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Flashcards in 3 Anticoagulants HH Oral Deck (17):
1

Check baseline ......(3)...... when starting warfarin

INR
FBC
LFT

2

Usual loading dose for warfarin:

reduce this in.... and ...

10mg od for 2 days

(reduce in elderly and liver impaired)

3

2 reasons warfarin interactions are so common?

1. metabolised by cyp
2. highly bound to plasma - other protein bound drugs compete

4

What factors does Warfarin inhibit synthesis of?

clotting factors: II, VII, Ix, X
regulatory factors: protein C and protein S

5

What are the actions of
protein C
protein S

vitamin K dependent anticoagulant proteins

6

Why do we overlap Warfarin and Heparin

Warfarin initially decreases protein C and S faster than coagulation factors - therefor it can increase blood's tendency to coagulate when first begun

7

Baseline monitoring for NOACs

Prothrombin time
Liver function
Renal function
BP

8

Do we use TED stockings from stroke patients?

No they do worse with them

9

UFH is rarely used now except in (2)

high bleed risk or renal failure

10

Why is depression risky with Warfarin?

Risk of self harm?

11

Why is illicit drug use risky with Warfarin?

Risk of infection and bleed

12

Why is uncontrolled hypertension risky with NOACs?

Bleeding

13

How to change from Warfarin to apixiban

-you would consult product literature
-Wait for the INR to drop below a certain level (~2.5)

14

Monitor NOACs for (5)

Bleeding & anaemia

Adherence
Liver func
Renal func

Pregnancy and BF - avoid!

15

What do we try to use for managing NOAC overdose

Activated charcoal
Stop drug
Supportive therapy and fluid replacement to insure excretion
Consider factors, tranexamic acid, dialysis

16

Contraindications for NOACs

-recent GI ulceration
-neoplasm at risk bleeding
-recent brain or spinal injury
-recent brain, spinal or ophthalmic surgery
-recent intercraneal haemorrage
-oesophageal varices
-arteriovenous malformation
-cocomitant other anticoagulants

17

Caution - check NOAC doses in what patients?

elderly