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anti-coagulation Flashcards

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1
Q

What is the CHA2DS2 VASC assessment used for?

A

To assess the patient’s risk of a stroke

CHA2DS2 VASC stands for Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, Stroke or transient ischemic attack, Vascular disease, Age 65-74 years, Sex category.

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2
Q

List the risk factors included in the CHA2DS2 VASC assessment.

A
  • congestive heart failure
  • hypertension
  • age over 75
  • diabetes
  • stroke
  • vascular diseases
  • age 65-74
  • sex catagory (female)

Each risk factor contributes to the overall stroke risk score.

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3
Q

What does a CHA2DS2 VASC score of 0 for men and 1 for women indicate?

A

No need for treatment

This score suggests that the risk of stroke is low.

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4
Q

When is parenteral anticoagulation indicated?

A

In patients with new-onset AF who are not receiving anticoagulants or are under therapeutic

AF stands for atrial fibrillation.

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5
Q

Who should receive oral anticoagulation?

A
  • Patients with confirmed AF
  • Sinus rhythm not resolved within 48 hours
  • Patients at high risk of recurrence of AF

Oral anticoagulation is important to prevent stroke in these patients.

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6
Q

What can be used for non-valvular AF?

A
  • Apixaban
  • Rivaroxaban
  • Edoxaban
  • Dabigatran

Warfarin is also an option but is less preferred for non-valvular AF.

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7
Q

What is the purpose of the HAS-BLED tool?

A

To assess the patient’s risk of bleeding

HAS-BLED stands for Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol.

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8
Q

What is Class 1 in the Vaughan Williams Classification?

A
  • Lidocaine
  • Flecainide

This class includes sodium channel blockers used to treat arrhythmias.

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9
Q

What medications are included in Class 2 of the Vaughan Williams Classification?

A

Beta blockers

Beta blockers help reduce heart rate and lower blood pressure.

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10
Q

List the drugs in Class 3 of the Vaughan Williams Classification.

A
  • Amiodarone
  • Sotalol

Class 3 agents primarily work by prolonging the action potential duration.

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11
Q

What is an example of a Class 4 drug in the Vaughan Williams Classification?

A

Non-dihydropyridine calcium channel blocker (e.g., verapamil)

Class 4 drugs are used to slow down heart rate and are particularly effective in controlling ventricular rate in atrial fibrillation.

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12
Q

what is a thromboembolism

A

circulating blood clot that gets stuck and causes an obstruction

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13
Q

what are the two forms of venous thrmboembolism

A

deep vein thrombosis

pulmonary embolism

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14
Q
A
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15
Q

What is a common reversible side effect of Amiodarone?

A

Corneal microdeposits

Corneal microdeposits are reversible once amiodarone is stopped.

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16
Q

What vision-related issues can occur with Amiodarone use?

A

Optic neuritis, optic neuropathy, and vision disturbances

These complications necessitate discontinuation of amiodarone.

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17
Q

What thyroid dysfunctions can be caused by Amiodarone?

A

Hyperthyroidism and hypothyroidism

Hypothyroidism can be treated with medication without stopping amiodarone.

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18
Q

What should patients report if they experience hepatotoxicity while on Amiodarone?

A

Yellowing of skin, dark urine, pale skin

These symptoms indicate potential liver issues.

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19
Q

What respiratory symptoms should patients on Amiodarone report?

A

Shortness of breath or cough

These may indicate possible pneumonitis.

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20
Q

What is a noted skin side effect of Amiodarone?

A

Grey skin discoloration

This side effect is distinct and noticeable.

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21
Q

what are the risk factors for thrombosis

A

immobility
obesity
60+
pregnancy

critical care
malignancy
thrombophillic disorders
Varicose veins with phlebitis

HRT

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22
Q

what are the 4 risk factors for bleeding

A

thrombocytopenia
acute stroke
bleeding disorders
anticoagulants

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23
Q
A
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24
Q

What monitoring should be performed at the start of Amiodarone treatment?

A

Liver function, thyroid function, potassium levels, vision checked

These parameters are crucial for assessing the patient’s baseline health before starting Amiodarone.

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25
What specific monitoring should occur at 6 months during Amiodarone treatment?
Thyroid function, liver function ## Footnote Regular monitoring helps to identify any adverse effects early in the treatment course.
26
What counselling advice should be given to patients taking Amiodarone?
Counsel on signs of hepatotoxicity and pulmonary toxicity, advise use of wide spectrum sunscreen, shield skin from light during and for several months after stopping Amiodarone ## Footnote This advice is essential to minimize the risk of serious side effects related to the drug.
27
What is a potential interaction of Amiodarone?
Increased risk of digoxin toxicity ## Footnote Amiodarone can affect the metabolism of digoxin, leading to elevated levels in the body.
28
How does Amiodarone affect heart rate?
Increased risk of bradycardia ## Footnote Bradycardia is a condition where the heart rate is slower than normal, which can be exacerbated by Amiodarone.
29
What electrolyte imbalance can Amiodarone cause?
Hypokalemia ## Footnote Hypokalemia refers to low potassium levels, which can lead to various cardiac issues.
30
What effect does Amiodarone have on the QT interval?
Prolongs QT interval ## Footnote A prolonged QT interval can lead to serious arrhythmias, necessitating careful monitoring.
31
what is the prophylaxis for thrmboembolism types
mechanical pharmacological
32
what is an example of mechanical prophylaxis for thromboembolism
stockings
33
what is an example of pharmacological prophylaxis for thromboembolism
NOACS Warfarin
34
35
What are anti fibrinolytic drugs used for?
To prevent fibrinolysis ## Footnote Fibrinolysis is the process that leads to the breakdown of fibrin in blood clots.
36
What is the name of the anti fibrinolytic drug mentioned?
Tranexamic Acid
37
Is Tranexamic Acid available over the counter (OTC) for all age groups?
No, it is available OTC for 18-45 year olds
38
For how many days can Tranexamic Acid be taken for menorrhagia?
A maximum of 4 days
39
What must be done before prescribing Tranexamic Acid for menorrhagia?
A consultation ruling out any referrals or red flags
40
41
What is the time frame for starting pharmacological prophylaxis?
Started within 14 hours ## Footnote Timely initiation is crucial for effective prophylaxis.
42
Under what condition should pharmacological treatment be used for patients with risk factors for bleeding?
If the risk of VT outweighs the risk of bleeding ## Footnote This balance is essential for safe treatment decisions.
43
What is the initial treatment for VT?
Low molecular weight heparin (LMWH) or parental heparin as an intravenous loading dose ## Footnote Both options are effective for initial management.
44
What is the follow-up administration method for heparin in treating deep vein thromboembolism?
Intermittent subcutaneous administration ## Footnote This method can be used after initial treatment.
45
When should Warfarin be started in relation to Heparin or LMWH?
At the same time ## Footnote This simultaneous initiation helps manage anticoagulation effectively.
46
How long should Heparin be continued?
For at least 5 days or until INR is >2 for at least 24 hours ## Footnote Monitoring INR is key to ensuring safe anticoagulation.
47
What should patients with disabling ischaemic stroke receive initially?
Aspirin for two weeks ## Footnote This is the preferred initial treatment before anticoagulant therapy.
48
What should be done for patients with a prosthetic heart valve who are at risk and already on anticoagulants?
Stop anticoagulants for 7 days and give aspirin ## Footnote This protocol helps mitigate bleeding risks.
49
What are the preferred treatments for VT in pregnancy?
Heparins, particularly LMWH ## Footnote Heparins are preferred because they do not cross the placenta.
50
Why are LMWH preferred over standard heparin in pregnancy?
Lower risk of osteoporosis and heparin-induced thrombocytopenia ## Footnote This makes LMWH safer for pregnant patients.
51
52
What is the immediate treatment for a Transient Ischaemic Attack (TIA)?
Aspirin should be given immediately. ## Footnote If a patient is allergic or intolerant, an alternative anti-platelet should be given.
53
What is the treatment for Ischaemic Stroke (IS) within 4.5 hours of symptoms?
Alteplase is given if intracranial haemorrhage is excluded. ## Footnote This treatment is critical for restoring blood flow.
54
What should be started within 24 hours of symptom onset for Ischaemic Stroke if intracranial hemorrhage is excluded?
Aspirin or an alternative anti-platelet if allergic or intolerant. ## Footnote This is important for secondary prevention of stroke.
55
56
What medication should patients receive for two weeks after disabling ischaemic stroke?
Aspirin ## Footnote Aspirin is recommended before starting anticoagulant treatment.
57
How long should anticoagulant treatment be stopped for patients with a prosthetic heart valve after a disabling ischaemic stroke?
7 days ## Footnote This is necessary for patients at risk who are already on anticoagulants.
58
What is the primary medication recommended for patients with a prosthetic heart valve after stopping anticoagulants?
Aspirin ## Footnote Aspirin is given to reduce the risk during the 7-day period.
59
True or False: Patients should immediately continue anticoagulant treatment after a disabling ischaemic stroke.
False ## Footnote Patients should receive Aspirin first before anticoagulants.
60
what is the duration of vte prophylaxis for spinal surgery
30 days
61
what is the duration of vte prophylaxis for general surgery
5-7 days
62
what is the duration of vte prophylaxis for major cancer surgery in abdomen
28 days
63
what is the duration of vte prophylaxis for elective hip surgery
lmwh 10 low dose aspirin 28 days
64
what is the duration of vte prophylaxis for elective knee replacement
low dose aspirin 14 days
65
what is the first line pharmacological treatment for prophylaxis of vte
low molecular weight heparin
66
What is the first-line medication recommended for patients who have had a TIA or IS without atrial fibrillation?
Clopidogrel
67
What should be given if Clopidogrel is contraindicated or intolerant?
M/R Dipyridamole or Aspirin
68
What is recommended if both Aspirin and Clopidogrel are contraindicated?
M/R Dipyridamole alone
69
When should high-intensity statin therapy, such as Atorvastatin, be started after symptom onset?
48 hours after symptoms onset
70
What is the target blood pressure for treatment in long-term management?
<130/80
71
What lifestyle changes should be advised if appropriate?
Diet, exercise, alcohol reduction, and smoking cessation
72
True or false low molecular weight heparin do not cross the placenta
true
73
why are low molecular weight heparins preferred
lower risk of osteoporosis lower risk of heparin induced thrombocytopenia
74
What type of drug is warfarin?
A vitamin K antagonist ## Footnote Warfarin is used to prevent blood clots.
75
How long does it take for warfarin to work?
48-72 hours
76
What does INR stand for in relation to warfarin?
International Normalized Ratio ## Footnote INR is used to monitor the anticoagulation effect of warfarin.
77
What is the target INR for patients on warfarin?
2.5
78
What conditions is warfarin commonly used to treat?
* Deep vein thromboembolism (DVT) * Pulmonary embolism (PE) * Atrial fibrillation * Cardioversion
79
what are the side effects of heparin
haemorrhage hyperkalaemia osteoporosis thrombocytopenia
80
what is the main side effect of warfarin
haemmorhage
81
82
What should be avoided during the first trimester of pregnancy?
Warfarin ## Footnote Warfarin crosses the placenta causing congenital malformations, placenta, fetal and neonatal hemorrhage.
83
What is a significant interaction that increases the risk of bleeding with warfarin?
Altered anticoagulant effect with penicillins ## Footnote This interaction can lead to an increased risk of bleeding.
84
Name three substances that increase the anticoagulant effect of warfarin.
* Cranberry juice * Metronidazole * Tetracyclines ## Footnote These substances can potentiate the effects of warfarin.
85
How often should monitoring be done during the early days of anticoagulant treatment?
Daily or on alternate days ## Footnote Monitoring frequency can be adjusted based on the patient's response.
86
What is the recommended monitoring frequency after the initial phase?
Longer intervals and then every 12 weeks ## Footnote This depends on the patient's response to treatment.
87
What should be provided to patients undergoing anticoagulant treatment?
Anticoagulant treatment booklet ## Footnote This booklet contains important information about the treatment.
88
What should patients always carry when on anticoagulant therapy?
An alert card ## Footnote This card informs healthcare providers about the patient's anticoagulant treatment.
89
Fill in the blank: Patients should not make drastic changes in their diet involving _______. when on warfarin
vegetables like broccoli, spinach ## Footnote These vegetables can affect the anticoagulant effect of warfarin.

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