Blood and Electrolytes Flashcards
DOACs
Factor Xa inhibitors
Apixaban 2.5-5mg bd. Treatment 10mg bd for 7 days
Rivaroxaban 20mg od with food. Treatment 15mg bd for 21 days
Direct thrombin inhibitor
Dabigatran for VTE prevention post surgery 110-220mg od. For AF or VTE treatment and secondary prevention- 110-150mg bd. swallow whole with food. Not suitable for webster pack- do not remove from packaging
I- VTE prevention inc post surgery, Acute VTE treatment, high risk non-valvular AF
M- renal function, signs of bleeding, anaemia, drug interactions (particularly dabigatran- amiodarone and verapamil)
AE-
Dabigatran- dyspepsia, abdo pain, ND, headache,
Apixaban- nausea, deranged LFT
Rivaroxaban- peripheral oedema, itch, skin blisters, muscle spasms
C- Take at same time each day, use a calander to mark doses, if you miss a dose take is ASAP and then continue as normal- dont double dose, tell all HCP you’re taking this medication, ask HCP before taking other meds, consider medic alert bracelet, dont stop treatment without advice, see dr asap if signs of bleeding, SOB, weakness, dizziness
Warfarin
Anticoagulant- vitamin K antagonist, inhibits synthesis of vit K dependent clotting factors
I- prevention and treatment of VTE (inc in prosthetic heart valves), secondary prevention of stroke and MI, prevention in high risk AF
D- 1-10mg od (depending on INR)
M- INR (target 2-3 (can be 2.5-3.5 for high risk valves) asses after 2-3 days), signs of bleeding
C- take same time each day, use calendar or patient support tools to remind, dont swap brands, constant vit K in diet, avoid excess alcohol, tell all HCP you’re taking warfarin, regular INR checks, consider medic alert bracelet, many DDIs talk to HCP before taking anything,
see dr if you have missed a dose/diarrhoea/infection/fever extra blood tests may be required, avoid large amount of cranberry juice, see dr ASAP for painful purple bruise like rash unexplained bleeding headaches SOB dizziness weakness
P2Y12 antagonist
Antiplatelet- P2Y12 antagonist, binds platelet receptor and inhibits aggregation
I- history of symptomatic atherosclerosis (only clopidogrel), acute coronary syndrome (only ACS managed with PCI for prasugrel)
Clopidogrel
D- 75mg/d, 300mg stat in MI
Ticagrelor
D-180mg loading then 90mg bd (take with 75-100mg aspirin once daily- increases effectiveness)
Prasugrel
D- 60mg stat then 10mg daily, 5mg daily if <60kg or >75yo (take 75-100mg aspirin daily- increases effectiveness)
M- signs of bleeding, GI AE, surgery (stop > 5 days clopidogrel, >7 days prasugrel and 5 days ticagrelor before), AE- bleeding, skin reactions, diarrhoea, GI ulcer, Ticagrelor- dyspnoea (caution in asthma/COPD), uric acid level (causes hyperuricaemia), DDIs CI with strong CYP3A4 inhibitors, renal function
C- take at same time each day irrespective of food (unless combo therapy with aspirin DAPT), CAL 18 grapefruit for clopidogrel and ticargrelor, see dr asap for signs of bleeding, tell all HCP you’re taking this medication, dont stop abruptly, dont take NSAIDs unless told by dr
CALs
Clopidogrel- 9, 10a, 18
Prasugrel- 9, 10a
Ticagrelor- 9 (?not in APF), 10a, 18
Enoxaparin and Heparin
LMW heparin anticoagulant- inactivates clotting factors IIa (thrombin) and Xa by binding antithrombin II
I- treatment and prevention of VTE, prevention of DVT, acute STEMI, non STEMI and unstable angina
Enoxaparin- imobilisation SC 20-40mg for 1-2 weeks or until mobilised. VTE treatment 1mg/kg bd or 1.5mg/kg od- bd
Heparin- prevention SC 5000IU bd or tds, treatment IV 1300IU/hour or SC 17500IU bd
M- signs of bleeding, antifactor Xa, FBE, LFT, platelet count, HIT (heparin induced thrombocytopenia- immune mediated), APTT
AE- ND, peripheral oedema, fever, confusion, injection site reactions, bleeding, bruising
C- SC injection technique, see dr ASAP for signs of bleeding, ask HCP before taking other medication, tell all HCP you’re taking, use calendar to mark doses
Folic acid
B group vitamin/Haematinic- required for erythropoiesis, embryonic organogenesis, purine/pyrimidine/amino acid synthesis
I- macrocytic anaemia due to folate deficiency, prevention of neural tube defects
D- 0.5-5mg once daily, or 5-10mg once weekly (for use with methotrexate)
M- serum folic acid, Hb levels
C- dietary sources leafy greens, veg, citris fruits, bread, grains, cereals, very well tolerates, for methotrexate- take on different day, for pregnancy- take before conception and first trimester
Iron
Mineral, required for haemaglobin and myoglobin formation
I- iron deficiency anaemia
D- 100-200mg od (elemental iron)
M- iron studies (serum ferritin (storage), serum iron), Hb levels, GI AE
C- oral liquid drink with draw and aim for back of throat, rinse mouth with water after, take 1h before or 2h after food for best absorption (take with food if GI upset but avoid tea and coffee), AE- abdo pain, NV, constipation, black faeces, can take a few months to restore iron, store in safe place (toxic in over dose)
Hydroxocobalamin
Cyanocabalamin
Vitamin B12- essential for nerve development, nucleic acid synthesis and erythropoiesis
I- macrocytic anaemia due to vit B12 deficiency, optic neuropathies
D- treatment 1000mcg IM on alternate days for 1-2 weeks, then for cyanocabalamin once monthly, for hydroxocobalamin once every 2-3 months. Cyanocobalamin oral 50-200mcg/d
M- serum potassium (risk of hypokaelaemia), serum Vit B12, FBE, Hb levels
C- oral take between meals, see dr asap if signs of B12 deficiency, well tolerates- N, headache rarely, dr will monitor you with blood tests
Dipyridamole
C- Antiplatelet agent: inhibits phosphodiesterase increases platelet cAMP which inhibits platelet function, also inhibits endogenous adenosine reuptake causing coronary vasodilation
I-Secondary prevention of ischemic stroke and TIA (+/- aspirin), cardiac stress testing (IV)
D- CR 200mg bd
M- signs of bleeding, surgery, blood pressure, Headache
CI- acute MI, unstable angina, severe aortic stenosis, PE or infarction, uncontrolled arrhythmias, uncontrolled HF, acute myocarditis, pericarditis, active endocarditis, acute aortic dissection, systolic BP <90, recent unexplained fainting or TIA, asthma
C- swallow whole irrespective of food, can cause bad headaches especially at initiation- talk to dr if
problematic, may cause dizziness on standing- get up slowly dont stop taking without drs advice, dont take any NSAIDs without drs advice, signs of bleeding
CALS- 10a, 16, A
