Module 2 exam 1 recorded lecture

Question 1

NOAC/DOAC drugs

Answer 1

DTI- dabigatran
FXa- all the -bans
Rivaroxaban
Apixaban
Edoxaban
Betrixaban

Question 2

What are all of the possible uses of NOAC/DOAC drugs (6)

Answer 2

Post-op prophylaxis
non-vascular A fib
DVT tx
PE tx
indefinite anticoagulation (secondary prevention of DVT and PE)
VTE prophylaxis

Question 3

Which of the 6 uses can rivaroxaban be used for?

Answer 3

all of them

Question 4

Which one of the 6 uses can apixaban be used for

Answer 4

All 5 except for VTE prophylaxis

Question 5

which one of the 6 uses can dabigatran be used for

Answer 5

everything except
VTE prophylaxis
secondary prevention of recurrent DVT/PE

POST OP only for HIP not knee

Question 6

Which one of the 6 uses can betrixaban be used for

Answer 6

ONLY for VTE prophylaxis

Question 7

Which one of the 6 uses can edoxaban be used for?

Answer 7

DVT/PE tx and non valvular a fib

Question 8

VTE prophylaxis can be treated by which NOAC/DOACs

Answer 8

RIvaroxaban and betrixaban

Question 9

secondary prevention of recurrent DVT/PE can be treated by which NOAC/DOAC

Answer 9

Apixaban and rivaroxaban

Question 10

DVT/PE can be treated by

Answer 10

evenrything except betrixaban

Question 11

Non valvular A fib can be treated by

Answer 11

everything except betrixaban

Question 12

Post op prophylaxis meds

Answer 12

Rivaroxaban
Apixaban
Dabigatran (HIP only)

Question 13

What does the body use Vit K for?

Answer 13

to create clotting factors II, VII, IX, X and proteins C and S

Question 14

How does warfarin work?

Answer 14

stops the reduction of Vit K and stopping the production of Vit K dependent CF

Question 15

Which enantiomer of warfarin is more active and has more drug-drug i/a

Answer 15

S enantiomer

Question 16

Drug drug interactions of warfarin come from

Answer 16

CYP2C9
CYP1A2
CYP3A4

Question 17

peak effect of warfarin

Answer 17

3-5 days

Question 18

does warfarin inhibit activity of already present CF?

Answer 18

no, only inhibits productions of new ones.

Question 19

Which drugs increase INR

Answer 19

Metronidazole
Ciprofloxacin
Bactrim
Amiodarone

Question 20

Drugs the decrease INR

Answer 20

rifampin

Question 21

which drugs are contraindicated with warfarin due to bleeidng risk

Answer 21

Aspirin
NSAIDs

Question 22

What are the different ways alcohol affects INR

Answer 22

Acute alcohol consumption can increase INR
chronic alcohol consumption without liver damage can decrease INR
Chronic alcohol consumption with liver damage can increase INR

Question 23

CHADSVASC scale of 1 recommendation

Answer 23

Aspirin

Question 24

what can be used with warfarin in people with prosthetic heart valves

Answer 24

dipyridamole

Question 25

how do we reverse effects of UFH, LMWH for bleeding management

Answer 25

protamine sulfate

Question 26

How do we reverse effects of Dabigatran for bleeding management

Answer 26

Idarucizumab

Question 27

How do we reverse effects of rivaroxaban and apixaban for bleeding management

Answer 27

andexanet

Question 28

How should we use protamine sulfate in UFH

Answer 28

1mg of protamine per 100 units of UFH infuse dover past 3 hours

Question 29

How should we use protamine sulfate in LMWH

Answer 29

within last 8 hours of LMWH 1 mg per 100 antifactor Xa units 1 mg per 1 mg enoxaparin >8hours 0.5 mg per 100 antifactor Xa Units 0.5 mg per 1 mg enoxaparin

Question 30

idarucizumab MOA

Answer 30

Binds dabigatran stronger than thrombin It is also given IV

Question 31

What should we monitor when giving idarucizumab

Answer 31

aPTT

Question 32

Bleeding management while on warfarin

Answer 32

INR between 4.5 and 10 + no evidence of bleeding- avoid vit K INR >10 +no Evidence of bleeding- PO vit K MAJOR bleeding- PCC preferred over FFP

Question 33

Why is PCC preferred over FFP

Answer 33

Because it is so fast

Question 34

VTE prophylaxis options

Answer 34

UFH LMWH Factor X1 inhibitor Vit K antagonist

Question 35

Rank VTE risks from low to high

Answer 35

Low- minor surgery fully ambulatory no specific pcol therapy moderate- Non-orthopedic surgery Acutely ill medical patients (COPD, stroke, general surgery patients) High risk- Orthopedic surgery (knee, hip) Major trauma/spinal cord

Question 36

What types of meds are recommended in moderate risk pts

Answer 36

UFH, factor Xa, LMWH continue prophylaxis upto 28 days after discharge

Question 37

What meds are recommended for high risk patients

Answer 37

LMWH, fondaparinux, rivaroxaban, apixaban, dabigatran (HIP), UFH or vit K antagonist continue 10-14 days post op

Question 38

1st thing to ask ourself when treating a VTE

Answer 38

Does patient have a PE with severe pulmonary compromise or DVT with high risk of limb loss If yes to either, use thrombolytic therapy followed by anticoagulant If no continue to 2nd question

Question 39

2nd question to ask yourself when treating a patient with VTE

Answer 39

Does patient have active bleeding OR contraindication to anticoagulant if yes ask if VTE is in lower extremity of patient. If yes use IVC filter (catches blood clot travelling from leg to lung) If not in lower extremity, ask 3rd question.

Question 40

3rd question to as when treating patient with VTE

Answer 40

Does patient have PE with poor prognosis or DCT unstable for outpatient tx? if CRCL<30- UFH x 5 days overlap with warfarin and INR>2 If CRCL>30, rivaroxaban apixaban LMWH x fondaparinux X 5 days THEN dabigatran or edoxaban LMWH X fondaparinux X 5 days AND warfarin and INR>2

Question 41

How are rivaroxaban and apixaban taken

Answer 41

both oral (rivaroxaban 15 mg BID for 1st 21 days; then 20 mg QD apixaban 10 mg BID for 1st 7 days, then 5 mg BID)

Question 42

How is UFH, LMWH or fondaparinux with dabigatran and edoxaban taken

Answer 42

UFH, LMWH or fondaparinux X 5 days all SQ, then dabigatran/edoxaban daily

Question 43

How is UFH, LMWH or fondaparinux taken with warfarin

Answer 43

UFH, LMWH, fondaparinux x 5 days overlap with warfarin for atleast 5 days AND INR>2, then dose adjusted to target INR target 2-3

Question 44

What does CHADS- VASc measure? What does HAS-BLED measure

Answer 44

CHADS-VASc measures risk for stroke or systemic VTE HAS-BLED- risk for bleeding

Question 45

What does CHADSVASc stand for with the points

Answer 45

Congestive HF-1 Hypertension- 1 Age 75 and above- 2 diabetes- 1 Stroke/TIA- 2 Vascular disease- 1 Age 65-75- 1 female1

Question 46

What does vascular disease mean in CHADS-VASc

Answer 46

Prior MI, peripheral arterial disease (PAR), aortic plaque

Question 47

What does HAS-BLED stand for with the points

Answer 47

-Hypertension(SB>160)-1 -abnormal renal or liver function- 1 or 2 -stroke- 1 -Bleeding tendency/predisposition- 1 -Labile INR (if on warfarin and time in therapeutic range <60%)- 1 -Age>65- 1 drug/alc- 1 or 2

Question 48

Bleeding risk meaning

Answer 48

predisposition- anemia or there is a hx of bleeding

Question 49

Labile INR meaning

Answer 49

If patient is on warfarin and time in therapeutic range <60%

Question 50

What are abnormal renal functions

Answer 50

chronic dialysis Renal transplant SCl>2.26

Question 51

abnormal liver tests

Answer 51

Cirhosis, hepatic impairments

Question 52

What CHADS-VASc score do we consider anticoag

Answer 52

2 or higher

Question 53

What HAS-BLED score is a high risk of bleeding

Answer 53

3 or above