Cardiovascular 2 Flashcards
DOACs are preferred in what type of AF
Non valvular AF
List the parameters for DOACs that may require dose reduction
ABCD
Age> or = 80yrs
Body weight= <61/60kg
CRCL=15- 50
Do not give DOAC if CRCL is less than 15
Drugs- Verapamil, amiodarone, erythromycin and ciclosporin
The only DOAC used in ACS is …
Rivoraxaban
Example of DOACS used once daily
RE
Rivaroxaban
Edoxaban
DOACs used BD
AD
Apixaban
Dabigatran
What’s the dose of Rivoraxaban for VTE prophylaxis and stroke
10mg OD- VTE
20mg OD - Stroke
Whats the prophylaxis dose of Apixaban for VTE and stroke
VTE- 2.5mg BD
Stroke - 5mg BD
What organ do you monitor while on DOACS
Monitor kidneys
DOACS are contraindicated in….
Antiphospholipid syndrome
( immune response which created antibodies which make blood clot increases risk of recurrent thrombotic events
See bnf for more
Facts about DOACs
Less bleeding
No monitoring required
All have pt alert card
Label 10- take this drug with additional info
Which DOAC inhibit Thrombin
Dabigatran
DOACs that inhibit factor Xa inhibitor
Apixaban
Edoxaban
Rivoraxaban
A DOAc with no antidote
Edoxaban
What’s the reversal agent with Apixaban and Rivoraxaban
Andexanet Alfa (Ondexxya)
Indication of DOACs
Prophylaxis of stroke and systemic embolism in patients with non Valvular AF
Secondary prevention and tx of DVT/ PE
Prevention of VTE after elective hip or knee replacement surgery
MOA of warfarin
Inhibits Vit K decreasing clotting factors 2, 7
What’s the MHRA warning for rivaroxaban?
15mg and 20mg tablets should be given with food
Label 21
State when to reduce the dose of apixaban in prophylaxis of stroke or systemic embolism in non valvular Af and at least Two risk factor [ stroke(TIA)HF, diabetes, HTN, age 75 and over
5mg BD to 2.5mg BD
if
ABCC
Age - >or = 80
Weight = <or = 60kg
Creatinine >or = 133micromol/litre
CrCL- 15-29ml/min
What is the antidote for Dabigatran( pradaxa)
Idarucizumab( praxbind)
Antidote for Heparin
Protamine
Antidote for Warfarin
Vit K or phytomenadione
Whats the cautionary label for Dabigatran
Label 10
And 25- swallow this medicine whole ,do not chew or crush
3 different strength of Pradaxa
75mg , 110mg and 150mg
Indication of Tranexamic acid
Local fibrinolysis
Menorrhagia
Hereditary angioedema
Epistaxis( nose bleed)
Adult dose for Tranexamic acid used in Fibrinoysis
1-1.5g BD or TDS
Adult dose of tranexamic acid for menorrhagia (heavy period)
1g TDS for up to 4days to be initiated when menstruation has started.
Max 4g daily
Dose of Tranexamic acid for nose bleed
1g TDS for 7days
Indication of Tranexamic acid as a P medication
Menorrhagia
Caution with Tranexamic acid
Increase risk of DVT when taken with contraceptive pill
Contraindications of Tranexamic acid
Epilepsy, DVT, PE, irregular periods, renal problems and pregnancy
Red flags for pt on Tranexamic acid
Discontinue if colour vision or visual impairment
Coughing up blood or Coughing
Anaphylaxis rxn
SOB, legs or arms painful and swollen, red and warm to touch
