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Delivery Pharmaceutical care to patients > VTE > Flashcards

VTE Flashcards

Venous thromboembolism and the dosage requirement for them

1
Q

What is the role of a pharmacist in regard to patients with VTE

A

To support the safe care of patients by checking for appropriate treatment or chemoprophylaxis

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2
Q

What is taken into consideration as a pharmacist when determining drug treatment.

A
  • Clinical scenario: i.e VTE event or prophylaxis
  • Contra-indications and cautions for any drugs
  • Choice of drug
  • Dose appropriate: Indication, Body weight, Renal function
  • Drug interactions
  • Intervene if necessary
  • Educate patient
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3
Q

What is a VTE

A

It is a disturbance of the body’s normal blood clotting mechanisms due to:

  • Vascular damage
  • increased coagulability
  • slow blood flow
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4
Q

What are the possible outcomes of VTE.

A
  • Morbidity
    • Acute
    • Long term complication
  • Mortality
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5
Q

What percent of people die within an hour of PE and how many within 30 days

A
  • 20%

- 45%

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6
Q

What are the long term complication that occur after a VTE event

A

Recurrent VTE
Post thrombotic syndrome
Chronic pulmonary hypertension

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7
Q

What are the risk factors

A 
Personal history of VTE
Smoking
Family history of VTE
Cancer
Acute illness
Male
Surgery 
Thrombophilia
Immobility 
Heart failure
Dehydration
Varicose veins
Increasing age
Pregnancy 
Obesity 
OCP/HRT
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8
Q

What are the clinical presentation of deep vein thromboembolism

A 
Red, swollen and painful calf 
Swelling and oedema
Pain and tenderness
Discolouration of the skin 
Skin warm to the touch
Superficial venous distention
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9
Q

What tests are the done to determine if a patient has had a DVT

A

-Ultrasound imaging of veins (compression and doppler)
>Diagnostic test
-D – dimer (product of fibrin degradation)
>Positive result; non-specific but raises suspicion
>Negative result indicates no VTE
>Can be used to priorities patients for ultrasound

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10
Q

What are the presentation of Pulmonary embolisms (PE)

A
  • SOB- shortness of breath
  • Chest pain
  • Cough and haemoptysis (coughing up blood)
  • Hypotension
  • Tachycardia
  • Low grade fever
  • Any chest symptoms in patient with -DVT symptoms
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11
Q

Investigation/Diagnosis for PE

A
  • Take full history an Physical diagnosis
  • CTPA: computed tomography pulmonary angiography: Diagnostic test
  • D-dimer which is no specific but raises suspicion
  • VQ scans (scintigraph) : less reliable than diagnostic test
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12
Q

Classes of VTE treatment

A
  • Anticoagulants
  • Oral anticoagulants
  • Thrombolysis
  • Embolectomy
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13
Q

Examples of anticoagulants

A

Low molecular weight heparin
Enoxaparin
dalteparin

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14
Q

What dose of enoxaparin is given as a treatment for VTE

A
  • 1mg/kg bd -1.5mg/kg OD for those with low risk of recurrence or PE
  • started straight away
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15
Q

How long is the treatment of VTE with enoxaparin for

A

A minimum of 5 days till oral anticoagulants are established

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16
Q

What is the adjusted dose of enoxaparin in the treatment of VTE in a patient with renal impairment?

A

1mg/kg OD for severe impairment (eGFR less than or equal to 30)

17
Q

what is used when LMWH is contraindicated.

A

unfractionated heparin

18
Q

what other factor is taken into consideration when prescribing an alternative to LWMH

A

If there is a high risk of bleeding

19
Q

Examples of Oral anticoagulants

A

Warfarin

DOACs/ NOACs: rivaroxaban, apixaban, edoxaban, dabigatran

20
Q

what is given to counteract excessive bleeding caused by anticoagulants

A

Protamine
Vitamin K
idarucizumab
Andexanet alfa

21
Q

What is the purpose of protamine in treating excessive bleeding.

A

Full reversal of UFH, some reports of partial LMWH reversal

22
Q

What is the purpose of Vitamin K in treating excessive bleeding.

A

Reversal agent of Warfarin

23
Q

What is the purpose of idarucizumab in treating excessive bleeding.

A

Reversal agent of dabigatran

24
Q

What is the purpose of andexanet alfa in treating excessive bleeding.

A

Apixaban or rivaroxaban (direct factor 10a) inhibitors- recently licensed

25
Q

When is VTE prophylaxis given

A

when an risk assessment is taken and shows risk of VTE or bleeding risk.

26
Q

What is the standard dose of enoxaparin for chemoprophylaxis

A

40mg OD

27
Q

When does the dose of enoxaparin need to be adjusted for chemoprophylaxis and what are the doses.

A

when a patient weighs less than 50kg the dose needs to be to 20mg OD.
ClCr is 15-50ml/min = 20mg OD
100-150kg= 40mg BD
150kg+ = 60mg BD

Delivery Pharmaceutical care to patients (6 decks)

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