Exam 3 old Flashcards
Which NOAC causes increased GI bleeding?
apixaban
Which NOAC has an antidote and what is it called?
dabigatran, antidote is idarucizumab
What are the investigational NOAC antidotes? (2)
andexanet alfa
ciraparantag
Which investigational NOAC is factor Xa specific and which one is universal?
Xa: andexanet alfa
universal: ciraparantag
Which NOACs do not use starter injectable anticoag?
rivaroxaban
apixaban
What are the inhibitors and inducers of NOAC DDI?
inHIBitors: dronaderone, ketoconazole, diltiazem
inDUCers: rifampin, St. John’s wort
Which NOAC is heavily reliant on renal CL?
dabigatran, but all are renally metabbed to some extent
Which NOAC is dialyzable?
dabigatran
Which NOAC needs to be taken with food?
rivaroxaban
Which NOACs require an injectable lead-in anticoag?
dabigatran
edoxaban
Which NOACs are indicated for orthopedic surgery?
rivaroxaban
apixaban
What is the dosing of apixaban in prevention of thrombus in atrial fibrillation?
5 mg po BID
IF two or more of the following are present 2 mg po BID
≥ 80 years weight
≤ 60 kg
CrCL≥1.5mg/dL
on strong dual inhibitors of 3A4 or p-gp
What is the dosing of dabigatran in prevention of thrombus in atrial fibrillation with and without p-gp inhibitors?
CrCL > 30 mL/min: 150 mg BID
CrCL 15-30 mL/min: 75mg BID
CrCL 30-50 mL/min with p-gp inhibitors dronaderone or ketoconazole: 75 mg BID
CrCL < 30 mL/min with p-gp inhibitors: avoid
What is the dosing of edoxaban in prevention of thrombus in atrial fibrillation?
CrCL 50-95 mL/min: 60 mg QD
CrCL 15-50 mL/min: 30 mg QD
CrCL > 95 mL/min: contraindicated
What is the dosing of rivaroxaban in prevention of thrombus in atrial fibrillation?
CrCL ≥ 50 mL/min 20 mg QD with evening meal
CrCL 15-50 mL/min 15 mg QD with evening meal CrCL
CrCL < 15 mL/min: not recommended
What is the dosing of apixaban in VTE prevention in hip or knee replacement?
2.5 mg BID
What is the dosing of apixaban in treatment of VTE?
10 mg BID x7D then 5 mg BID
after 6 months: 2.5 mg BID
What is the dosing of dabigatran in treatment of VTE with and without p-gp inhibitors?
CrCL > 30 mL/min: 150 mg BID after 5-10 days of parenteral anticoag
CrCL < 30 mL/min or dialysis: avoid
CrCL < 50 mL/min with p-gp inhibitors: avoid
What is the dosing of edoxaban in treatment of VTE with and without p-gp inhibitors?
60 mg QD after 5-10 days of parenteral anticoag
CrCL 15-50 mL/min, < 60 kg, and use of certain p-gp inhibitors: 30 mg QD
What is the dosing of rivaroxaban in VTE prevvention in hip or knee replacement?
CrCL ≥ 30 mL/min: 10 mg QD
CrCL < 30 mL/min: avoid
What is the dosing of rivaroxaban in the treatment of VTE?
CrCL ≥ 30 mL/min: 15 mg BID x21D then 20 mg QD
CrCL < 30 mL/min: avoid
Which NOAC cannot be crushed or taken out of the original bottle?
dabigatran
How should switching between LMWH and NOAC be done both way?
start and stop at next scheduled dose both ways
How should UFH and NOAC be switched both ways?
stop UFH, start NOAC immediately
stop NOAC, start UFH at next scheduled dose
