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Anticoagulants Flashcards

(78 cards)

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1
Q

What are anticoagulants used for

A

To prevent thrombus formation in veins

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2
Q

Anticoagulants include

A

Coumarins - phenindione and warfarin

DOACs

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3
Q

Can you use coumarins in pregnancy

A

No because it crosses the placenta- teratogenic - avoid!

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4
Q

Coumarins MOA

A

Antagonise vitamin K

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5
Q

Onset of coumarins is (how long they take to give full anticoagulation)

A

2-3 days

48-72 hours

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6
Q

A patient requires immediate effect of anticoagulation, what option would you give?

A

LMHW or unfractionated heparins have a quicker onset

Coumarins onset is 48-72 hours hence theyre not preferred in immediate onset requirement

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7
Q

Coumarins is required in a patient - drug of choice is ….

A

Warfarin

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8
Q

What are the different strengths of warfarin, what colours are their boxes

A

0.5 mg - white

1mg - brown

3mg - blue

5mg - pink

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9
Q

What colour box is 3mg warfarin

A

Blue

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10
Q

What colour box is 0.5 mg warfarin

A

White

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11
Q

What colour box is 1mg warfarin

A

Brown

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12
Q

What colour box is 5mg warfarin

A

Pink

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13
Q

Warfarin MHRA advice includes

A

Calciphylaxis

Miconazole interaction - daktarin oral gel

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14
Q

Describe miconazole (daktarin oral gel) and warfarin interaction.

Can you give them together?

A

Causes bleeding - seek medical advice if nose bleeds, blood in urine or unexplained bruising

Avoid unless patients INR is monitored closely

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15
Q

Describe calciphylaxis - where is this seen?

What action would you take if a patient presents to the pharmacy with this?

A

Painful rash

Its seen in patients taking warfarin especially if they are renally impaired

Refer to the GP

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16
Q

Warfarin antidote

A

Phytomenadiaone / vitamin K1

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17
Q

What foods are avoided with warfarin?

A

Cranberry juice
Pomegranate juice
Heavy alcohol - decreases effect of warfarin - inducer

Avoid diet change (liver, sprouts, broccoli, green tea, salads, leafy greens)

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18
Q

Cranberry and warfarin interaction

A

Cranberry juice increases anticoagulation affect of warfarin

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19
Q

Heavy alcohol interaction with warfarin

A

Heavy alcohol decreases the anticoagulation affect of warfarin

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20
Q

Warfarin in pregnancy, can it be given?

A

Avoid especially in 1st and 3rd trimester- risk if haemorrhage

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21
Q

What would you give a pregnant lady instead of warfarin?

A

LMWH

Tinazaparin, deltaparin, enoxeparin

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22
Q

INR can be within ……. Of target values when on warfarin

A

0.5

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23
Q

When is the required INR 3.5

A

Patients with recurrent DVT or PE

Patients with mechanical prosthetic heart valves

INR can be within 0.5 of target hence 3 or 4

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24
Q

Patient on warfarin for treatment of DVT or PE INR target

A

2.5

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25
Patient on warfarin for recurrent DVT or PE target
3.5
26
Patient on warfarin for AF INR target
2.5
27
Patient on warfarin for Cardioversion INR target
2.5
28
Patient on warfarin for Mechanical prosthetic heart valve INR target
3.5
29
Patient on warfarin for Dilated cardiomyopathy INR target
2.5
30
Patient on warfarin for Mitral stenosis or regurgitation INR target
2.5
31
Patient on warfarin for Myocardial infarction INR target
2.5
32
Patient on warfarin for Acute arterial embolism INR target
2.5
33
A patient is on warfarin and has an INR of 5-8 with no bleeding, what do you do?
Withhold 1 or 2 doses of warfarin Reduce subsequent maintenance dose
34
A patient on warfarin has an INR 5-8 with minor bleeding
Stop warfarin Give phytomenadione/vit K1 slow IV injection Restart when INR <5
35
A patient on warfarin with an INR >8 with no bleeding
Stop warfarin IV phytomenadione by mouth orally Repeat dose of vit K if INR still too high after 24hours Restart when INR <5
36
A patient on warfarin with an INR of >8 with minor bleeding
Stop warfarin Give phytomenadione/vit K1 by slow IV injection Repeat dose of vit K if INR still too high after 24hrs Restart INR <5
37
A patient on warfarin with major bleeding
Stop warfarin Give phytomenadione/ Vit K by slow IV injection and or dried prothrombin complex/ fresh frozen plasma (less effective)
38
When would you use dried prothrombin complex/frozen plasma in warfarin patients
When a warfarin patient has major bleeding, you add if if IV vitmain K isnt effective alone
39
Which is more effective fresh plasma or dried plasma
Dried
40
Warfarin drug interactions
Miconazole, fluconazole, itraconazole St johns wart Heavy alcohol Amiodarone Aspirin Bezafibrate Carbamazepine Ciprofloxacin
41
Warfarin and ciprofloxacin interaction
Increases warfarin anticoagulation effect
42
Amiodarone and warfarin interaction
Increases anticoagulant effect
43
Aspirin and warfarin interaction
Increased bleeding risk
44
Carbamazepine and warfarin interaction
Decreases the effects of warfarin
45
Clotrimozole and warfarin interaction
No interaction
46
Fluconazole and warfarin interaction
Increases anticoagulant effect
47
Warfarin and clarithromycin interaction
Increases anticoagulant effect of warfarin
48
Greeny leafy veg/green tea and warfarin interaction
Affects anticoagulant control
49
Theres a higher risk of bleeds with warfarin and Aspirin or clopidogrel
Clopidogrel
50
A patient is on antiplatelet therapy - aspirin and requires warfarin, what do you do
Withhold aspirin until if possible or only use it short term
51
Heparin (unfractionated) onset and duration of action
Rapid onset but short duration of action
52
In high risks of bleeding patients taking warfarin, which is preferred, warfarin or heparin and why
Heparin because it has a short duration of action hence if bleeds occur and you withhold/ stop heparin the effect will be removed quicker
53
Can heparins be used in pregnancy and why
Yes because they dont cross the placenta
54
LMWH indications
DVT, PE, MI
55
Which is preferred, LMWH or standard heparin (unfractionated) and why
LMWH because of lower risks of osteoporosis and heparin induced thrombocytopenia
56
Monitoring requirements for LMWH
Doesnt require any
57
Which has a longer duration of action Heparin LMWH
LMWH hence can be given OD subcutaneously
58
What medications are licensed for extended treatment and prophylaxis in VTE patients with solid tumours How many units/ml
Deltaparin and tinzaparin 20,000units/ml syringe
59
Are anti platelets given for primary or secondary prevention
Secondary prevention
60
Examples of antiplatelets
Ticagrelor Aspirin Dipyridamole Clopidogrel
61
Prasugrel class
Antiplatelet
62
Cangrelor class
Antiplatelet
63
Antiplatelet MOA
Glycoprotein IIb/IIIa inhibitors such as tirofiban, eptifibatide, abciximab
64
Why isnt aspirin used in primary prevention
No benefit in patients with or without diabetes
65
If a patient is on an antiplatelet and is at a high risk of bleed you can give ….
PPI
66
dipyridamole dose for secondary prevention of ischaemic stroke and TIA
200mg BD with food
67
Dipyridamole dispensing information
It should be dispensed in original container- dont split because pack contains desiccant. Any remaining caps should be discarded after 6 weeks of opening
68
Discard dipyridamole………… after opening
6 weeks
69
Aspirin secondary prevention dose
75mg OD
70
Aspirin secondary prevention in deep vein thrombosis or pulmonary embolism dose
75mg OD or 150mg
71
Aspirin dose in Suspected TIA
300mg once daily until diagnosis established
72
Long term management of TIA and ischaemic stroke not associated with AF aspirin dose
75mg OD with or without dipyridamole
73
Acute ischaemic stroke aspirin dose
300mg daily for 14 days 24hrs after alteplase (thrombolysis) or 48hrs within symptom onset in patients not receiving alteplase
74
AF following disabling ischaemic stroke aspirin dose
300mg daily for 14 days whilst being considered for anticoagulant treatment
75
Warfarin dose
Initially 5-10mg (adjusted to INR later) - day 1 Maintenance dose 3-9mg same time each day
76
Is warfarin preferred in valvular or non valvular AF
Valvular
77
Warfarin interaction with green tea
Reduces warfarin affect
78
Does warfarin interact with smoking
Yes If a person taking warfarin stops smoking, their INR might increase

Cardiovascular (9 decks)

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