The drugs the bank asks about most: uses, adverse effects, monitoring, interactions and the exam trap for each.
| Aspect | Notes |
|---|---|
| Class | Vitamin K antagonist (blocks factors II, VII, IX, X and proteins C and S) |
| Main uses | Mechanical valves, AF with moderate-severe mitral stenosis, VTE, LV thrombus, antiphospholipid syndrome |
| Key adverse effects | Bleeding; skin necrosis in early therapy (protein C deficiency); teratogenic (embryopathy, weeks 6-12) |
| Monitoring | INR. Target 2-3 for AF/VTE. Mechanical valve (ESC): aortic without risk factors 2.5; mitral, or aortic with risk factors 3.0 |
| Contraindications / interactions | INR up (enzyme inhibitors): amiodarone, macrolides, fluconazole, metronidazole, ciprofloxacin, TMP-SMX. INR down (inducers): rifampicin, carbamazepine, phenytoin. Avoid in pregnancy (use LMWH) |
Reversal: minor bleed or high INR = hold ± oral vitamin K; major bleed = IV vitamin K 5-10 mg + 4F-PCC.
| Aspect | Notes |
|---|---|
| Class | Activate antithrombin (UFH: anti-IIa and anti-Xa; LMWH: mainly anti-Xa) |
| Main uses | ACS, VTE treatment and prophylaxis, bridging, anticoagulation in pregnancy (LMWH), acute limb/mesenteric ischemia (UFH) |
| Key adverse effects | Bleeding; HIT (day 5-10, platelets fall > 50%, thrombosis); hyperkalemia (aldosterone suppression); osteoporosis with long use |
| Monitoring | UFH: aPTT. LMWH: anti-Xa only in renal failure, pregnancy, extreme weight. Platelets for HIT |
| Contraindications / interactions | UFH preferred if CrCl < 30, high bleeding risk or possible thrombolysis/surgery (short half-life, fully reversible). Protamine fully reverses UFH, only partly LMWH |
| Aspect | Notes |
|---|---|
| Class | Direct factor Xa inhibitors (-xaban); direct thrombin inhibitor (dabigatran) |
| Main uses | Non-valvular AF, DVT/PE treatment and prevention |
| Key adverse effects | Bleeding (GI bleeding more with dabigatran and rivaroxaban); dyspepsia with dabigatran |
| Monitoring | Renal function (CrCl) and hemoglobin at least yearly; more often in elderly or CKD |
| Contraindications / interactions | Avoid: mechanical valves, moderate-severe mitral stenosis, pregnancy, triple-positive antiphospholipid syndrome, CrCl < 15 (dabigatran mostly renal - avoid < 30). Rifampicin and strong CYP3A4/P-gp drugs interfere |