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DOACS Flashcards

1
Q

What is the Apixaban (eliquis) drug class?

A

Factor Xa inhibitor

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2
Q

what is the % bioavailability of Apixaban (eliquis)?

A

60%

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3
Q

what is the team to peak effect of Apixaban (eliquis)?

A

1-2 hours

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4
Q

what is the 1/2 life of Apixaban (eliquis)?

A

12 hours

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5
Q

what % of Apixaban (eliquis) is renally cleared?

A

25%

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6
Q

what is Dabigatran (Pradaxa) drug class?

A

Direct Thrombin Inhibitor

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7
Q

is Dabigatran (Pradaxa) a prodrug?

A

YES

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8
Q

what is the % bioavailablity of Dabigatran (Pradaxa)?

A

6%

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9
Q

what is the time to peak effect of Dabigatran (Pradaxa)?

A

1-3 hours

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10
Q

what is the 1/2 life of Dabigatran (Pradaxa)

A

8-15 hours

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11
Q

what is the drug class of Edoxaban (Savaysa)?

A

Factor Xa inhibitor

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12
Q

what is the bioavalibity of Edoxaban (Savaysa)?

A

62%

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13
Q

what is the time to peak effect of Edoxaban (Savaysa)?

A

1-2 hours

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14
Q

what % of Edoxaban (Savaysa) is renally cleared?

A

50%

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15
Q

What class of drug is Rivaroxaban (Xarelto)?

A

Factor Xa inhibitor

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16
Q

what is the bioavailablity of Rivaroxaban (Xarelto)?

A

60-80%

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17
Q

what is the time to peak effect of Rivaroxaban (Xarelto)?

A

2-4 hours

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18
Q

what is the 1/2 life of Rivaroxaban (Xarelto)?

A

7-11 hours

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19
Q

what % of Rivaroxaban (Xarelto) is renally cleared?

A

33%

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20
Q

what are the 6 CI for Apixaban?

A
  1. active pathological bleeding
  2. server hypersensivity
  3. mech prosthetic heart valve
  4. Triple postiive APS
  5. pregnancy
  6. breastfeeding (secrection into milk)
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21
Q

what are the 3 DOAC that are clinically recommended to be avoided in pregancy?

A

Dabi
edoxa
riva

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22
Q

which DOAC does not need to be adjusted for hepatic impairment?

A

Dabigatran

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23
Q

which 2 DOACs are eliminated by P-GP efflux transporter system?

A

Dabi

Edoxaban

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24
Q

which 2 DOACS are eliminated/metabolized by P-GP efflux transporter system AND CYP3A4 hepatic isoenzyme system

A

Rivaroxaban

apixaban

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25
what are the 5 examples of P-GP and/or STRONG CYP3A4 inducers
1. barbiturates 2. carbamazepine 3. pheytoin 4. rifampin 5. St. Johns wort
26
what DOAC can be use if pt has p-GP and or STRONG CYP 3A4 inducers
NONE- it decreases the availablity of the DOACS increase risk of thrombosis
27
what are the P-GP inhibitors? (8 classes/drug)
1. amiodarone 2. carvedilol 3. diltizem 4. dronaderone 5. azithro/clarithro/erythromycin 6. itra/ketoconazole 7. quinidine 8. verapamil
28
which DOACs are not affected by p-GP inhibitors
Apixaban and Rivaroxaban
29
what are the dual P-GP annd STRONG CYP3A4 inhibitors?
``` Clarithromycin itra/ketocontazole cobicistat indinavir ritonavir saquinavir telprevir ```
30
when using dual P-GP annd STRONG CYP3A4 and APIXBAN - how much do you reduced dose
50% if on 5mg BID or 10mg BID dont use if on 2.5mg (DONT NEED TO REDUCE IF ITS CLARITHROMYCIN)
31
what is Apixaban dose for AFIB?
5mg BID 2.5mg BID (if 2 / 3 criteria weight , 60kg, age >80, Scr >1.5)
32
what is the DABI dose for AFIB and renal dose adjustments?
150mg BID <15ml/min - DONT USE 15-30ml/min: 75mg BID
33
what is the dose for edoxaban for AFIB and any renal dose adjustments?
60mg daily Crcl > 95ml/min: DONT USE 15-50ml/min: 30mg daily
34
what is the dose of rivaroxaban for AFIB? and renal dose adjustements
20mg daily CrCL <50 ml/min = 15mg daily
35
what is the dose of apixaban for VTE
10mg BID x 7 days then 5mg BID NO RENAL DOSE ADJUSTMENT
36
what is the dose of dabi for VTE and the renal adjustment
150mg BID AFTER 5-10 days of parentreral lead in NO DOSE adjust (avoid only if CrCL <30ml/min
37
what is the dose of edoxaban for the treatment of VTE?
60mg daily after 5-10 day of parenteral lead in. 15-50ml/min or bodyweight <60kg = 30mg daily
38
what is the dose of rivaroxaban for VTE
15mg BID x 21 days then 20mg daily AVOID if CrCL <30ml/min
39
what is the PPX dose for DVT/PE S/p hip or knee replacement procedure for APixaban?
2. 5mg BID for 12 days (KNEE) 2. 5mg BID for 36 days (HIP) give 1st dose 12-24 hours after surgery
40
what is the PPX dose for DVT/PE S/p hip or knee replacement procedure for Dabi?
ONLY HIP not FDA approved for KNEE | 110mg day 1 then 220mg daily for 28-35 days
41
what is the PPX dose for DVT/PE S/p hip or knee replacement procedure for Edoxaban
NOT CLEARED for this
42
what is the PPX dose for DVT/PE S/p hip or knee replacement procedure for Rivaroxban?
10mg daily for 12 days (knee) | 10mg daily for 35 days (hip)
43
what is the only DOAC and dose that is approved for PPX of VTE in acutely ill medical patients at risk ofr VTE but not at high risk for bleeding?
Rivaroxaban 10mg daily after discharge recommended for 31-39 days
44
What is the only DOAC recommended for the reducation of MACE (MI,CVA, Stroke and chronic CAD/PVD?)
Rivaroxaban 2.5mg BID with Apsirin 81mg
45
How to transition Dabi to warfarin
start warfarin and overlap with DABI for 3 days if CrCL is greater than 50ml/min if 30-50ml/min only overlap for 2 days if less than 30ml/min only over lap for 1 day
46
how to transition between apixaban and rivaroxaban to warfarin
stop DOAC and start warfarin and bridge until INR is greater than 2
47
how to transition from edoxaban to warfarin
if pt was on 60mg dose reduce dose to 30mg then start warfarin and continue together until INR is 2 if pt was on 30mg dose reduce dose to 15mg then start warfarin and continue together until INR is 2
48
what DOACS should be avoided if pt is taking one of the following 1. phenytoin 2. Rifampin 3. Carbamzepine (Tegretol) 4. St Johns wort 5. Apalutamide
ALL OF THEM!
49
IF pt is taking dronedarone or Ketoconazole what should you consider to do with your Dabi dose?
reduce from 150mg BID to 75mg BID for pts with CrCl 30-50ml/min NO adjustment if CrCl is greater than 50
50
Do you need to adjust Dabi dose for amiodarone, Verapamil or clarithromyicn?
NO
51
what is the ONLY Combined P-GP and Strong CYP3a4 inhibitor that does not sig increase apixaban or rivaroxaban exposure so concomitant use is acceptable with out dose adjustment?
Clarithromycin
52
If pt is on a combined Strong CYP3A4 and p-GP inhibitior (ritonavir) what should you do with the dose of apixaban?
Reduce by 50% if pt is already on 2.5mg BID then they need to avoid use
53
What are the combined PGP and Moderate CYP3A4 inhibitors ? and how do they affect Apixaban and Riva?
Drondarone Verapamil Erythromycin Apixaban - no adjustment needed Rivaroxaban - avoid use if crcl is 15-80ml/min
54
How do you reverse DABI? if 1st choice is not available what can you do
5g idarucizumab IV (2 separate 2.5g/50ml vials) if bleeding continues and Dabi is still present in blood after 12-24 hours you can do a 2nd dose 1. if you dont have Idarucizumab you can do PCC (aPCC) 50units/kg IV HD can also be considered if drug level is high and pt has poor kidney function
55
what do you use for the reversal of apixaban and rivaroxaban what do you do if 1st choice is not available?
ANDEXXA if andexa is not available you can use 4f -PCC at 50units/kg IV
56
can you use Fresh frozen plasma for the reversal of DOAC
NO
57
If last dose of apixaban and Rivaroxaban was greater than 8 hours ago what dose of andexxa do you use?
LOW DOSE - INITIAL IV BOLUS = 400mg at a target rate of 30mg/min - FOLLOW ON INFUSION= 4mg/min for up to 120mins (480mg) total of 200mg vials is usually 5 (2 for bolus 3 for infusion)
58
what is the HIGH dose of Andexa
INITAL BOLUS = 800mg at a target rate of 30mg/min Follow on Infusion = 8mg/min for up to 120mg/min (960mg total) total number of 200mg vials = 9
59
In what situations would you use HIGH dose andexa for apixaban
if pt took apixaban dose greater than 5mg less thatn 8 hours ago or didnt know when he took it
60
in what situations would you use LOW dose andexa for apixaban?
if pt took apixaban greater than 8 hours ago or if pt took 2.5mg less than 8 hrs ago or unknown
61
in what situations would you use HIGH dose andexa for rivaroxaban?
if pt took riva 10mg or more less than 8 hours ago or unknown
62
in what situation would you use low dose andexa for rivaroxaban?
if pt took riva dose that was less than 10mg les than 8 hours ago or unknown or if pt took any dose of rivroxaban greater than 8 hours ago
63
what are the 7 indication for which DOACS have been proven inefficacious or harmful
1. mechanical heart valve replacement 2. LVAD 3. APS 4. ESUS 5. TAVR 6. within 3 months of a bioprosthetic heart valve replacement 7. Valvular AFib
64
which DOAC is a PRO DRUG that requires acidic environement for absorption? therefore will see at 20% reduction when given with antiacids (however clinically insig)
DABI
65
what is the only DOAC that cannot be administered through enteral feeding tube?
DABi
66
What is the DOAC that is most likely to be affect by Colectomy
Apixaban
67
HOW do you convert from DABI to a parentaral agent?
stop Dabi and wait 12 hours if crcl > 30ml/min 24 hours if crcl <30ml/min
68
HOW do you convert from rivaroxaban/apixaban/edoxaban to a parentaral agent?
STOP DOAC and start the injections at next schedule dose
69
Which anticoagulation (ORAL) is the most renally cleared?
Dabi then Edoxaban, then Riva, then Apix
70
which parentral agent is the most renally cleared?
Dalteparin then fondaparinux, enoxaparin HEPARIN HAS NO RENAL CLEARNCE
71
what is the recommended dose of apixaban for pts undergoing HD?
apixaban 2.5mg BID was equal to 5mg BID for these pts

CACP (8 decks)

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