Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Emergency Drugs |Emergency Drug Antidotes |Emergency Cardiac Drugs |Emergency Endocrine Drugs |Emergency Gastrointestinal Drugs |Emergency Haematology Drugs |Emergency Neuropsychiatric drugs |Emergency Pain drugs |Emergency Respiratory drugs |Emergency Obstetric and Gynaecology Drugs |Emergency Paediatric Drugs
DRUG (UK Name) | MOA | DOSE (IV/Subcut) | DOSE PO | INDICATION | CONTRAINDICATION / CAUTION |
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Enoxaparin (Clexane) | Low Molecular Weight Heparin (LMWH); binds antithrombin III, inhibiting Factor Xa > IIa | 1 mg/kg subcut every 12 h OR 1.5 mg/kg subcut daily | N/A | Prevention/treatment of PE, NSTEMI, unstable angina | Monitor anti-Xa in renal impairment or obesity (>150 kg). Avoid with spinal/epidural anaesthesia/puncture. Check BNF for pregnancy advice. |
Heparin (Unfractionated) | Binds antithrombin III, inactivating thrombin and factors IX, Xa, XI, XII; prevents fibrin formation |
VTE: 80 units/kg IV bolus, then 18 units/kg/h infusion
ACS/Afib: 60 units/kg IV bolus, then 12 units/kg/h infusion |
N/A | Venous thromboembolism, ACS (LMWH often preferred for NSTEMI) | Bleeding risk; Protamine sulfate can reverse. Check BNF for use in pregnancy (generally acceptable). Monitor APTT. |
Protamine sulfate | Ionically binds and neutralises heparin | 1 mg neutralises ~100 units of heparin (max 50 mg), give IV at ≤5 mg/min | N/A | Reversal of heparin-induced anticoagulation | Risk of anaphylaxis (especially if fish allergy), hypotension if infused rapidly; check with BNF for pregnancy considerations |
Warfarin | Vitamin K antagonist, inhibits vitamin K epoxide reductase and reduces synthesis of factors II, VII, IX, X | Rarely given IV; usually oral | Typically start at 5 mg PO daily, adjust per INR | Prevention/treatment of VTE, stroke prevention in AF, mechanical heart valves | Contraindicated in pregnancy (especially first trimester and near term), active bleeding, multiple drug interactions. Regular INR monitoring required. |
Apixaban (Eliquis) | Direct Factor Xa inhibitor | N/A |
AF stroke prophylaxis: 5 mg PO twice daily
VTE treatment: 10 mg PO twice daily for 7 days, then 5 mg PO twice daily |
Stroke prevention in AF, VTE treatment | Active bleeding, caution in severe hepatic impairment. Check BNF for pregnancy advice. |
Dabigatran (Pradaxa) | Direct thrombin (Factor IIa) inhibitor | N/A | AF stroke prophylaxis: 150 mg PO twice daily (adjust for renal function) | Stroke prevention in AF, VTE treatment | Active bleeding, contraindicated in patients with mechanical heart valves, check BNF for use in pregnancy. |
Rivaroxaban (Xarelto) | Direct Factor Xa inhibitor | N/A |
AF stroke prophylaxis: 20 mg PO once daily with food
VTE treatment: 15 mg PO twice daily for 21 days, then 20 mg PO once daily |
Stroke prevention in AF, VTE treatment | Active bleeding, severe hepatic impairment, check BNF for pregnancy advice. |
Vitamin K (Phytomenadione) | Essential cofactor for synthesis of vitamin K-dependent clotting factors | Serious bleeding on warfarin: 5–10 mg IV given slowly | Mildly elevated INR without significant bleeding: 2.5–5 mg PO | Warfarin reversal, correction of vitamin K deficiency | Rare hypersensitivity reactions with IV infusion, anaphylactoid reactions if infused rapidly. Consult BNF for pregnancy guidance. |
Idarucizumab (Praxbind) | Monoclonal antibody fragment that binds dabigatran, neutralising its effect | 5 g IV total (given as two 2.5 g doses no more than 15 min apart) | N/A | Reversal of dabigatran anticoagulant effect | Hypersensitivity reactions possible. Check BNF for pregnancy advice. |