Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardio > DOACs and Warfarin > Flashcards

DOACs and Warfarin Flashcards

1
Q

name the DOACs

A

rivaroxaban, edoxaban, apixaban, dabigatran

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

rivaroxiban brand name

A

xarelto

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

apixaban brand name

A

eliquis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

edoxaban brand name

A

savaysa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

dabigatran brand name

A

pradaxa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

dabigatran indications

A

NVAF, VTE prophylaxis (orthopedic surgery), treatment of VTE & risk of reduction of recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

rivaroxaban indications

A

NVAF, VTE prophylaxis, treatment of VTE, reduction in risk of recurrence of DVT/PE in pts @ continued risk, reduction in risk of major CV events (death, MI, stroke) in chronic CAD or PAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

apixaban indications

A

NVAF, VTE prophylaxis (orthopedic surgery), treatment of VTE and reduction in risk of recurrence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

edoxaban indications

A

NVAF, treatment of DVT and PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the apixaban dosing for NVAF

A

5 mg po bid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the apixaban dosing for NVAF if pt is older than 80, weighs less than 60 kg, or has serum creatinine greater than 1.5

A

2.5 mg po bid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

do DOACs require bridging like warfarin?

A

NO!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

overdosing DOACs doubles risk of ____

A

bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

underdosing DOACs causes a 5-fold increased risk of _____

A

stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

which DOACs can we use in patients who weigh more than 120 kg or have BMI over 40 (OBESE)

A

rivaroxaban or apixaban

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

which anticoagulants have safer profile: DOACs or warfarin

A

DOACs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

adverse effects of DOACs

A

bleeding (GI hemorrhage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

adverse effects specific to dabigatran

A

dyspepsia, nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

contraindications to DOACs

A

active major bleed, advanced CKD (CrCL <15) except apixaban, and CrCL<30 mL/min for VTE prophylaxis/treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what types of drug-drug interactions exist for DOACs

A

P-glycoprotein and CYP3A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

strong P-gp inhibitors ____ DOAC concentrations

A

increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are some strong P-Gp inhibitors

A

ketoconazole, itraconazole, clarithyromycin, dronedarone, amiodarone, verapamil, quinidine, cyclosporine, conivaptan, ritonavir, lopinavir, indinavir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

strong P-gp inducers ____ DOAC concentrations

A

decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are some strong p-gp inducers

A

rifampin, carbamazepine, phenytoin, St. John’s wort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Strong CYP3A inhibitors _____ DOAC concentrations

A

increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are some strong CYP3A inhibitors

A

azole antifungals, macrolides, protease inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

strong CYP3A inducers _____ DOAC concentrations

A

decrease

28
Q

what are some strong CYP3A inducers

A

rifampin, carbamazepine, phenytoin, st. john’s wort

29
Q

dabigatran and edoxaban are metabolized by __

A

P-gp

30
Q

apixaban and rivaroxaban are metabolized by ___

A

CYP3A and P-gp

31
Q

what are the DOAC trial exclusions in NVAF

A

mechanical heart valves, hemodynamically significant mitral stenosis, advanced CKD, significant liver disease, recent stroke (7-14 days), pregnancy/lactation, severe HTN, reversible causes of AFib

32
Q

what are the guidelines for pregnancy w/ anticoagulants

A

no DOACs. warfarin is teratogenic in first 2 trimesters, use enoxaparin. can use warfarin in 3rd trimester

33
Q

reversal agent/antidote for dabigatran

A

idaracizumab (praxbind)

34
Q

what is the reversal agent FDA approved for apixaban and rivaroxaban

A

coagulation factor Xa (andexxa)

35
Q

all DOACs are at least ____ to warfarin for reducing risk of stroke/systemic embolism

A

not inferior

36
Q

which DOACs are superior to warfarin for risk of stroke/ systemic embolism

A

dabigatran 150 mg and apixaban

37
Q

all DOACs reduce the risk of ____ versus warfarin

A

major bleeding

38
Q

you should withhold DOACs for ____ prior to procedure depending on bleed risk and kidney function

A

24-48 hours

39
Q

after initiating warfarin, there is a ______ state

A

hypercoagulable

40
Q

explain how warfarin causes a hypercoagulable state when first initiated

A

it also depletes some of your body’s own natural anticoagulants like protein c and protein s

41
Q

how do we allow for a slow onset of warfarin since there is a hypercoagulable state?

A

use a parenteral to bridge for 3-5 days

42
Q

warfarin interferes with _____ dependent clotting factors

A

vitamin k

43
Q

the protein target of warfarin is ____

A

VKORC1 (vitamin K oxide reductase 1)

44
Q

VKORC1 is the enzyme responsible for ___

A

activation of clotting factors that depend on vitamin K as a cofactor

45
Q

VKORC1 oxidizes the reduced form of Vit K, and carboxylates the inactive clotting factors to make them ___

A

active

46
Q

warfarin is a ___ mixture

A

racemic (r and s isomers)

47
Q

warfarin is highly bound to ____

A

albumin (95%)—> drug interactions

48
Q

the r isomer of warfarin is metabolized by ___

A

CYP3A4

49
Q

the s isomer of warfarin is metabolized by ___

A

CYP2C9

50
Q

how do you monitor warfarin

A

INR

51
Q

what drug interactions with warfarin would INCREASE inr (risk for bleed)

A

alcohol, amiodarone, anabolic steroids, cimetidine, clarithromycin, cotrimoxazole, erythromycin, fluconazole, isoniazid, metronidazole, miconazole, omeprazole, phenylbutazone, piroxicam, propafenone, propranolol, vit. E

52
Q

what drug interactions with warfarin would DECREASE INR (risk for clot)

A

barbiturates, carbamazepine, chlordiazepoxide, cholestyramine, nafcillin, rifampin, sucralfate, dicloxacillin, azathioprine, cyclosporine, trazodone, vit K

53
Q

is a loading dose necessary for most patients starting warfarin

A

NO

54
Q

what is the initial dose for warfarin

A

2-5 mg daily

55
Q

bridge warfarin with ______ for 4-5 days

A

heparin

56
Q

how do you adjust the dose of warfarin

A

10-15% of weekly dose

57
Q

adverse effects of warfarin

A

bleeding, skin necrosis, purple toe

58
Q

indications for warfarin

A

DVT, PE, prevention of systemic embolism (stroke)—> biprosthetic heart valves short term, acute MI, LV dysfunction, LV thrombus, AFib, mechanical prosthetic valve (mitral), mechanical prosthetic valve (aortic)

59
Q

what is the therapeutic INR range for warfarin

A

2-3

60
Q

what is the therapeutic INR range for warfarin if indication is mechanical mitral prosthetic valve

A

2.5-2.5

61
Q

patient counseling points for warfarin

A

signs of bleed, signs of clot, INR monitoring and dosage, tablet identification, common drug interactions, consistent intake of dietary vitamin k

62
Q

what are the reversal agents for warfarin

A

vitamin k (phytonadione), fresh frozen plasma, prothrombin complete concentrates like profilnine (3 factor) and kcentra (4 factor), recombinent factor VIIa (novoseven)

63
Q

what is the target of dabigatran

A

thrombin (factor IIa)

64
Q

what is the target of apixaban

A

Xa

65
Q

what is the target of rivaroxiban

A

Xa

66
Q

what is the target of edoxaban

A

Xa

Cardio (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions