Drugs Flashcards
Includes anticoagulants, antiplatelets, analgesics.
ANTICOAGULANTS
Describe the mechanism of action of warfarin.
Vit K antagonist, prevents synthesis of vit K dependent clotting factors 2, 7, 9, 10 and protein C and S.
ANTICOAGULANTS
What are the indications for warfarin ?
DVT, AF, MI, pulmonary embolism, mitral stenosis, prosthetic heart valves.
ANTICOAGULANTS
What is the normal INR ?
INR 1
ANTICOAGULANTS
What does INR measure ?
Prothrombin time.
ANTICOAGULANTS
How often should INR be checked in patients which have stabilised their warfarin INR ?
Every 4-8 weeks.
Will be more regular if poorly controlled.
ANTICOAGULANTS
How long before a procedure should a patient taking warfarin’s INR be checked ?
24 hours ideally.
Up to 72 hours if stable.
ANTICOAGULANTS
What drugs can cause an increase in INR in patients taking warfarin ?
Antibiotics, NSAIDs.
ANTICOAGULANTS
SDCEP GUIDANCE - your patient’s INR is >4 and they require an extraction, how do you manage this patient ?
Post-pone treatment until INR under control.
If emergency treatment required - refer to secondary care.
ANTICOAGULANTS
SDCEP GUIDANCE - your patient’s INR is between 2-4 and is taking warfarin, and they require an extraction, how do you manage this patient ?
Can be treated.
ANTICOAGULANTS
How does SDCEP guidance suggest extra measures you can use to manage a patient taking warfarin if they have an INR 2-4 ?
Staging of treatment.
Delay treatment if short term use.
Treat early in day and early in week.
Use atraumatic techniques.
Avoid IDB where possible.
Use local haemostatic measures.
Give good post-operative advice.
Ensure bleeding has stopped for 30 mins after procedure.
ANTICOAGULANTS
What medications should you not prescribe to a patient on Warfarin ?
Aspirin, NSAIDs, azoles.
ANTICOAGULANTS
Describe the mechanism of action of apixiban.
Inhibits factor Xa - preventing the production of thrombin.
ANTICOAGULANTS
Describe the mechanism of action of rivaroxaban.
Factor Xa inhibitor - prevents production of thrombin.
ANTICOAGULANTS
What is the mechaism of action of dabigatran ?
Inhibits thrombin directly.
ANTICOAGULANTS
How often do patients take apixiban tablets ? How should their medication be managed if undergoing high risk treatment ?
2x daily.
Miss morning dose, continue with normal night time dose.
ANTICOAGULANTS
How often do patients take dabigatran ? How should their medication be managed if undergoing high risk treatment ?
2x daily.
Miss morning dose, continue with night time dose as normal.
ANTICOAGULANTS
How often do patients take rivaroxaban ? How should their medication be managed if undergoing high risk procedures ?
1x morning dose.
Delay morning dose until 4 hours since HA.
ANTICOAGULANTS
How often do patients take edoxaban ? How should their medication be managed if they are undergoing high risk treatment ?
1x night time dose.
Take treatment as usual at night.
ANTICOAGULANTS
What reasons would you not change a patients NOAC medication regime for treatment ?
Taking for mitral heart valves or coronary stent.
Have had pulmonary embolism or DVT in last 3 months.
Taking for cardioversion.
ANTICOAGULANTS
Your patient is taking low weight molecular weight heparin (injectable anticoagulants) - how do you manage their medication if they require high risk treatment ?
Treat without interrupting.
ANTIPLATELETS
Name some antiplatelet drugs.
Aspirin, clopidogrel, prasugrel, dipryridamole.
ANTIPLATELETS
How should you manage your patients drug regime if they require high risk procedure and are taking a single or dual antiplatelet drug ?
Do not interrupt medication.
ANTIPLATELETS
How should you manage a patient’s drug regime if they require a high risk procedure and are taking an anticoagulant and antiplatelet drug ?
Consult prescribing clinician.
