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Cardiovascular > Doacs > Flashcards

Doacs Flashcards

1
Q

Which DOACs inhibit thrombin and which inhibit factor Xa

A

Dabigatran inhibits thrombin

Edoxaban, apixaban, rivaroxaban inhibit factor xa

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2
Q

Andexanat alpha is the antidote for…

A

Apixaban
Rivaroxaban

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3
Q

Which DOAC doesnt have an antidote

A

Edoxaban

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4
Q

Ondexxya is also known as

Whats its indication

A

Andexanat alpha

Apixaban
Rivaroxaban

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5
Q

What is dabigatrans antidote

A

Idarucizumab (praxbind)

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6
Q

Praxbind is the brand name for

A

Idarucizumab

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7
Q

Whats anticoagulant is preferred in non valvular AF

A

DOACs

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8
Q

What anticoagulant is preferred in valvular AF

A

Warfarin

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9
Q

What causes more bleeding, DOACs or warfarin

A

Warfarin

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10
Q

When would you reduce/half the dose of a DOAC

A

ABCD

aged 80 or over
Body weight <61/60kg
Crcl 15-50
Drugs verapamil, Amiodarone, erythromycin, ciclosporin

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11
Q

What eGFR would you NOT use a doac in

A

EGFR <15ml/min/1.73m

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12
Q

When would you use a DOAC in stroke prophylaxis

A

If they have at least one of the chadvasc risk factors

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13
Q

Which is the only DOAC used in acute coronary syndromes with aspirin and clopidogrel

Whats the dose?

A

Rivaroxaban
2.5mg BD

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14
Q

Which DOACs are OD and which are BD

A

Rivaroxaban and edoxaban are OD

apixaban and dabigatran are BD

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15
Q

Rivaroxaban dose for VTE prophylaxis

A

10mg OD

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16
Q

When would DOACs be given in VTE prophylaxis

A

In elective hip/ knee surgery after LMWH or low dose aspirin

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17
Q

Rivaroxaban dose for stroke prophylaxis

A

20mg OD

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18
Q

Apixaban dose for VTE prophylaxis

A

2.5mg BD

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19
Q

Apixaban dose for stroke prophylaxis

A

5mg BD

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20
Q

What monitoring requirement is important in DOAC use

A

Renal/ kidney

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21
Q

DOACs are contraindicated in which syndrome? Why?

A

Antiphospholipid

It creates antibodies which cause increased risk of blood clots, risking patient of recurrent thrombotic events

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22
Q

What do patients on DOACs have to carry at all times

A

Patient alert cards

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23
Q

DOAC indications

A

Prophylaxis of VTE in elective hip or knee replacement surgery
Confirmed VTE treatment
Prophylaxis of stroke and embolism in NON VALVULAR AF PATIENTS

Rivaroxaban used in prophylaxis of ACS (2.5mg OD)

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24
Q

DOACs duration of action

A

12 hours - apixaban and dabigatran

24 hours - rivaroxaban and edoxaban

25
Q

Is routine monitoring required in DOACs

A

No

26
Q

DOACs - monitor signs of ….

Stop if …… occurs

A

Bleeding or anaemia

Severe bleeding

27
Q

Which DOAC needs to be taken with food, at which strength

Why?

A

Rivaroxaban when given at strengths 15mg and 20mg need to be taken with food as it could affect the stomach causing GI bleeds

28
Q

In stroke prophylaxis apixaban is given as 5mg BD, when would you reduce this dose to 2.5mg BD

They must have how many factors?

A

If they have at least 2 of the following factors:

Aged 80 or more
Body weight <60kg
CrCl 15-50ml/min
Creatinine 133mmol/l or more

ABCC

29
Q

Rivaroxaban dose for confirmed DVT or PE

With food or without?

A

Initially 15mg BD for 21 days (3weeks) then 20mg maintenance

WITH FOOD

30
Q

Rivaroxaban dose for prophylaxis of stroke and systemic embolism in patients with non valvular AF with at least 1 of the chadvasc factors

A

20mg OD

31
Q

When is the only time rivaroxaban is given BD

A

Acute coronary syndrome

2.5mg BD

Confirmed DVT/PE - 15mg BD for 21 days then 20mg daily

32
Q

Rivaroxaban is given in prophylaxis of atherombotic events in ACS for a duration of……

A

12 months

2.5mg BD with food with aspirin or with both aspirin and clopidogrel

33
Q

Rivaroxaban Dose for prophylaxis of atherombotic events in patients with artery disease or symptomatic peripheral artery disease at high risk of ischaemic events

A

2.5mg BD with aspirin

34
Q

Dabigatran dose for prophylaxis of VTE following total knee replacement surgery in 18-74 yrs

A

110mg to be taken 1-4 hrs after surgery followed by 220mg OD for 10 days starting the day after surgery

35
Q

Dabigatran dose for prophylaxis of VTE following total knee replacement surgery in 75yrs and over

A

75mg taken 1-4 hrs after surgery followed by 150mg OD for 10 days starting day after surgery

36
Q

Dabigatran dose for prophylaxis of VTE following total knee replacement surgery in patients taking concomitant Amiodarone or verapamil

A

75mg 1-4 hrs after surgery followed by 150mg OD for 10 days starting day after surgery

37
Q

Prophylaxis of VTE for knee replacement rivaroxaban dose

A

10mg OD for 2 weeks (14 days)

38
Q

Prophylaxis for VTE for hip replacement rivaroxaban dose

A

10mg OD for 5 weeks (35 days)

39
Q

Rivaroxaban dose prophylaxis of recurrent DVT or PE

A

10mg OD
20mg OD in high risk

40
Q

Treatment of DVT/PE or prophylaxis of recurrent DVT/PE dabigatran dose

A

18-74yrs: 150mg BD for at least 5 days

75-79yrs: 110-150mg BD

Adults 80yrs or over: 110mg BD

41
Q

Prophylaxis of stroke dabigatran dose

A

110-150mg BD

42
Q

Rivaroxaban brand name

A

Xarelto

43
Q

Dabigatran brand name

A

Pradaxa

44
Q

Whats the cautionary label for ALL DOACS

A

Read the additional information given with this medicine

45
Q

Dabigatran cautionary label

A

Swallow this medicine whole. Do not chew or crush

46
Q

Rivaroxaban cautionary label

A

Take 15mg and 20mg with food or just after a meal

47
Q

Apixaban prophylaxis VTE for knee replacement dose

A

2.5mg BD for 10-14 days

48
Q

Apixaban prophylaxis VTE for hip replacement dose

A

2.5mg BD for 32-38 days

49
Q

Treatment of DVT /PE apixaban dose

A

10mg BD for 7 days
Maintenance 5mg BD daily

50
Q

Apixaban dose prophylaxis of recurrent DVT/PE

A

2.5mg BD

51
Q

Apixaban prophylaxis of stroke dose, when would you reduce this dose and to what?

A

5mg BD

Reduce if aged 80 or over, body weight 60 or less, crcl 15-50 or creatinine >133

Reduce to 2.5mg BD

52
Q

Edoxaban prophylaxis of stroke/AF

A

In 60kg or less give 30mg OD

In >60kg give 60mg OD

53
Q

Edoxaban dose for treatment of DVT/PE

A

In 60kg or less give 30mg OD

In >60kg give 60mg OD

54
Q

Edoxaban dose in prophylaxis of recurrent DVT/PE

A

In 60kg or less give 30mg OD

In >60kg give 60mg OD

55
Q

When would you reduce edoxaban dose 60mg OD and reduce to what

A

Weight 60kg or less
Crcl 15-50
Drugs- ketoconazole, dronedarone, cyclosporine, erythromycin

Reduce to 30mg OD

56
Q

When would you reduce apixaban 5mg BD and to what

How many factors

A

At least 2 out of 3 factors:

Age
Weight
Creatinine clearance
Creatinine >133

Reduce to 2.5mg

57
Q

When would you reduce dabigatran 150mg BD and to what

A

Age 75-79, crcl 30-50ml/min and drugs (verapamil, Amiodarone): 110-150BD

Age 80 and over 110mg BD

58
Q

DOAC contraindications

A

Antiphospholipid syndrome
Significant risk factors of bleeding
Concomitant treatment with other DOACs
eGFR <15ml/min/1.73m

Switching from rivaroxaban to warfarin (stop warfarin first to reduce risks of bleeding)

Cardiovascular (9 decks)

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