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Year 4 Prescribing > Warfarin And Noacs > Flashcards

Warfarin And Noacs Flashcards

1
Q

what is measured to assess effectiveness of Warfarin

A

prothrombin time reported as INR

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2
Q

what is the initial dose of warfarin

A

5-10mg

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3
Q

what is the usual maintenance dose of warfarin

A

3-9mg daily depedning on INR

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4
Q

name three conraindications to warfarin

A

within 48hours post partum
haemorrhagic stroke
significant bleeding

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5
Q

can warfarin be used in pregnancy

A

no stop 6 weeks before conception

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6
Q

can warfarin be used while breast feeding

A

yes but increased risk of haemorrhage in baby

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7
Q

patients on long term arfarin get their INR checekd how often

A

every 12 weeks

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8
Q

what are general factors which may potentiate warfarin

A 
liver disease
p450 enzyme inhibitors 
cranberry juice
drugs which displace warfarin from plasma albumin such as nsaids
drugs that inhibit platelet fn: NSAIDS
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9
Q

inducers of the p450 system do what to the INR

A

decrease it

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10
Q

inhibitors of the p450 system do what to the INR

A

increase it

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11
Q

name p450 system inducers

A 
antiepileptics - phenytoin, carbemazepine
barbituates 
st johns wart 
chronic alcohol intake 
griseofulvin 
smoking
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12
Q

name inhibitors of the p450 system

A 
ciprofloxacin
omeprazole 
allopurinol 
ketoconazole
SSRIs 
sodium valproate 
acute alcohol intake
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13
Q

when is unfractionated heparin used for VTE prophylaxis

A

in renal failure

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14
Q

when are patient deemed at high risk of developing a VTE

A

medical pts with significant reduction in mobility for three days or more
surgical/ trauma pts - particularly ortho pts
anaesthetic over 90 minutes

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15
Q

what are general risk factors for VTE

A 
active cancer or chemo
age 60>
thrombophilia 
bmi>35
dehydration
HRT / pill
varicose veins 
pregnant or <6wks post partum
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16
Q

what are the three main meds used for vte prophylaxis

A

fondoparinux (sc injection)
LMWH - enoxaparin
unfractionated heparin

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17
Q

what are the three ops which require vte prophylaxis no matter what

A

elective hip
elective knee
fragility fractures of pelvis, hip and proximal femur

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18
Q

what are the three options for vte prophylaxis in elective hip

A

lmwh 10 days following by 75-150mg for further 28 days

lmwh 28 days with stockings

rivaroxaban

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19
Q

what are the three options for vte prophylaxis in elective knee replacemenet

A

aspirin 75-150mg 14 days

lmwh 14 days and stockings

rivaroxaban

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20
Q

what is given for vte prophylaxis in fragility fractures of pelvis hip or proximal femur

A

lmwh

fondoparinux sodium

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21
Q

what are the types of LMWH

A

dalteparin
enoxaparin
tinzaparin

22
Q

what is fragmin

A

lmwh - dalteparin

23
Q

what are contraindications to heparin

A 
endocarditis 
major trauma
epidural 
haemophilia 
peptic ulcer 
cerebral haemorrhage 
recent surgery to eye or NS
thrombocytopenia
24
Q

he cautious when prescribing heparin in

A

elderly

severe hypertension

25
Q

how do you monitor heparin

A

platelet count should be measured just before treatment

if given for longer than 4 days platelet count should be regularly monitored

26
Q

what is a common electrolyte abn caused by heparin

A

hyperkalaemia

27
Q

if someone is on heparin and are requiring monitoring due to their increased risk of bleeding what is tested

A

anti factor Xa activity

28
Q

what else other than heparins and warfarin and noacs can be used in vte

A

fondoparinux - synthetic but inhibits factor 5

29
Q

whatn are the tow contraindications to fondoparinux

A

active bleeding

bacterial endocarditis

30
Q

what is a common side effect of fondoparinux not including haemorrhage

A

anaemia

31
Q

which anti vte drugs are commonly given orally

A

NOACS

32
Q

what type of drug is rivaroxaban

A

direct inhibitor of factor xa

33
Q

give 3 cautions related to noacs

A
  • increased risk of recurrent thrombotic events in antiphospholipid syndrome
  • should be taken with food as less efficient when on empty stomach
  • bleeding risk
34
Q

what is a common side effect of dabigatran

A

hepatic fn abnormal

35
Q

what should be assessed before starting dabigatran

A

renal fn

36
Q

what coprescribing edoxaban with what do you need to alter the dose of edoxaban because of interactions

A

concurrent ciclosporin, dronedarone, erythromycin, or ketoconazole.

37
Q

when stop edoxaban before surgery

A

at least 24 hours before

38
Q

how long should a patient be on vte prophylaxis after sugrery

A

Pharmacological prophylaxis in general surgery should usually continue for at least 7 days post-surgery, or until sufficient mobility has been re-established. Pharmacological prophylaxis should be extended to 28 days after major cancer surgery in the abdomen, and to 30 days in spinal surgery.

39
Q

what is first line in vte prophylaxis

A

LMWH

40
Q

what is first line for treatment of dvt or pe

A

apixaban or rivaroxaban

41
Q

provoked dvt

A

3 mths so long as provokative factor removed

42
Q

unporvoked

A

6mths

43
Q

what is used for rapid reversal of heparin

A

protamine sulphate

44
Q

how long does it take for warfarin to work when initiated

A

2-3 days

45
Q

if prescribing warfarin and you want the effect to be immediate what do uou need to do

A

concomitantly prescirbe unfractionated or LMW heparin

46
Q

for people on anticoagulation inr target is

A

2.5

47
Q

for peiple with recurrent dvt/pe with INR>2 then target INR should be

A

3.5

48
Q

when should warfarin be stopped before surgery

A

5 days before elective surgery

49
Q

if INR>1.5 before surgery what should you do

A

vitamin K1 (phytomenadione)

50
Q

emergent surgery on warfarin

A

if cen be delayed 6-12 hrs then give iv vit k

if not give dried prothrombin complex and IV vitK

Year 4 Prescribing (28 decks)

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