Decision Making in Therapeutics

Question 1

What is the CHA2DS2VaSc?

Answer 1

Risk stratification for stroke and need for anticoagulation therapy
≥2= anticoagulation with warfarin or DOAC

Question 2

What is the mechanism of action of Apixaban?

Answer 2

Direct inhibitor activated factor Xa

Question 3

Advantages and Disadvantages of prescribing Apixaban?

Answer 3

Advantages:
Quick onset and offset
No monitoring required
Less drug interactions
Safety profile good

Disadvantages:
No antidote
(*Dabigatran - idarucizumab)

Question 4

Advantages and Disadvantages of prescribing Warfarin?

Answer 4

Advantages:
More experience with
Antidote (vitamin K)

Disadvantages:
Monitoring (INR) required
Drug/nondrug interactions ++
Slower onset and offset

Question 5

What considerations should be made when prescribing apixaban?

Answer 5

1. Age: if older than 80
2. Weight: if less than 61kg
3. Renal Function-Creatinine (reduce is 133+)
   CrCl 15-29- reduce dose

Question 6

What considerations should be made when prescribing warfarin?

Answer 6

bleeding risk
gastrointestinal bleeding
peptic ulcer, haemorrhagic
hepatic impairment, stroke, 
surgery

Question 7

How will you manage a sub-therapeutic INR?

Answer 7

start a LMWH (e.g. enoxaparin, tinzaparin)

Question 8

Lisinopril

Answer 8

ACE inhibitor

Question 9

Signs of Opiate Toxicity

Answer 9

Subtle agitation
Drowsiness/confusion
Miosis (pinpoint pupils)
Vivid dreams
Hallucinations
Myoclonus

Question 10

How would you reverse paracetamol toxicity?

Answer 10

Acetylcysteine

Question 11

How would you reverse anti-depressant toxicity?

Answer 11

Activated charcoal

Question 12

How would you reverse benzodiazepine overdose?

Answer 12

Flumazenil

Question 13

How would you reverse warfarin toxicity?

Answer 13

Phytomenadione