Module 2 exam 1 recorded lecture Flashcards
NOAC/DOAC drugs
DTI- dabigatran
FXa- all the -bans
Rivaroxaban
Apixaban
Edoxaban
Betrixaban
What are all of the possible uses of NOAC/DOAC drugs (6)
Post-op prophylaxis
non-vascular A fib
DVT tx
PE tx
indefinite anticoagulation (secondary prevention of DVT and PE)
VTE prophylaxis
Which of the 6 uses can rivaroxaban be used for?
all of them
Which one of the 6 uses can apixaban be used for
All 5 except for VTE prophylaxis
which one of the 6 uses can dabigatran be used for
everything except
VTE prophylaxis
secondary prevention of recurrent DVT/PE
POST OP only for HIP not knee
Which one of the 6 uses can betrixaban be used for
ONLY for VTE prophylaxis
Which one of the 6 uses can edoxaban be used for?
DVT/PE tx and non valvular a fib
VTE prophylaxis can be treated by which NOAC/DOACs
RIvaroxaban and betrixaban
secondary prevention of recurrent DVT/PE can be treated by which NOAC/DOAC
Apixaban and rivaroxaban
DVT/PE can be treated by
evenrything except betrixaban
Non valvular A fib can be treated by
everything except betrixaban
Post op prophylaxis meds
Rivaroxaban
Apixaban
Dabigatran (HIP only)
What does the body use Vit K for?
to create clotting factors II, VII, IX, X and proteins C and S
How does warfarin work?
stops the reduction of Vit K and stopping the production of Vit K dependent CF
Which enantiomer of warfarin is more active and has more drug-drug i/a
S enantiomer
Drug drug interactions of warfarin come from
CYP2C9
CYP1A2
CYP3A4
peak effect of warfarin
3-5 days
does warfarin inhibit activity of already present CF?
no, only inhibits productions of new ones.
Which drugs increase INR
Metronidazole
Ciprofloxacin
Bactrim
Amiodarone
Drugs the decrease INR
rifampin
which drugs are contraindicated with warfarin due to bleeidng risk
Aspirin
NSAIDs
What are the different ways alcohol affects INR
Acute alcohol consumption can increase INR
chronic alcohol consumption without liver damage can decrease INR
Chronic alcohol consumption with liver damage can increase INR
CHADSVASC scale of 1 recommendation
Aspirin
what can be used with warfarin in people with prosthetic heart valves
dipyridamole
how do we reverse effects of UFH, LMWH for bleeding management
protamine sulfate
How do we reverse effects of Dabigatran for bleeding management
Idarucizumab
How do we reverse effects of rivaroxaban and apixaban for bleeding management
andexanet
How should we use protamine sulfate in UFH
1mg of protamine per 100 units of UFH infuse dover past 3 hours
How should we use protamine sulfate in LMWH
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
idarucizumab MOA
Binds dabigatran stronger than thrombin
It is also given IV
What should we monitor when giving idarucizumab
aPTT
Bleeding management while on warfarin
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
Why is PCC preferred over FFP
Because it is so fast
VTE prophylaxis options
UFH
LMWH
Factor X1 inhibitor
Vit K antagonist
Rank VTE risks from low to high
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
What types of meds are recommended in moderate risk pts
UFH, factor Xa, LMWH
continue prophylaxis upto 28 days after discharge
What meds are recommended for high risk patients
LMWH, fondaparinux, rivaroxaban, apixaban, dabigatran (HIP), UFH or vit K antagonist
continue 10-14 days post op
1st thing to ask ourself when treating a VTE
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
2nd question to ask yourself when treating a patient with VTE
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.
3rd question to as when treating patient with VTE
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
How are rivaroxaban and apixaban taken
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)
How is UFH, LMWH or fondaparinux with dabigatran and edoxaban taken
UFH, LMWH or fondaparinux X 5 days all SQ,
then dabigatran/edoxaban daily
How is UFH, LMWH or fondaparinux taken with warfarin
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
What does CHADS- VASc measure?
What does HAS-BLED measure
CHADS-VASc measures risk for stroke or systemic VTE
HAS-BLED- risk for bleeding
What does CHADSVASc stand for with the points
Congestive HF-1
Hypertension- 1
Age 75 and above- 2
diabetes- 1
Stroke/TIA- 2
Vascular disease- 1
Age 65-75- 1
female1
What does vascular disease mean in CHADS-VASc
Prior MI, peripheral arterial disease (PAR), aortic plaque
What does HAS-BLED stand for with the points
-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
Bleeding risk meaning
predisposition- anemia
or there is a hx of bleeding
Labile INR meaning
If patient is on warfarin and time in therapeutic range <60%
What are abnormal renal functions
chronic dialysis
Renal transplant
SCl>2.26
abnormal liver tests
Cirhosis, hepatic impairments
What CHADS-VASc score do we consider anticoag
2 or higher
What HAS-BLED score is a high risk of bleeding
3 or above
