What is the maintenance dose of Apixaban for recurrent DVT/PE?
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2.5 mg BD.
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What is the maintenance dose of Apixaban for recurrent DVT/PE?
2.5 mg BD.
Is aspirin recommended for primary prevention of cardiovascular disease (CVD)?
No, aspirin is not recommended.
What is the initial dose of Warfarin on Day 1?
5 to 10 mg.
Which demographic groups are at greater risk for CVD?
Men, individuals with a family history of CVD, South Asians, and those over 50 years old.
What is the maintenance dose range for Warfarin?
3 to 9 mg daily.
What is the threshold for prescribing statins for primary prevention?
A 10-year CVD risk greater than 10%.
What is the mechanism of action for Apixaban and Rivaroxaban?
Direct inhibitor of activated factor Xa.
What is the target INR range for Warfarin treatment?
2.5 to 3.5.
What is the initial dose of Warfarin on day 1?
5 – 10 mg.
Name two examples of risk calculators used in England/Wales.
QRISK2 and JBS3.
What is the cholesterol range for high-density lipoprotein (HDL) considered good?
Greater than 1 mmol/L.
What should be done for patients intolerant to statins or ezetimibe?
Refer for bile acid sequestrant, nicotinic acid, or a fibrate.
What is the dose of Edoxaban for adults weighing less than 61 kg?
30 mg OD.
What is the initial management for intracerebral haemorrhage?
Treat hypertension and avoid all medications.
What is the onset of action for Warfarin?
48 to 72 hours.
What are some causes of hyperlipidaemia?
Liver/kidney disease, family history of high cholesterol, hypothyroidism, lifestyle factors, and certain drugs.
What is the action to take for minor bleeding with an INR > 8?
Stop Warfarin and administer Vitamin K via slow IV injection.
What dietary changes should be avoided while on Warfarin?
Changes in intake of liver, sprouts, broccoli, green tea, salads, and leafy green vegetables.
What is the risk associated with combined anticoagulant and antiplatelet therapy?
Increased bleeding risk.
What should be done regarding antiplatelet therapy and Warfarin therapy?
Withhold antiplatelet therapy until Warfarin therapy is complete and vice versa.
What is the mechanism of action of antiplatelets?
Decrease platelet aggregation and inhibit thrombus formation in arterial circulation.
What does CVD stand for?
Cardiovascular Disease.
What are some modifiable risk factors for CVD?
Hypertension, abnormal lipids, obesity, diabetes mellitus, depression, low physical activity, poor diet, smoking, and excess alcohol.
What is the antidote for Warfarin?
Vitamin K.
What is the antidote for Warfarin?
Vitamin K [Phytomenadione].
What is the aim of treatment for CVD?
To prevent the occurrence of a CVD event by reducing modifiable risk factors through lifestyle changes and drug management.
What is the mechanism of action of statins?
Statins inhibit HMG CoA reductase in the liver.
What are the criteria for reducing the dose of Apixaban?
Age > 80 years, body weight < 60 kg, serum creatinine > 133 micromol/L.
What is the role of Aspirin in cardiovascular disease?
Secondary prevention of established CVD.
What is the drug of choice for anticoagulation?
Warfarin.
What is the antidote for Apixaban and Rivaroxaban?
Andexanet alfa [Ondexxya].
How should Warfarin be adjusted for elderly patients?
They should receive a lower induction dose.
What should be avoided with Warfarin due to increased INR?
Cranberry juice and pomegranate juice.
What effect do enzyme inhibitors have on Warfarin?
They increase Warfarin concentration and INR.
What should be monitored in long-term management of stroke?
Blood pressure, targeting <130/80 mmHg.
What is a key characteristic of Heparin?
Rapid but short anticoagulation.
What is the indication for Dipyridamole?
Prophylaxis of thromboembolism associated with prosthetic heart valves.
What is the recommended lipid-lowering drug for patients with a 10-year CVD risk greater than 10%?
Atorvastatin at a low dose.
What should be done in case of major bleeding while on Warfarin?
Stop Warfarin and administer Vitamin K via slow IV injection and/or dried prothrombin complex/fresh frozen plasma.
What is the prophylactic dose of Rivaroxaban for knee replacement?
10 mg OD for 2 weeks.
What is the initial management for TIA?
Immediately give Aspirin 300mg + PPI and arrange assessment by a specialist stroke physician.
What is the initial dose of Dabigatran for adults aged 18-74 after knee replacement?
110 mg for 1 – 4 hours after surgery, then 220 mg OD for 10 days.
What is the mechanism of action for Warfarin?
Inhibits Vitamin K, decreasing clotting factors 2, 7, 9, and 10.
When should statins be discontinued in renal impairment?
If elevated creatinine kinase indicates signs of myopathy.
What is the indication for Clopidogrel?
Prevention of atherothrombotic events such as Ischaemic stroke and ACS.
What blood pressure level indicates the need for antihypertensives in high-risk patients?
Blood pressure greater than 140/90 mmHg.
Which medications are used for secondary prevention of CVD to prevent strokes?
Low dose aspirin, clopidogrel, and dipyridamole.
What is the antidote for Dabigatran?
Idarucizumab [Praxbind].
What is the initial treatment dose of Rivaroxaban for VTE/PE?
15 mg BD for 21 days.
What is the diagnosis threshold for hyperlipidaemia?
Cholesterol level greater than or equal to 6 mmol/L.
What is the first-line treatment for non-AF patients in long-term management of TIA and Ischaemic Stroke?
Clopidogrel 75mg OD.
What is the recommendation for statin use in patients with hepatic impairment?
Caution in liver disease; avoid in active liver disease or unexplained persistent elevations in serum transaminases.
When should Simvastatin, Fluvastatin, and Pravastatin be taken?
Nighttime.
What is the mechanism of action of Warfarin?
Antagonizes vitamin K.
What is the maintenance dose of Warfarin?
3 – 9 mg at the same time each day.
What condition is common in patients with renal disease related to Warfarin?
Calciphylaxis.
What effect do enzyme inducers have on Warfarin?
They reduce Warfarin concentration and INR.
What combination should be avoided due to increased risk of rhabdomyolysis?
Statin + Gemfibrozil.
What is the adult dose of Apixaban for stroke prophylaxis?
5 mg BD, reduced to 2.5 mg BD for certain patients.
When can Atorvastatin and Rosuvastatin be taken?
Anytime.
What is the target reduction in non-HDL cholesterol for patients on atorvastatin?
A reduction greater than 40%.
What is the purpose of risk calculators in CVD?
To predict the likelihood of a CVD event occurring and determine whether a statin should be given for primary prevention.
What are the three types of strokes?
What is the prophylactic dose of Apixaban for hip replacement?
2.5 mg BD for 28 – 32 days.
What is the risk associated with Warfarin during pregnancy?
Teratogenic effects and increased risk of hemorrhage.
What is the prophylactic dose of Dabigatran for stroke?
110 – 150 mg BD.
What advice should be given to patients regarding muscle symptoms while on statins?
Report ASAP for unexplained muscle pain, tenderness, or weakness.
What are some disorders included in CVD?
Atherosclerosis, thrombosis, CHD (angina & MI), stroke, peripheral arterial disease, and aortic disease.
Which statin is preferred over simvastatin due to myopathy risk?
Atorvastatin.
What is the antidote for Heparin?
Protamine.
What is the second-line treatment for Familial Hypercholesterolaemia?
Ezetimibe.
What is the mechanism of action for Edoxaban?
Direct and reversible inhibitor of activated factor Xa.
What should be done regarding statin use in pregnancy?
Avoid statins and discontinue 3 months before attempting to conceive.
What is the recommended statin for stroke patients?
High Intensity statin, e.g., Atorvastatin (20 – 80 mg) 48 hours after stroke.
What is the dosing recommendation for MR capsules of Dipyridamole?
200 mg BD with food.
What are some indications for Warfarin use?
Prophylaxis of embolization in rheumatic heart disease and AF, prophylaxis after insertion of prosthetic heart valve, prophylaxis and treatment of VTE, PE, TIAs.
What are the colors of Warfarin tablets and their corresponding dosages?
0.5mg - white, 1mg - brown, 3mg - blue, 5mg - pink.
What is the LDL cholesterol reduction percentage for atorvastatin at a dose of 80 mg?
55%.
What additional risk factors does QRISK3 consider?
CKD stage 3+, migraine, corticosteroid use, SLE, atypical antipsychotic use, severe mental illness, erectile dysfunction, and systolic BP variability.
What is the duration for administering Alteplase in Ischaemic Stroke?
Within 4.5 hours for 24 hours.
Which combination has a higher bleeding risk: Clopidogrel + Warfarin or Aspirin + Warfarin?
Clopidogrel + Warfarin.
Why is Heparin suitable for patients at high bleeding risk?
Its effects can be stopped rapidly by stopping the infusion.
What are the first-line treatments for Familial Hypercholesterolaemia?
High-intensity statins (Atorvastatin/Rosuvastatin) for > 50% LDL reduction.
What should be given if a patient is intolerant to Aspirin?
Clopidogrel 75mg OD (unlicensed).
What is the mechanism of action for Dabigatran?
Direct thrombin inhibitor with a rapid onset of action.
What are examples of LMWH?
Dalteparin, Enoxaparin, Tinzaparin.
What lifestyle changes should be advised to stroke patients?
Modify diet, exercise, weight, and reduce alcohol/smoking.
What is a significant advantage of LMWH over Heparin?
Lower risk of HIT and no monitoring required.
What does the acronym F.A.S.T stand for in recognizing signs of stroke?
F (Face Drop), A (Arm Weakness), S (Speech Slurred), T (Time to Dial 999).
What should be given with Aspirin to reduce high bleeding risk?
Proton Pump Inhibitor (PPI).
