in bariatric patients?
Warfarin
Why is warfarin the oral anticoagulant of choice in bariatric patients?
As we can measure the effect through INR
What is the recommended dosing of apixaban for acute treatment of proximal DVT and PE (in patients with CrCl more than 25 mL/min)?
10 mg orally, twice daily for 7 days, then decrease to 5 mg twice daily
A target INR range of 2.5–3.5 is the current recommendation in patients for which indication?
Patients who have undergone mechanical mitral valve replacement
What is the target INR for treatment of DVT/PE?
2 to 3
What is the treatment dose for dabigatran younger than 75 years and CrCl more than 50 mL/min?
150 mg orally, TWICE daily
When are anti-factor Xa levels most often used?
They are used to confirm the doses in patients such as obese patients (however they are not directly correlated with effect).
What is the indication of dabigatran as per Medication Profiler?
A blood thinner to treat or prevent blood clots
What does the “other important information” section on MedProfiler say about dabigatran?
This medicine will make you bruise easily and bleeding will take longer to stop.
Paracetamol can be taken for pain relief. Do not take aspirin or anti-inflammatories (e.g. Nurofen®, Voltaren®) for pain unless your doctor has told you to.
Check with your doctor or pharmacist before starting or stopping any other medicine, including those you buy without a prescription from a pharmacy, supermarket or health food shop.
Tell your doctor if you have any signs of bruising or bleeding that worries you or lasts longer than usual (e.g. blood noses, bleeding gums, dark bowel motions (poo) or pink, red or brown urine) or if you have any falls or other major injuries.
What 4 anticoagulants are tested for using an anti-Xa assay?
- Apixaban
- Rivaroxaban
- Low molecular weight heparin
- Unfractionated heparin levels
Which of the P2Y12 antagonists has the highest bleeding risk?
Prasugrel
Which of the P2Y12 antagonists has the best evidence for reduction in cardiac stent thrombosis and reduced mortality in cardiac stent patients?
Ticagrelor
If a chemotherapy patient is on an antiplatelet, what should you always do?
Confirm the plan with oncology
Which has a lower bleeding risk: apixaban or dabigatran?
Apixaban
Which has a lower bleeding risk: apixaban or dabigatran?
Apixaban
What must a patient be on if they have a mechanical aortic valve?
Warfarin (not a DOAC).
Name 4 Erythropoietin Agonists
- Darbepoetin alfa
- Epoetin alfa
- Epoetin beta
- Methoxy pegepoetin beta
How long can Aranesp (Darbepoetin Alfa) be kept out of the fridge?
2 Days
What is a restriction on the prescribing of darbepoetin?
Only nephrologists can prescribe darbepoetin
Describe the practical limitations of phosphate binders?
The tablets are quite big, patients will often need to take 6 to 9 tablets a day, the tablets taste quite bad, and patients won’t notice any difference in how they feel from taking them.
What is the standard (oral) dose of sodium polystyrene sulfonate powder?
15 g as a suspension or paste, 3 or 4 times daily.
