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30 Cards in this Set
- Front
- Back
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what drugs will increase pts risk of VTE |
oestrogen containing meds antipsychotics tamoxifen |
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what diseases increase a pts risk of VTE |
IBD, CKD, HF |
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VTE prevention |
LMWH like enoxaparin and dalteparin UFH aspirin weak effect |
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how to measure LMWH levels |
activated factor 10a |
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Rx for VTE |
warfarin |
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Warfarin also indicated in |
prevention of TE in pts with prosthetic heart valves prevent stroke in pts with previous MI and increased embolic risk pts with nonvalvular AF and a high risk of stroke or systemic embolism |
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what drugs to inhibit thrombus formation in arterial circulation |
clopidogrel prasugrel ticagreclor |
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Indications for clopidogrel + aspirin |
acute coronary syndromes prevent thrombosus after PCI |
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prasugrel + aspirin indication |
prevent atherothrombotic events in pts with ACS who are to undergo PCI |
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ticagrelor + aspirin indication |
preventon of atherothrombotic events in pts with ACS (unstable angina, non ST elevation MI, ST elevation MI) in setting of PCI or CABG |
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Dabigatran CI |
hepatic and rena impairment increased risk for bleeding uncontrolled HTN (SBP>180) recent malignancy or radiation therapy avoid in those who have poor med adherence as there is no monitoring of INR |
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Effects compared dabigatran and warfarin |
Dabigatran 150 mg twice daily increased the risk of gastrointestinal bleeding, but reduced the risk of intracranial bleeding. |
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which drugs to be cautious of when taking dabigatran |
amiodarone, HIV-protease inhibitors or verapamil. These and other inhibitors of P-glycoprotein can increase dabigatran plasma levels and, therefore, the risk of bleeding |
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Apixaban MOA |
orally active selective inhibitor of factor Xa an essential element of the coagulation cascade inhibits thrombus generation no direct effect on plately aggregation |
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Apixaban indication |
prevention of stroke or systemic embolism in pts with NVAF who also have priot stroke,, age>75, HTN, DM, HF and/or ventricular EF<35% prevent VTE in pts who have undergone elective knee or hip replacement surgery |
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Apixaban C/I |
prosthetic heart valves clinically active bleeding hepatic disease associated with coagulopathy (can be used in mild/mod) bleeding risk includ severe hepatic impairment CrCl<25ml
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Apixaban precaution use in... |
increased risk of haemorrhage (congenital bleeding disorders), active ulcerative GI disease & history of haemorrhagic stroke |
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Compare apixaban and warfarin |
apixaban is superior to warfarin in preventing TE events particularly haemorrhagic stroke in people with NVAF reduction in death from any cause but not occurrence of MI fewer major bleeds |
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Meds that would interact with apixaban |
other Anticoagulants antiplatelet aspirin NSAIDs SSRIs and SNRIs SJW Grapefruit juice |
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rivaroxaban C/I in... |
people with NVAF with either significant hepatic disease with an increased INR, or severe renal impairment |
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rivaroxaban compared to warfarin |
non inferior in people with mod renal impairment wrt any major bleeding fewer intracranial haemorrhages GI bleeding, epistaxis and haematuria more common |
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why rivaroxaban is dangerous in people with poor compliance |
drug has short half life , increased risk of stroke if doses are missed |
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rivaroxaban is C/I in people with... |
severe renal impairment sig hepatic disease concomitant Rx with strong inhibitors of both CYP3A4 and Pgp (HIV protease I, or ketoconazole) |
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arterial thrombosis presentation |
chest discomfort upper body discomfort SOB nausea lightheadedness |
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RFs for arterial thrombosis |
DM hyperlipidemia HTN inflammation, fibrinolytic defects in heparin induced thrombocytopenia hyperhomocysteinemia smoking lack of exercise obesity |
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venous thrombosis presentation |
red clots composed of fibrin enmeshed with cellular components including RBC pain, erythema, tenderness, heat DVT unilateral leg swell |
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MOA of rivaroxaban |
competitive reversible antag of activated factor Xa (prothrombin to thrombin)
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MOA of dabigatran |
antag of thrombin (converts fibrinogen to fibrin, cross linking fibrin monomers) activates platelets, generates AC activity via activation of protein C and initiates wound healing |
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DDI of rivaroxaban |
CYP4503A4 Pgp inhibitors (ketoconazole, clarithromycin, ritonavir) |
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DDI of dabigatran |
PPI reduce absorption possible interactions with Pgp inhibitors and inducers |
