Cardio

Question 1

What does Warfarin Inhibit?

Bonus Mark: Vit K Clotting factors?

Answer 1

Vit K Production enzyme

Epoxide reductase (Allows Vit K to become active and become cofactors in carboxylation of the 1972 clotting factors)

1972 (10,9,7,2)

Question 2

Target Warfarin INRs

A- VTE
B- AF
C - Mechanical Heart Valves

Answer 2

A - 2.5 (3.5 if recurrent)
B - 2.5
C - Dependent on location and valve type [Mitral > Aortic valves]

Question 3

Mnemonics for Warfarin Drug interactions?

Answer 3

O-DEVICES 
O- Omeprazole
D-Disulfiram 
E-Erythromycin
V-Valproate
I-Isoniazid
C-Ciproflaxin + Cimetidine
E-Ethanol
S-Sulphonamides

Question 4

Factors affect warfarin efficacy?

Answer 4

Liver disease
P450 Enzyme Inducers (CRAP GPS). INR DOWN ++
Cranberry juice
NSAIDS
P450 Enzyme Inhibtors - (SICKFACES.COM G) INR UP ++

Phenytoin, Carbamazepine, Barbituates, Rifampicin, Alcohol, Sulphonylureas

Question 5

Managment of High INR
A - Major Bleed
B - INR >8 + No Bleed 
C - INR >5-8 + No Bleeding
D - INR 5 - 8 + Minor Bleed

Answer 5

A - Stop Warfarin + IV Vit K5mg + FFP/Prothrombin Complex Concentrate

B- Stop Warfarin + Oral Vit K (5mg + IV Dose) + Repeat Dose if >INR5. Restart Warfarin at INR <5

C- Withold Warfarin for 1/2 Doses + Reduce subsequent maintenance doses

D - Stop Warfarin + Give IV Vit K 3mg + Restart Warfarin at INR <5

Question 6

Most common cause of Mitral Stenosis?

Answer 6

Rheumatic heart disease