Thrombophilia and Acquired Anticoagulation Flashcards

Question

advantage of oral anticoagulation and anti-platelet medication

Answer 1

swallow (not injection)

Answer 2

disadvantage: injection advantage: very responsive low molecular weight and normal types

Answer 3

Atrial fibrillation Deep venous thrombosis Heart valve disease Mechanical heart valves Thrombophilia

Answer 4

Onset and duration of Tx is deciding factor on method Whilst stay in hospital post operation - heparin for short term as not in community care so pills less efficient Pills at home - less likely to clot in atria - less likely stroke in brain - managed in community

Answer 5

coumarins (warfarin) direct factor Xa inhibitors - rivaroxaban - apixaban (common in Ggow) direct thrombin inhibitors

Answer 6

Most used drug in the world for anticoagulation (coumarin) Cheap Process to put on and Monitoring is complicated

Answer 7

Rivaroxaban Apixaban Dabigatran Increasing use as ‘safer’ and ‘cheaper’ alternative No routine monitoring - Always 50% bioavailability - Easy to work out dose - Constant - -- Warfarin bioavailability is unpredictable not in hospital on heparin first – physicians, nurse - Used in short term treatment time established would need to stop if used warfarin

Answer 8

amount of drug doing work

Answer 9

Increasing use as ‘safer’ and ‘cheaper’ alternative No routine monitoring - Always 50% bioavailability - Easy to work out dose - Constant - -- Warfarin bioavailability is unpredictable not in hospital on heparin first – physicians, nurse - Used in short term treatment time established would need to stop if used warfarin

Answer 10

INR - checked every 4-8 weeks - all pt should carry an anticoagulant booklet daily dose between 1 and 15mg varies

Answer 11

Safest all drugs would interfere with warfarin Test warfarin the day after starting new medication (24-48hrs) - Less effect - increase dose - More effect - lower dose Always seek advice from GP if you are prescribing - They need to do testing – rare to do at home Antibiotic - get GP involved as need treatment next today

Answer 12

Aspirin (as an analgesic) Most antibiotics - Amoxycillin least likely to cause problems Azole antifungal drugs - Fluconazole - Itraconazole

Answer 13

internationalised normalised ratio Prothrombin time ratio corrected for the warfarin sensitivity of the thromboplastin reagent - Ratio between pt and control pt If normal pt – should be 1 Bigger ratio – PT time of pt will increase?? INR = Patient PT/ Mean Normal PT (international sensitivity index)

Answer 14

Patient PT/ Mean Normal PT (international sensitivity index) should be 1

Answer 15

3.0-4.0 vary from person to person – depending on what you need to do

Answer 16

3.0-4.0 vary from person to person – depending on what you need to do

Answer 17

2.0-3.0 vary from person to person – depending on what you need to do

Answer 18

Haemorrhage (higher risk than if not on, greater trauma risk) 1% per annum risk of serious bleed (needing hospitalisation/transfusion) - 25% of these are fatal Issue in elderly – need to have operation, stroke

Answer 19

Fatal thromboembolic events Non-fatal thromboembolic events Rebound hypercoagulable state - Restarting warfarin makes coagulation more likely

Answer 20

Use warfarin stop function of vitamin K - Restore Clotting Factors to normal - ----give pt vit K to overcome fact warfarin stop making vit K Reverse effect of warfarin quickly - No excess bleeding with trauma

Answer 21

Extractions Minor oral surgery Periodontal surgery biopsies

Answer 22

Prosthodontics Conservation Endodontics Hygiene phase therapy (less risk of blood)

Answer 23

use LA containing a vasoconstrictor - reduce blood flow to tissue, decrease bleeding issue Where possible use an infiltration, intrafilamentary or mental nerve injection If there is no alternative an inferior alveolar nerve block is used the injection should be administered slowing using an aspirating technique - Very dangerous for haemophilia if give ID nerve block – don’t give

Answer 24

in morning and early in the week | - still available in surgery in coming days if an issue

Answer 25

INR must be checked in the 48 hours prior to treatment but should be as near as possible to time of treatment

Answer 26

``` 3 teeth (roots) i.e. 3 incisors or 1 lower 6 ```

Answer 27

LA infiltration oxidised cellulose sutures pressure good post operative instructions (must inc emergency contact details)

Answer 28

unfractionated low molecular weight (less common that oral anticoagulants)

Answer 29

Given by IV infusion in hospital – check APPT - Drip stand with pump on it in hospital, not out in community Very short half-life so very controllable

Answer 30

Given by subcutaneous injection by the pt at home Once daily injection Doesn’t bleed excessively – no issues Dose weight related – no monitoring

Answer 31

Low dose aspirin (95mg daily) Clopidogrel Dipyridamole

Answer 32

Delayed haemostasis but adequate haemostasis

Answer 33

usually aspirin and clopidogrel If stent pt, discuss with cardiologist Otherwise – stop one of the drugs 7 days prior to surgery (discuss with doctor) Do not stop unless discuss with doctor first

Answer 34

7 days takes 7 days for anti-platelet medication to leave system