3 Anticoagulants HH Oral Flashcards
Check baseline ……(3)…… when starting warfarin
INR
FBC
LFT
Usual loading dose for warfarin:
reduce this in…. and …
10mg od for 2 days
reduce in elderly and liver impaired
2 reasons warfarin interactions are so common?
- metabolised by cyp
2. highly bound to plasma - other protein bound drugs compete
What factors does Warfarin inhibit synthesis of?
clotting factors: II, VII, Ix, X
regulatory factors: protein C and protein S
What are the actions of
protein C
protein S
vitamin K dependent anticoagulant proteins
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
Baseline monitoring for NOACs
Prothrombin time
Liver function
Renal function
BP
Do we use TED stockings from stroke patients?
No they do worse with them
UFH is rarely used now except in (2)
high bleed risk or renal failure
Why is depression risky with Warfarin?
Risk of self harm?
Why is illicit drug use risky with Warfarin?
Risk of infection and bleed
Why is uncontrolled hypertension risky with NOACs?
Bleeding
How to change from Warfarin to apixiban
- you would consult product literature
- Wait for the INR to drop below a certain level (~2.5)
Monitor NOACs for (5)
Bleeding & anaemia
Adherence
Liver func
Renal func
Pregnancy and BF - avoid!
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
