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PRE-REG-Thuri > BLOOD CLOTS > Flashcards

BLOOD CLOTS Flashcards

1
Q

What is VTE?

A

Venous thromboembolism is blood clots which form in deep veins and can travel to lungs.

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2
Q

What are 3 symptoms of DVT/VTE?

A

Unilateral pain/ swelling

Warm/red skin

Vein distension

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3
Q

What are 3 symptoms of pulmonary embolism?

A

Dyspnoea

Chest pain

Coughing blood

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4
Q

What 7 factors can increase risk of VTE?

A

Immobility

Obesity - BMI>30

Malignancy

60+ years

1st deg relative

Pregnancy, post-partum

Oestrogen

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5
Q

What are 5 risk factors which can increase bleeding risk?

A

Acute stroke

Anti-coagulants

Systolic HypERtension

Thrombocytopenia (low platelets)

Bleeding disorders: Acquired - Liver Failure

Inherited - haemophilia, Von Willebrands

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6
Q

What is thrombocytopenia?

A

Low platelets

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7
Q

What are 2 pharmacological treatments of VTE prophylaxis?

A
  1. DOAC
  2. Heparain
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8
Q

What medication is used for thromboprophylaxis in renal insufficiency?

A

Unfractionated heparin

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9
Q

What is an alternative to heparin?

A

Fondaparinux

-Option for pt undergoing abdominal, bariatric, thoracic or cardiac surgery, or for patients with lower limb immobilisation

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10
Q

How many days should you take heparin after general surgery?

A

7 days

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11
Q

How many days should you take heparin after having major cancer surgery in abdomen?

A

28 days

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12
Q

How many days should you take heparin after having spinal surgery?

A

30 days

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13
Q

What are 2 mechanical methods for thromboprophylaxis?

A

Pneumatic compression

Anti- embolism stockings

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14
Q

When to NOT offer anti-embolism stockings?

A

NOT in acute stroke or leg conditions. e.g. PAD

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15
Q

When to offer anti-embolism stockings?

A

worn day and night until the patient is sufficiently mobile
or
30 days after spinal injury/acute stroke

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16
Q

What mechanical method is used to prevent VTE after knee replacement surgery?

A

Pneumatic compression

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17
Q

What mechanical method is used to prevent VTE after Hip replacement surgery?

A

Anti-embolism stockings

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18
Q

How many days to take Rivaroxaban after having Hip surgery for thromboprophylaxis?

A

for 35 days

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19
Q

How many days to take Rivaroxaban after having knee surgery for thromboprophylaxis?

A

14 days

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20
Q

How many days should you take LMWH after hip surgery for thrombophrophylaxis?

A

Take LMWH for 28 days with anti-embolism stockings

OR

Take LMWH for 10 days PLUS low dose aspirin 28 days.

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21
Q

How many days should you take LMWH + aspirin after knee surgery for thromboprophylaxis? (2 opts)

A

Take LMWH for 14 days + use anti-embolism stockings

OR

Low dose aspirin for 14 days.

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22
Q

What are 2 alternatives to taking low dose aspirin for thromboprophylaxis after knee surgery?

A

Use Apixaban or dabigatron

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23
Q

What is treatment drug option and duration for venous thromboembolism for proximal DVT/PE?

A

Apixaban or rivaroxaban for at least 3 months

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24
Q

How long should treatment be for venous thromboembolism for proximal DVT/PE?

A

At least 3 months (3-6 months if ACTIVE cancer)

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25
Q

How long should treatment be for venous thromboembolism for proximal DVT/PE if UNPROVOKED?

A

3 months PLUS (6 months plus if active cancer)

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26
Q

What are alternatives that can be used for proximal DVT/PE thromboembolism treatment aside from apixaban/ rivaroxaban?

A

LMWH for 5 days + Edoxaban

OR

LMWH/ unfractionated + VIT K antagonist (warfarin)for 5 days

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27
Q

What is used first line for thromboprophylaxis in pregnancy?

A

LMWH

if immobile too + add in pneumatic compression/stocking

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28
Q

What is used first line for VTE in pregnancy if high risk of haemorrhage?

A

IV unfractionated heparin- short half life

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29
Q

List 3 factor Xa inhibitors?

A

Apixaban
Edoxaban
Rivaroxaban

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30
Q

List 1 Thrombin inhbitor?

A

Dabigatran

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31
Q

List 3 LMWH?

A

Tinzaparin
enoxaparin
Dalteparin

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32
Q

What are heparins split into?

A

LMWH

Unfractionated Heparin

Fondaparinux (Synthetic heparin/same ish)

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33
Q

What is the process of blood clotting?

A

Fibrinogen is converted to fibrin by enzyme thrombin

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34
Q

What enzyme is responsible for converting fibrinogen to fibrin?

A

Thrombin

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35
Q

What are 3 common errors with anticoagulants?

A
  1. Dose - wrong/missed dose
  2. Drug interaction - giving NSAIDs too or duplication
  3. Monitoring - inadequate/errors
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36
Q

What is MOA of heparin?

A

activates ANTITHROMBIN which inhibits clotting facts Xa and IIa (thrombin)

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37
Q

What is 2 advantage of using heparin?

A

Less risk of thrombocytopenia + osteoporosis.

Fast onset of action BUT short duration

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38
Q

What is unfractionated heparin good for?

A

When there is high risk of bleeding

Used in

Renal impairment

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39
Q

Why is heparin used in pregnancy?

A

Does NOT cross BBB - safer.

Less risk of osteoporosis + thrombocytopenia

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40
Q

What are 4 SE of Heparin?

A
  1. Bleeding

2.HypERkalaemia

  1. Heparin induced thrombocytopenia
  2. osteoporosis
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41
Q

What 2 things to monitor when on heparin?

A

K+ levels if more than 7 days tx
Platelet count if more than 4 days tx

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42
Q

What are 3 clinical signs of heparin induced thrombocytopenia?

A

Less than 30% platelets

Skin allergy

Thrombosis

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43
Q

What is the antidote for heparin called?

A

Protamine - partially reverses

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44
Q

What are some drug classes that can cause hypERkalaemia when taken with heparin?

A

ACEi/ARB, spironolactone, NSAIDs, potassium supplement, trimethoprim

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45
Q

What 5 drug classes can cause bleeding when taken with heparin?

A

Other anticoagulants
Anti-platelets
NSAIDs
Venlafaxine
SSRI

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46
Q

What is MOA of warfarin?

A

Antagonist of vitamin K + prevents blood clotting.

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47
Q

What is duration of warfarin?

A

48-72 hrs

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48
Q

What is the Indication of warfarin?

A

VTE, AF

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49
Q

What is the dose of Warfarin?

A

3-9mg daily at SAME TIME.

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50
Q

What to do if missed dose of warfarin?

A

Only take dose if missed more than 1 day of dose + take it the day you missed it.

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51
Q

What are the 4 strengths of warfarin + colours?

A

O.5 mg = white

1mg = brown

3mg = blue

5 mg= pink

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52
Q

What is dose and duration of treatment of warfarin for isolated calf DVT?

A

3mg blue tablet for 6 weeks

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53
Q

What is dose and duration of treatment of warfarin for Provoked VTE?

A

5mg pink tab for 3 months

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54
Q

What is dose and duration of treatment of warfarin for Unprovoked VTE/AF?

A

1mg brown tab for 3+ months

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55
Q

What is provoked VTE?

A

Reason for risk of clot
e.g surgery, COC pill , pregnancy , leg cast

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56
Q

Can warfarin be used in pregnancy?

A

NO- teratogenic

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57
Q

What is monitoring req for warfarin?

A

Base-line prothrombin time but 1st dose should not be delayed whilst getting result.

Monitor daily until between 2-3, then twice weekly for 1-2 weeks.

Then weekly measurements until at least 2 INR measurements are within the therapeutic range.

Every 3 months measure INR, change in warfarin doses or clinical condition

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58
Q

What is target INR for VTE, AF, MI, cardioversion or artificial valves?

A

2.5

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59
Q

What is INR target for patient with recurrent VTE if ALREADY on anticoagulant and if INR >2?

A

3.5- longer to clot

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60
Q

What MRHA advice was released on warfarin in 2016?

A

Report of calciphylaxis

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61
Q

What is calciphylaxis?

A

Build up of calcium in blood vessels of fat, skin + tissue?

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62
Q

What is a risk factor of calciphylaxis?

A

End stage renal disease

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63
Q

What is treatment of calciphylaxis in warfarin?

A

Consider stopping warfarin if diagnosed.

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64
Q

What to counsel patient on if they develop calciphylaxis on warfarin?

A

Report PAINFUL SKIN RASH

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65
Q

What is a main SE of warfarin?

A

Bleeding

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66
Q

What to do if patient’s INR is 5-8 and there is NO bleeding?

A

Withold 1 to 2 doses of warfarin

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67
Q

What to do if patient’s INR is 5-8 and there is MINOR bleeding?

A

give IV phytomenadione (warfarin antidote)

Restart warfarin sodium when INR <5.0

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68
Q

What to do if patient’s INR is over 8 and there is NO bleeding?

A

Give oral phytomenadione

repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin when INR <5.0

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69
Q

What to do if patient’s INR is over 8 and there is MINOR bleeding?

A

IV phytomenadione

repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin sodium when INR <5.0

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70
Q

What is phytomenadione?

A

Vitamin K
Antidote for warfarin

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71
Q

What is the normal INR range?

A

0.8 to 1.1

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72
Q

How long does is take for blood to normally clot in normal person?

A

11 to 13.5 secs

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73
Q

What are 3 counselling points to reduce/prevent bleeding instances in patient on warfarin?

A
  1. look out for Nose bleeds > than 10 mins, cuts which don’t stop bleeding. RED urine, Blood in vomit, tarry stool, severe headaches
  2. Avoid contact sports , can bruise
  3. Use soft toothbrush to avoid bleeding gums
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74
Q

What ‘bleeding rules’ red flags to look out for when on warfarin?

A

Nose bleeds > than 10 mins, cuts which don’t stop bleeding. RED urine, Blood in vomit, tarry stool, severe THUNDERCLAP headaches

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75
Q

What 3 drink/ foods interact with Warfarin?

A

Alcohol

Cranberry juice

Green leafy vegs

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76
Q

Why does leafy green veg interact with warfarin?

A

contains vit K so antagonises Warfarin anticoagulant effect

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77
Q

What 4 OTC drugs can interact with Warfarin?

A

Vit E and Vit K supplements

NSAIDs

Miconazole

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78
Q

What counselling point should be done for warfarin patients?

A

patient alert card and yellow book

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79
Q

What to do when patient on warfarin is about to have an elective surgery?

A

STOP warfarin 5 days before + then restart immediately after surgery.

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80
Q

What to do when patient on warfarin is about to have an emergency surgery which cannot be delayed?

A

IV phytomenadione
+
Dried prothombin complex

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81
Q

What to do when patient on warfarin is about to have an surgery BUT is high risk of VTE?

A
  1. Bridge with LMWH
  2. STOP LMWH 24 hrs before surgery.

3.If surgery has high risk of bleeding, the LMWH should NOT be restarted until at least 48 hrs AFTER surgery.

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82
Q

What is the interaction between NSAID + warfarin?

A

increased Bleeding risk

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83
Q

What does the interaction between warfarin + pomegranate juice cause?

A

Pomegranate juice increases the INR in response to warfarin.

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84
Q

What drug classes increase the anti-coagulation effect?

A

Amiodarone,

Azole anti-fungals e.g. fluconazole

Macrolide Abx- Clarithromycin + erythromycin

Metronidazole

Quinolones

Cimetidine

Cranberry juice

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85
Q

What ‘term’ increases anticoagulant effect?

A

Enzyme inhibitors - prevent breakdown of active drug + increase conc.

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86
Q

What ‘term’ decreases anticoagulant effect?

A

Enzyme inducers

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87
Q

What enzyme inducers reduce anti-coagulant effect?

A

Carbamazepine

Phenobarbital (anti-epileptic drugs)

Rifampicin

St John’s wort

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88
Q

What is the risk of bleeding with aspirin compared to clopidogrel + warfarin?

A

Less bleeding risk with aspirin + warfarin

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89
Q

What are the enzyme Inducers? - SCRAP GPS

A

Smoking
Carbamazepine
Rifampicin
Alcohol
Phenytoin

Griseofulvin
Phenobarbital
Sulphonyureas -e.g. Gliclazide

90
Q

What does alcohol and warfarin interact to cause?

A

(Heavy) Alcohol is an enzyme inducer- so it decreases warfarin effect.

Acute drinking- increase bleeding

91
Q

What does cranberry juice and warfarin interact to cause?

A

cranberry juice is enzyme inhibitor = increases warfarin effect.

92
Q

What does warfarin and OTC miconazole interact to cause? what to do?

A

Miconazole increases the anticoagulant effect of Warfarin

MHRA = says avoid unless INR can be monitored closely.

93
Q

What are enzyme inhibitors? SICKFACES COM

A

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole

Fluconazole + Fluoxetine
Alcohol + grapefruit juice
Chloramphenicol
Erythromycin
Sulphonamides

Ciprofloxacin
Omeprazole
Metronidazole

94
Q

What to do when patient on warfarin is about to have an emergency surgery which can be delayed by 6 -12 hrs?

A

IV phytomenadione

95
Q

What is MHRA advice (2017) around warfarin and Micoazole?

A

OTC oral miconazole gel is contra-indicated with warfarin

Report sign of serious bleeding.

96
Q

What is MOA of DOAC?

A

Directly inhibits clotting factor Xa or IIa (thrombin).

97
Q

What is indication of DOAC?

A

VTE
Non-valvular AF

98
Q

What are DOACs an alternative to?

A

Warfarin alternative.

99
Q

What are 3 reasons that DOACs are better than warfarin?

A

Fixed dose regimen

No monitoring

Less food interactions

100
Q

What to do if you miss a dose of a DOAC and it is more than 6 hrs?

A

If a dose is more than 6 hours late, the missed dose should NOT be taken.

The NEXT dose should be taken at the normal time.

101
Q

How long does DOAC last in body?

A

Lasts 12 -24 hours in body

102
Q

What DOAC requires to be in a special container + has short 4 month expiry?

A

Dabigatran

103
Q

What DOAC is taken after food and can be crushed?

A

Rivaroxaban (esp high doses 15mg and 20mg)

104
Q

What is an antidote for dabigatran?

A

Idarucizumab

Used in life-threatening or uncontrolled bleeding, emergency surgery.

105
Q

What is an antidote for apixaban and rivaroxaban?

A

Andexanet alfa

106
Q

What is Andexanet alfa used for?

A

Antidote for apixaban and Rivaroxaban.

107
Q

What is a big SE of DOACS?

A

Bleeding

108
Q

What to monitor in DOACs?

A

Signs of bleeding and anaemia.

Renal profile in renal impairment.

109
Q

What is a MHRA (2020) advise given for DOACs regarding bleeding risk?

A

Be aware of signs of bleeding.

Caution in Renal impairment- in case reduce dose + monitor.

Counsel pt, read PIL

110
Q

What is MHRA (2023) advise given for DOACs regarding dose adjustments in patients with renal impairment?

A

Review patients regularly during treatment + calculate CrCL

111
Q

For Dabigatron, what do do if patient has CrCL of 30?

A

Avoid if creatinine clearance less than 30 mL/minute.

112
Q

What is an MHRA 2018 warning for patients with prosthetic heart valves and rivaroxaban?

A

NOT for thromboprophylaxis- can increase mortality , bleeding events.

113
Q

Why should patients with prosthetic heart valves not take rivaroxaban?

A

increased risk mortality, bleeding events.

114
Q

What are patients with anti-phospholipid syndromes more at risk of with DOAC?

A

Increased risk of recurrent thrombotic events

115
Q

What condition do patients have in which they are recommended NOT take DOACs?

A

Anti-phospholipid syndrome

116
Q

What is the risk with using 2 DOACs referred to by MHRA Oct 2013?

A

Significant bleeding risk with new oral anticoagulants- contra-indication

117
Q

What is rivaroxaban brand?

A

Xarelto

118
Q

What is rivaroxaban dose and duration for VTE prevention for hip replacement patients?

A

10mg OD for 35 days

119
Q

What is rivaroxaban dose and duration for VTE prevention for knee replacement patients?

A

10 mg OD for 14 days

120
Q

What is rivaroxaban dose recurrent VTE prevention?

A

10mg OD for 6 months +

consider 20mg daily if higher risk of clot.

121
Q

What is rivaroxaban dose for VTE treatment?

A

15 mg BD for 21 days with food, then 20mg OD

122
Q

What is rivaroxaban dose for stroke prevention in non-valvular AF?

A

20mg OD

123
Q

What is rivaroxaban dose for prevention of an atherothrombotic event ?

A

2.5mg BD-

can be used with aspirin + clopidogrel.

124
Q

What is treatment duration of rivaroxaban in preventing atherothrombotic event in acute coronary syndrome?

A

for 12 months. - 2.5mg BD

125
Q

What is apixaban dose for VTE prevention after hip replacement?

A

2.5mg BD for 32-38 days, 12- 24 hrs after surgery

126
Q

What is apixaban brand?

A

Eliquiz

127
Q

What is apixaban dose for VTE prevention after knee replacement?

A

2.5 mg BD for 10-14 days , 12- 24 hours after surgery

128
Q

What is apixaban dose for recurrent VTE?

A

2.5 mg BD

129
Q

What is apixaban dose for VTE treatment?

A

10mg BD for 7 days -THEN 5mg BD as maintenance.

130
Q

What is apixaban dose in stroke prevention in non-valvular AF?

A

5mg BD

REDUCE to 2.5 mg BD if patient over 80+, < 61kg, creatinine >133.

131
Q

What are the requirements for apixaban dose reduction in stroke prevention?

A

Reduce dose to 2.5 mg BD

-serum-creatinine 133 micromol/litre
- age 80 years+
-body-weight 60 kg or less

132
Q

What is edoxaban brand?

A

Lixiana

133
Q

What is edoxaban dose for VTE and stroke prevention and treatment in non- valvular AF?

A

30mg OD

134
Q

What is Rivaroxaban administration?

A

Manufacturer advises tablets may be crushed and mixed with water or apple puree just before administration.

135
Q

What DOAC can be taken with food for absorption?

A

Rivaroxaban

136
Q

What is edoxaban dose for VTE and stroke prevention and treatment in non- valvular AF if patient weighs 61kg and +?

A

60mg OD

137
Q

What is dabigatran brand?

A

Pradaxa

138
Q

What is Dabigatran VTE prevention dose after hip replacement?

A

220mg OD for 35 days

139
Q

What is Dabigatran VTE prevention dose after knee replacement?

A

220mg OD for 14 days

140
Q

What is Dabigatran VTE prevention dose in elderly patients over 75 years + on amiodarone or verapamil?

A

75 mg for 1 dose, then 150mg OD

141
Q

What is dabigatran dose for VTE treatment and stroke prevention in non-valvular AF?

A

150mg BD

142
Q

What is dabigatran dose for VTE treatment and stroke prevention in non-valvular AF in patients OVER 75 years, moderate RI and bleeding risk?

A

110-150mg BD

143
Q

What is dabigatran dose for VTE treatment and stroke prevention in non-valvular AF in patients OVER 80+ and on verapamil?

A

110mg BD

144
Q

What is the effect of possible interactions between DOACs and anticoagulants?

A

Increased bleeding

145
Q

What 5 drug classes can interact with DOAC to increase bleeding?

A

Heparins
Warfarin
NSAID
SSRI
antidepressant

146
Q

What 4 drug classes can increase anticoagulant effect? (TIP- inhibitors)

A

Amiodarone

Azole antifungals- e.g. ketaconazole

Ciclosporin

Erythromycin

147
Q

What 3 drugs/classes can reduce anticoagulant effect? (Think inducers)

A

Carbamazepine + phenobarbital (anti-epileptic drugs)

Rifampicin
St johns wort

148
Q

Why is LMWH better than unfractionated heparin?

A

Less risk of heparin-induced thrombocytopenia and just as effective.

149
Q

What are the 5 names of parenteral anti-coagulants?

A

Fondaparinux
Heparinoid
Argatroban
Hirudin
Epoprostenol

150
Q

What are 2 oral anticoagulant names?

A

Acenocoumarol
Phenindione

151
Q

What are heparinoids?

A

Danaparoid sodium

Prophylaxis of DVT in patients undergoing general or orthopaedic surgery.

Has a role in patients who develop heparin-induced thrombocytopenia.

152
Q

What is argatroban given with?

A

An oral anticoagulant can be given with argatroban monohydrate, but it should only be started once thrombocytopenia has substantially resolved.

153
Q

What are Hirudins?

A

Bivalirudin, a hirudin analogue + is a thrombin inhibitor.

Licensed for unstable angina or non-ST-segment elevation myocardial infarction in patients planned for urgent or early intervention.

154
Q

Why is epopreostenol given?

A

Inhibit platelet aggregation during renal dialysis when heparins are unsuitable or contra-indicated.

Also licensed for the treatment of primary pulmonary HTN resistant to other treatment, usually with oral anticoagulation; it should be initiated by specialists in pulmonary hypertension.

155
Q

Why is epoprostenol IV?

A

Epoprostenol is a potent vasodilator.

It has a short half-life of approximately 3 minutes

Therefore it must be administered by continuous IV infusion.

156
Q

What 3 situations to avoid vit K antagonists?

A

within 48 hours postpartum

haemorrhagic stroke; significant bleeding

157
Q

What is acenocoumarol?

A

Coumarin derivative used as an anticoagulant.

Inhibit the reduction of vitamin K by vitamin K reductase.

158
Q

What class of drugs was known to interact with Acenocoumarol (Vit K antagonists) in 2017 MHRA?

A

Direct-acting antivirals for Hep C-
Monitor INR

159
Q

Why should vit K antagonists NOT be given in 1st trimester?

A

Warfarin, acenocoumarol, + phenindione cross the placenta with risk of congenital malformations, and placental, fetal haemorrage.

160
Q

What is arterial thrombosis?

A

Blood clot in artery which blocks blood supply to heart and brain.

161
Q

What are 2 types of arterial thrombosis?

A
  1. Ischaemic - TIA
  2. Haemorrhagic
162
Q

What is TIA?

A

Transient ischaemic attacks - mini strokes that temporarily stop blood supply to brain.

163
Q

What are 2 causes of Ischaemic thrombosis?

A

Atherosclerosis, Thromboembolism/AF

164
Q

What are 3 causes of Haemorrhagic thrombosis?

A

High BP

Aneurysm
Arteriovenous malformation

165
Q

What are the Symptoms of Stroke?

A

Facial weakness
Arm weakness
Speech problems
Time - call 999

166
Q

What is a long-term treatment option for TIA + Ischaemic stroke?

A

1st line = Clopidogrel (monotherapy)

2nd line = aspirin (if above contra)

High intensity statin (48 hrs after stroke)

167
Q

What is 1st line long-term treatment option for TIA+ Ischaemic stroke?

A

clopidogrel

+ high intensity statin

168
Q

What anti platelet is unlicensed in TIA long term management?

A

clopidogrel

169
Q

What is treatment option for haemorrhagic stroke?

A

Anti-hypertensive

170
Q

Why does ischaemic stroke happen?

A

Build up of fatty deposits.

171
Q

What 3 drug classes to avoid in haemorragic stroke?

A

Aspirin
Statin
Anti-coagulants

172
Q

What is MOA of anti-platelets?

A

Reduces platelet aggegration + inhibits thrombus formation in arteries

173
Q

What BP to aim for after intracranial haemorrhage?

A

Aim for a systolic BP target of 130-139 mmHg within 1 hour and sustained for at least 7 days, ensuring that the magnitude drop does not exceed 60 mmHg within 1 hour of starting treatment.

174
Q

What is low dose aspirin?

A

75mg OD

175
Q

What is administration for Dipyridamole?

A

30 to 60 mins before food

176
Q

What is administration for MR Dipyridamole?

A

Take it after food

177
Q

What is storage for MR dipyridamole caps?

A

Special container

178
Q

What is expiry for MR dipyridamole caps?

A

Discard in 30 days.

179
Q

What are 6 examples of glycoprotein IIb/IIIa inhbitors?

A

Cangrelor
Prasugrel
Ticagrelor
Abciximab
Eptifibatide
Tirofiban

180
Q

What should patients do if they have acute stroke symptoms?

A

immediately hospital

181
Q

What is 1st line tx for TIA/minor stroke initial management?

A

Immediate aspirin 300mg

if contra = PPI or another antiplatelet

182
Q

What should patients presenting within 24 hrs of TIA/ minor stroke with low bleeding risk be on?

A

Dual Antiplatelet therapy

(clopidogrel/ticagrelor + aspirin)

183
Q

What to do if dual antiplatelet therapy Contra-indicated in TIA initial management?

A

monotherapy clopidogrel.

184
Q

What to give patients with dyspepsia on aspirin to reduce GI bleed?

A

PPI

185
Q

What is ischaemic stroke initial management in acute + within 4.5 hrs of symptoms?

A

Alteplase or tenecteplase

186
Q

When to administer TPa for stroke?

A

within 4.5 hrs of symptoms + intracranial haemorrhage excluded

187
Q

What condition should be excluded when giving alteplase for ischaemic stroke?

A

intracranial haemorrhage

188
Q

What should be started 24 hours after ischaemic stroke?

A

Antiplatelets

189
Q

What are patients with disabling ischaemic stroke started on?

A

Aspirin within 24 hrs + continue 2 weeks after

190
Q

How long is aspirin continued for in patients with disabling ischaemic stroke?

A

2 weeks then start long term

191
Q

When should patients be started EARLIER long term anti-thrombotic treatment after stroke?

A

If being moved to care home before 2 weeks of aspirin

192
Q

Is anticoagulant recommended as alternative to anti-platelet in ischaemic stroke + sinus rhythm?

A

NO only if stroke linked to AF.

193
Q

When may anticoagulants be indicated for stroke?

A

DVT + PE with stroke

194
Q

If patient has immobility with stroke , what should not be GIVEN?

A

LMWH
or

Graduated compression stockings

195
Q

What anticoagulant should NOT be given in acute phase of ischaemic stroke?

A

Warfarin

196
Q

Patients receiving anticoagulation for a prosthetic heart valve who experience a disabling ischaemic stroke + are at high risk of bleed should have their anticoagulant stropped for —- days?

A

7 days + switch to aspirin

197
Q

What can treatment of HTN in acute phase of stroke lead to?

A

Reduced cerebral perfusion

only treat HTN in emergency

198
Q

When can statin be given in stroke patients?

A

As soon as they can swallow medication

Does not matter their cholesterol level

199
Q

What drug should NOT be used for HTN management after stroke?

A

Beta blocker

200
Q

What method is required after intracerebral haemorrhage to remove the haematoma?

A

Surgery

201
Q

When should rapid BP lowering meds not be given to patients in Intracerebral haemorrhage? (4 reasons)

A

underlying structural cause

score <6 on glasgow coma scale

early neurosurgery

large Haematoma - poor diagnosis

202
Q

When to consider rapid BP meds after Intracerebral haemorrhage?

A

symptoms present within 6 hrs

BP 150 -220 mmhg

203
Q

What is target BP post haemorrhage?

A

130-139 mmhg within 1 hrs

maintain for 7 days

204
Q

What to do about BP control if patient present after 6 hours of symptom onset?

A

case by case basis

205
Q

Can patients be in anticoagulants after intracranial haemorrhage?

A

NO stop it- reverse it.

206
Q

What to give patient using anticoagulant for DVT but also has intracranial haemorrhage

A

Caval filter

207
Q

What cholesterol drug is avoided following intracerebral haemorrhage?

A

Statins

208
Q

1st line tx for blocked catheter lines?

A

Urokinase

209
Q

What are 5 risk factors of VTE if on COC?

A

40 years and older—if 50 years and older, seek specialist advice before use of contraceptives;

6 weeks -6 months postpartum in breastfeeding women.

3 to 6 weeks postpartum in non-breastfeeding women.

Smoking if age <35 years, or if 35 years + older + have stopped smoking at least 1 year ago.

body mass index 30 kg/m2 to 34 kg/m2

History of HTN during pregnancy

Family HX

Major surgery

210
Q

What crCL to stop apix, rivaroxaban and edoxaban?

A

less than 15ml/min

211
Q

What dose edoxaban if crcl 15-50?

A

Use a dose of 30 mg once daily if creatinine clearance 15–50 mL/minute

212
Q

What dose adjustment of edoxaban if taking with dronedarone, erythromycin, ciclosporin or ketoconazole? (DECK)

A

30MG OD

213
Q

What is edoxaban dose if patient weights less than 61kg?

A

30 mg OD

214
Q

Indication of Tranexamic acid?

A

Menorrhagia and local fibrinolysis

215
Q

Dose of Tranexamic acid for heavy periods?

A

1g TDS for 4 days

P med licensed for 18+ with regular menstrual cycle

216
Q

MOA of tranexamic acid?

A

Prevents bleeding

increased risk of VTE with contraceptives

217
Q

6 contraindications of tranexamic acid?

A

epilepsy, DVT, PE, irregular periods, renal problems, pregnancy

218
Q

3 SEs of tranexamic acid?

A

Colour vision change or visual impairment (discontinue), signs of DVT and thromboembolism.

219
Q

When to reduce dose of tranexamic acid?

A

if diarrhoea

220
Q

What 4 drugs does edoxaban interact with + need dose reduction? DECK

A

ciclosporin, dronedarone, erythromycin, or ketoconazole

221
Q

What is Fluconazole and warfarin interaction plan to prevent?

A

fluconazole - adjust the dose and monitor INR

222
Q

What INR is oral phytomeniadone given before surgery?

A

should be given the day before surgery if the INR is ≥1.5.

PRE-REG-Thuri (44 decks)

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