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Therapeutics P2 > Module 2 exam 1 recorded lecture > Flashcards

Module 2 exam 1 recorded lecture Flashcards

1
Q

NOAC/DOAC drugs

A

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

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2
Q

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

A

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

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3
Q

Which of the 6 uses can rivaroxaban be used for?

A

all of them

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4
Q

Which one of the 6 uses can apixaban be used for

A

All 5 except for VTE prophylaxis

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5
Q

which one of the 6 uses can dabigatran be used for

A

everything except
VTE prophylaxis
secondary prevention of recurrent DVT/PE

POST OP only for HIP not knee

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6
Q

Which one of the 6 uses can betrixaban be used for

A

ONLY for VTE prophylaxis

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7
Q

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

A

DVT/PE tx and non valvular a fib

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8
Q

VTE prophylaxis can be treated by which NOAC/DOACs

A

RIvaroxaban and betrixaban

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9
Q

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

A

Apixaban and rivaroxaban

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10
Q

DVT/PE can be treated by

A

evenrything except betrixaban

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11
Q

Non valvular A fib can be treated by

A

everything except betrixaban

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12
Q

Post op prophylaxis meds

A

Rivaroxaban
Apixaban
Dabigatran (HIP only)

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13
Q

What does the body use Vit K for?

A

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

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14
Q

How does warfarin work?

A

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

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15
Q

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

A

S enantiomer

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16
Q

Drug drug interactions of warfarin come from

A

CYP2C9
CYP1A2
CYP3A4

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17
Q

peak effect of warfarin

A

3-5 days

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18
Q

does warfarin inhibit activity of already present CF?

A

no, only inhibits productions of new ones.

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19
Q

Which drugs increase INR

A

Metronidazole
Ciprofloxacin
Bactrim
Amiodarone

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20
Q

Drugs the decrease INR

A

rifampin

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21
Q

which drugs are contraindicated with warfarin due to bleeidng risk

A

Aspirin
NSAIDs

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22
Q

What are the different ways alcohol affects INR

A

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

23
Q

CHADSVASC scale of 1 recommendation

A

Aspirin

24
Q

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

A

dipyridamole

25
Q

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

A

protamine sulfate

26
Q

How do we reverse effects of Dabigatran for bleeding management

A

Idarucizumab

27
Q

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

A

andexanet

28
Q

How should we use protamine sulfate in UFH

A

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

29
Q

How should we use protamine sulfate in LMWH

A

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

30
Q

idarucizumab MOA

A

Binds dabigatran stronger than thrombin

It is also given IV

31
Q

What should we monitor when giving idarucizumab

A

aPTT

32
Q

Bleeding management while on warfarin

A

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

33
Q

Why is PCC preferred over FFP

A

Because it is so fast

34
Q

VTE prophylaxis options

A

UFH
LMWH
Factor X1 inhibitor
Vit K antagonist

35
Q

Rank VTE risks from low to high

A

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

36
Q

What types of meds are recommended in moderate risk pts

A

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

37
Q

What meds are recommended for high risk patients

A

LMWH, fondaparinux, rivaroxaban, apixaban, dabigatran (HIP), UFH or vit K antagonist

continue 10-14 days post op

38
Q

1st thing to ask ourself when treating a VTE

A

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

39
Q

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

A

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.

40
Q

3rd question to as when treating patient with VTE

A

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

41
Q

How are rivaroxaban and apixaban taken

A

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)

42
Q

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

A

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

43
Q

How is UFH, LMWH or fondaparinux taken with warfarin

A

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

44
Q

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

A

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

45
Q

What does CHADSVASc stand for with the points

A

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

46
Q

What does vascular disease mean in CHADS-VASc

A

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

47
Q

What does HAS-BLED stand for with the points

A

-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

48
Q

Bleeding risk meaning

A

predisposition- anemia
or there is a hx of bleeding

49
Q

Labile INR meaning

A

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

50
Q

What are abnormal renal functions

A

chronic dialysis
Renal transplant
SCl>2.26

51
Q

abnormal liver tests

A

Cirhosis, hepatic impairments

52
Q

What CHADS-VASc score do we consider anticoag

A

2 or higher

53
Q

What HAS-BLED score is a high risk of bleeding

A

3 or above

Therapeutics P2 (41 decks)

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