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Haem > Therapeutics > Flashcards

Therapeutics Flashcards

1
Q

Exclusion criteria for use of thrombolytics in acute ischemic stroke

A
  1. Onset > 4.5 hours
  2. CT scan shows intracranial hemorrhage
  3. Suspicion of subarachnoid hemorrhage
  4. Seizure at the onset of stroke
  5. Minor symptoms or rapidly improving
  6. Stroke or serious head trauma in the last 3 months
  7. History of ICH, SAH, AV malformation or tumors
  8. Any internal bleed in last 21 days
  9. Major surgery or trauma in last 7 days
  10. Lumbar puncture in last 7 days
  11. Arterial puncture at non-compressible site in last 7 days
  12. SBP > 185 / DBP > 110
  13. Coagulopathy
  14. Current use of anticoagulants
  15. Glucose < 2.7 mmol/L
  16. Subacute bacterial endocarditis
  17. Pregnancy
  18. Symptoms of post myocardial pericarditis or known ventricular aneurysm
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2
Q

Lab parameters for monitoring of UFH

A

VTE treatment: aPTT
PCI: ACT

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3
Q

Lab parameters for monitoring of enoxaprin

A

Usual: nil
Renal impairment: anti-Xa

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4
Q

DOACs affected by 3A4

A

Apixaban, rivaroxaban

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5
Q

DOACs affected by BCRP

A

Apixaban, rivaroxaban

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6
Q

DOACs recommended for low body weight

A

Apixaban, edoxaban at reduced doses

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7
Q

DOACs recommended for high body weight

A

Apixaban, rivaroxaban

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8
Q

DOAC to be used with caution in at least 80 y.o.

A

Dabigatran

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9
Q

Antiseizure medicines contraindicated with DOACs

A
  • Dabigatran: carbamazepine, phenytoin, valproic acid
  • Rivaroxaban: carbamazepine, phenobarbital, phenytoin, valproic acid
  • Apixaban, edoxaban: valproic acid
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10
Q

Moderate CYP2C9 inhibitors

A

Amiodarone
Fluconazole
Voriconazole
Metronidazole
Bactrim
Ritonavir
Phenylbutazone

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11
Q

CYP2C9 inducers

A

Carbamazepine
Phenobarbital
Rifampicin
St John’s wort

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12
Q

Antimicrobials requiring preemptive warfarin adjustment

A
  • Bactrim (reduce 25-50%)
  • Ciprofloxacin (reduce 20-30%)
  • Azoles: fluconazole, voriconazole
  • Rifampicin (reduce 20-30%)
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13
Q

Counselling for warfarin

A
  • Non-interchangeability
  • MOA
  • Indication
  • Importance of compliance
  • Target ranges and blood tests
  • DDI
  • Who to inform about warfarin use
  • Diet
  • Alcohol
  • Acute illness
  • Precautions (injuries etc.)
  • Adverse events (GI discomfort, bleeding)
  • Emergency ID
  • Pregnancy, lactation
  • Storage
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14
Q

Contraindications for dabigatran

A
  • Concomitant azoles (keto, itra)
  • Severe liver impairment
  • ESRD
  • Prosthetic heart valves
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15
Q

Contraindications for warfarin

A
  • Potentially fluconazole
  • Severe liver impairment
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16
Q

Contraindications to apixaban, rivaroxaban

A
  • Concomitant azoles (except fluco)
  • Severe liver impairment
  • ESRD (except apix)
  • Prosthetic heart valves
17
Q

Follow-up checklist for anticoagulant monitoring

A
  • Adherence
  • Check for thromboembolism
  • Check for bleeding
  • Risk factors for bleeding
  • ADR
  • Concomitant meds
  • Optimal DOAC choice & dose
  • Blood samples
18
Q

Criteria for determining high bleed risk for DAPT

A

Major:
- Anticipated chronic use of anticoagulant
- CrCL <30
- Hb < 11 g/dL
- Spontaneous bleed requiring hosp or transfusion in last 6 months
- Moderate-severe thrombocytopenia (<100 x 10^9/L)
- Chronic bleeding diathesis
- Liver cirrhosis with portal hypertension
- Active malignancy in last 12 months
- Spontaneous ICH (anytime), traumatic ICH (last 12 months)
- Ischemic stroke (last 6 months)
- Requiring urgent surgery
- Major surgery/trauma in last 30 days

Minor:
- Age 75 and above
- CrCl 30-59
- Hb 11-12.9 (men), 11-11.9 (women)
- Spontaneous bleed within last 12 months
- Long-term use of NSAID or steroids
- Ischemic stroke occurring at any time (more than 6 months ago)

19
Q

Diagnosis of aplastic anemia

A

Any two of the following:
- WBC < 3.5 x 10^9
- Platelets < 55 x 10^9
- Hb < 10 and reticulocyte < 30 x 10^9

20
Q

Diagnosis of neutropenia

A

Neutrophil count < 1500/mcL

21
Q

Diagnosis of thrombocytopenia

A

Platelet count < 100 x 10^9 or
Drop of >50% from baseline

Haem (5 decks)

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