CVD Medications Flashcards
(23 cards)
What are the side effects of UFH?
haemorrhage: withdraw and give protamine sulphate (fully reversible)
hyperkalemia: monitor K+ levels before and after
osteoporosis: if long term use
heparin induced thrombocytopenia: monitor platelet counts, discontinue and give agatroban
What are the side effects of LMWHs?
haemorrhage: withdraw and give protamine sulphate (partially reversible)
hyperkalemia: monitor K+ levels before and after
osteoporosis: if long term use (< risk than UFH)
What should be done to LMWHs in renal impairment?
CrCl 15-30ml/min: dose reduce
CrCl <15ml/min: switch to UFH
When are DOACs contraindicated?
lesion or condition if significant risk factor of major bleeding
concomitant treatment with any other anticoagulant agent
pregnancy and breastfeeding
What is the MHRA warning for DOACs?
increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
- warfarin is preferred in APS
When should DOACs be dose reduced?
Creatinine > 133 micromol/litre + age > 80 yrs
Creatinine > 133 micromol/litre + body weight up to 61kg
CrCl 15–29 mL/min
What are the reversal agents for DOACs?
apiaxaban, rivaroxaban: andexanet alfa
dabigatran: idarucizumab
What does edoxaban dosing depend on?
body weight
Adult (body-weight up to 61 kg)
30 mg once daily.
Adult (body-weight 61 kg and above)
60 mg once daily.
What is the MHRA warning for rivaroxaban?
after transcatheter aortic valve replacement (TAVR): increase in all-cause mortality, thromboembolic and bleeding events in a clinical trial
15 mg and 20 mg tablets should be taken with food
- reduced absorption if taken without
What are the side effects of DOACs?
anaemia
haemorrhage
headache
nausea
What are the side effects of aspirin? What are the signs of overdose?
side effects
- dyspepsia, haemorrhage
overdose
- hyperventilation, tinnitus, deafness, vasodilation, sweating
What are the side effects of dipyridamole?
angina
What is a key point for dipyridamole?
MR formulation must be dispensed in original pack
What are the side effects of tranexamic acid?
diarrhoea: must dose reduce
nausea
vomiting
What are the MHRA warnings for warfarin?
direct acting anti-virals + vitamin K antagonists
- affect the efficacy of vitamin K antagonists, monitor INR
acute illness increases effects of warfarin + may need dose reduction
calciphylaxis (calcium build up in vessels)
- refer + withdraw if symptomatic: painful skin rash, ulcer (most common in end stage renal disease)
tramadol (SNRI) + warfarin
- high bleeding and bruising risk
What are the major drug interactions with warfarin?
reduced anticoagulation effects
- binge drinking, enzyme inducers, vitamin K complex
increased anticoagulation effects
- enzyme inhibitors (amiodarone, corticosteroids)
increasing bleeding risk
- SSRIs, NSAIDs
What are the major food interactions with warfarin?
cranberry juice , pomegranate juice
- increased anticoagulants effects, increased bleeding risk
vitamin K rich foods
- decreased anticoagulant effects
When is warfarin contraindicated?
pregnancy: teratogenic
severe hepatic impairment
< 48hrs post partum
< 72hrs post major surgery
When must warfarin be closely monitored?
thyroidism: hypo or hyper
When is the target INR for warfarin 2.5 vs 3.5?
2.5
treatment of DVT, PE, APS
AF
cardioversion
bioprosthesis
mitral stenosis
post MI
3.5
recurrent DVT or PE
What should be done if INR is
- Greater than 8 with minor bleeding
- Greater than 8 with no bleeding
- Between 5–8 with minor bleeding
- Between 5–8 with no bleeding
Greater than 8 with minor bleeding
- stop warfarin and give phytomenadione by slow intravenous injection, repeated after 24hrs if INR is still high
Greater than 8 with no bleeding
- stop warfarin and give phytomenadione by mouth using the intravenous preparation orally (off-label use)
- repeated after 24hrs if INR is still high
- restart warfarin when the INR is less than 5
Between 5–8 with minor bleeding
- stop warfarin and give phytomenadione by slow intravenous injection.
- restart warfarin when the INR is less than 5
Between 5–8 with no bleeding
- withhold 1 or 2 doses of warfarin and reduce subsequent maintenance dose.
What are counselling points for warfarin?
need regular monitoring: INR
must have a ‘yellow book’ (anticoagulation treatment book)
take warfarin at the same time each day.
should not miss doses or take additional doses
warfarin levels can be affected by diet, alcohol, acute illness, and other medications, including over-the-counter drugs, vitamins, food supplements, and herbal and homeopathic remedies
women of childbearing potential should use effective contraception during treatment
What should be done to warfarin pre and post operative?
INR must fall to 1.4 before the porcedure
If INR 1.5 - 1.9 discontinue 3 or 4 days prior to operation or procedure
If INR 2.0 - 3.0 discontinue 5 days prior to operation or procedure
If INR > 3.0 discontinue at least 5 days operation or procedure – discuss with haematologist.
restart on the evening of the operation
- at usual dose or two days of double maintenance dose followed by usual dose.
