Pharma_teaching Anticoagulants Flashcards
What are the different types of anticoagulants?
- unfractionated heparin
- LMWH
- Vitamin K antagonists
- NOACs
Unfractionated Heparin
- MoA
- Use
- monitoring requirements
- antidote
What are important things to consider when we prescribe heparins?
Contraindications to heparin prescription
- haemophilia
- active haemorrhage
- active peptic ulcer
- thrombocytopaenia
- recent/planned spinal/epidural
- severe renal impairment (CrCl <15)
Treatment with vitamin K antagonists
- options
- warfarin
- phenidione
- acenocoumarol
MoA of vitamin K antagonists
Prevents synthesis of:
- clotting factors: 2, 7, 9, 10 (mnemonic: 1972)
- protein C&S
Can warfarin be used in the treatment of DVT?
Yes, but it takes 48-72 hours to work therefore we bridge it with LMWH for 5 days and then check INR (must be >2 for 2 consecutive days)
What’s the duration of treatment (with warfarin) for:
a) isolated DVT
b) provoked VTE
c) unprovoked VTE
a) an isolated DVT → 6 weeks
b) provoked VTE → 3 months
c) unprovoked VTE → >3 months
BNF ⇒ Treatment summaries ⇒ oral anticoagulants
- warfarin prescribed on ‘oral-anticoagulant’ prescription chart
- always given at 6 pm
- adjust by small amounts
This patient’s INR target is 2.5
Currently, he is above 2.5 (around 3.5 ish) so we need to prescribe lower next dose → so decrease next dose by 1 mg
In STABLE patient → adjust WEEKLY dose (rather than by 1 day as in acute setting)
What are the important counselling points to tell someone when we initiate warfarin?
Examples of DOACs
Indications for DOACs
Contraindications for DOACs
Humalog with meals and Levemir at night and in the morning
Actrapid (or Humulin S) → the only soluble insulins
1 mg IM glucagon
