Week 4 - Arrhythmia Treatment 2 - anti-coagulants Flashcards
What are anti-coagulants used to treat?
in atrial fibrillaton to prevent clot formation. prevent stroke and PE.
What are risk factors for atrial fibrillation?
age, BP, diabetes, smoking, prior CVD or prior AF
Why is atrial fibrillation significant?
most common arrhythmia and can lead to stroke.
What is the scoring system used to determine risk score of stroke?
Chadsvasc.
Which drugs reduce risk of stroke with atrial fibrillation?
in order of least to most effective:
antiplatalets (clopidogrel)
clopidogrel and aspirin
warfarin
dabigataran
What is the benefit and harm of clopidogrel and aspirin?
reduce risk of stroke but increase risk of bleeding when used together
What is the benefit and negative of using warfarin?
reduces risk a lot and is efficient.
has many drug interactions involving metabolism of cytochrome p450
What is the benefit and harm of dabigataran?
most advantageous at reducing risk of stroke. however in patients with chronic kidney disease, risk of bleeding is higher. not ideal for them
What makes the ideal anticoagulant?
- oral drug
- that doesnt need monitoring.
- low interactions with food and other drugs.
- given 1/2 times a day.
- as/more effective then warfarin
What are 3 actions of anti-coagulants?
- vitamin k antagonist
- direct thrombin inhibitor
- direct factor 10 inhibitors (inhibits prothrombin to thrombin)
What is an example of a vitamin k antagonist?
warfarin
What is an example of a direct thrombin inhibitor?
dabigataran
What are examples of factor 10 inhibitors?
rivaroxaban, apixaban, edoxaban
what are adverse effects of anti-coagulants?
bleeding, drug interactions, teratogenic in pregnancy
What is used to determine risk of bleeding and what are the risk factors?
HASBLED score.
Hypertension
anormal liver/renal function
stroke history
bleeding history
labile INR
elderly
drug/alcohol use
