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CPD (Pre-Reg) > NOACs > Flashcards

NOACs Flashcards

1
Q

What NOAC is NOT licensed for the prevention of VTE after elective hip or knee replacement?

A

Edoxaban

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2
Q

What NOACs are licensed for the treatment and secondary prevention of DVT and/or PE?

A

All of them are: apixaban, dabigatran, edoxaban and rivaroxaban.

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3
Q

What NOAC is licensed for the prevention of adverse outcomes after acute management of ACS with raised biomarkers?

A

Rivaroxaban, in certain specified circumstances.

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4
Q

What NOACs are licensed for the prevention of stroke and systemic embolism in people with non-valvular AF?

A

All of them, in specified circumstances.

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5
Q

What is the mechanism of action of Apixaban?

A

Direct factor Xa inhibitor.

Factor Xa catalyses the conversion of prothrombin to thrombin, the final enzyme in the coagulation cascade that is responsible for fibrin clot formation.

Apixaban has no direct effect on platelet aggregation, but by inhibiting factor Xa, it indirectly decreases clot formation induced by thrombin.

See also: Edoxaban and Rivaroxaban.

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6
Q

Rivaroxaban and edoxaban are similar how?

A

Both have the same mech of action as Apixaban.

Direct factor Xa inhibitor.

Factor Xa catalyses the conversion of prothrombin to thrombin, the final enzyme in the coagulation cascade that is responsible for fibrin clot formation.

Apixaban has no direct effect on platelet aggregation, but by inhibiting factor Xa, it indirectly decreases clot formation induced by thrombin.

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7
Q

Idaruciziumab reverses the effect of which NOAC within ‘minutes’ (according to the manufacturer)?

A

Dabigatran: direct thrombin inhibitor.

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8
Q

What is the mechanism of action of Dabigatran?

A

Direct thrombin inhibitor, thrombin is the final enzyme in the coagulation cascade. It inhibits both free and fibrin-bound thrombin.

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9
Q

What is the main side effect of the NOACs?

A

Bleeding as with warfarin, patients should be told to watch out for signs of internal or external bleeding: bruising, epistaxis, haematuria, haemoptysis, melaena and abnormal genitourinary bleeding

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10
Q

Rivaroxaban and apixaban should not be taken with strong inhibitors or inducers of what isoenzyme?

A

CYP3A4 (or the efflux protein P-gp)

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11
Q

What are some common medicines with antiplatelet action that be avoided by patients taking NOACs (or used with caution)? [6]

A 
Aspirin
Clopidogrel
Dipyridamole
NSAIDs
Prasugrel
Ticagrelor
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12
Q

What medicines increase serotonin levels and should be avoided in those taking NOACs? Why?

A

SSRIs, SNRIs.

Serotonin reduces platelet aggregation.

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13
Q

What are some herbal medicines and supplements that have an antiplatelet or anticoagulant effect?

A 
Chondroitin 
Feverfew
Garlic
Ginger
Ginkgo biloba 
Ginseng
Glucosamine
Omega-3 fatty acids 
Saw palmetto
Willow bark
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14
Q

When should rivaroxaban be taken?

A

Once or twice daily with food

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15
Q

What should a patient taking once-daily rivaroxaban do if they miss a dose?

A

If it is within 12 months, the patient can take it straight away and take the next dose as normal

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16
Q

If a patient misses twice-daily apixaban or dabigatran what should they do?

A

Take it straight away if within 6 hours, after 6 hours patients should omit the dose and take their next dose as schedueled.

17
Q

Which NOAC is least renally excreted?

A

Apixaban 25%.
Rivaroxaban 33%.
Edoxaban 35%
Dabigatran 80%

18
Q

Octaplex is sufficient reversal agent for what?

A

Apixaban + edoxaban + rivaroxaban.

Dabigatran = idarucizumab

19
Q

Which NOAC is most renally excreted?

A

Apixaban 25%.
Rivaroxaban 33%.
Edoxaban 35%
Dabigatran 80%

20
Q

What is the dose of dabigatran in non-valvular AF?

A

150mg BD

21
Q

What is the dose of apixaban in non-valvular AF?

A

5mg BD

22
Q

What is the dose of rivaroxaban in non-valvular AF?

A

20mg OD

23
Q

What is the dose of edoxaban in non-valvular AF?

A

60mg OD

24
Q

Which NOAC is licensed for prophylaxis of atherothrombotic events following acute coronary syndrome in combination with dual (or singular) antiplatelet therapy?

A

Rivaroxaban:
Prophylaxis of atherothrombotic events following an acute coronary syndrome with elevated cardiac biomarkers (in combination with aspirin alone or aspirin and clopidogrel):
2.5mg bd, usually 12 months.

25
Q

Dabigatran is contraindicated if the creatinine clearance is below what?

A

<30ml/min, others are <15ml/min

26
Q

Apixaban, Rivaroxaban and edoxaban are contrainidicated if the creatinine clearance is below what?

A

<15ml/min, dabigatran = 30ml/min

27
Q

NOACs are known to be affected by certain enzyme inducers and inhibitors and there are therefore certain drug interactions that can affect the dose or whether the drug ought to be used. This includes what drugs which are frequently used in patients with AF? (3)

A
  1. Verapamil
  2. Amiodarone
  3. Dronedarone (increased exposureto NOAC)
28
Q

What baseline monitoring should accompany NOAC prescribing? (4)

A

FBC
U+E
LFT
Clotting screen

Checked annually

29
Q

What is CHA2DS2-VASc score?

A

Congestive heart failure = 1 point
Hypertension = 1 point
Age >75 years = 2 points

Diabetes = 1 point 
Stroke = 2 points
Vascular disease (peripheral or coronary) = 1 
Age >65 years = 1
Sex (female) = 1

Patients do not score a point for female sex alone (in absence of other points). A score of zero means low risk and no anticoagulation is required.

CPD (Pre-Reg) (21 decks)

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