Hey welcome back to the real-life pharmacology podcast this is eric christensen pharmacist and today we’re going to cover a pic seban which is an anticoagulant brand-name eliquis and starting off with its mechanism of action this drug inhibits the clotting factor 10a now clotting factors are kind of what they sound like they’re very very important in the clotting
Cascade and the formation or production of a blood clot so these drugs inhibit that production of a blood clot which can obviously be good in certain situations where we’ve got a clot that causes a stroke or causes dvt for example or a pe pulmonary embolism these drugs can help prevent that and or treat that in certain situations so when we go through that mechanism
The obvious downside or potential for concern is that we thin out the blood and thin it too much so bleed risk is a big big concern with any anticoagulant this one is a newer somewhat newer anticoagulant maybe five ten years old now at this point but in comparison to warfarin obviously is much much newer agent that leads to the potential downside of cost issues so
These drugs are much much more expensive as far as just the the pill compared to warfarin unique advantages okay so why would we in a patient with atrial fibrillation at risk for thromboembolic stroke why would we use these drugs instead of warfarin if they’re more expensive so the really nice thing about these this drug in particular and i’ll talk about some of
The others like rivaroxaban on an upcoming podcast but with a pic seban and the others these drugs have a stable dose so with a fixed dose patients do not need to come in and get their inr done so that’s probably the biggest advantage from a patient adherence convenience type perspective is that we don’t have to monitor that inr now with that said i’ve had a lot of
Patience and practice that are not adherent with medications and you may not be very comfortable with a medication where we don’t have to monitor that inr because that inr does tell us a story and can help us potentially identify if there’s adherence issues or other concerns going on that have led to kind of altered concentrations in the blood so just kind of keep
That in mind that certainly it’s a very nice patient convenience not to have to check i on ours but in the situation where we’re questioning if they can adhere to therapy or there’s a reason to question that that can be helpful to check that inr even though it’s inconvenient for the the patient comparing a picc seban to warfarin the onset of action of anticoagulant
Action is much much quicker for pics of ends so that is certainly nice warfarin takes a few days usually to kind of get up to speed at least and get into that therapeutic level the cost issue kind of talked about differences there and side-effect profile so we do not monitor inr with apixaban or eliquis however it is very important to you know monitor periodic cbc
Risk of bleeding you know bruising things of that nature and also keep an eye out for drug interactions which i’ll talk about here after the break common uses so prevention of stroke in patients with atrial fibrillation and dvt or deep vein thrombosis or pulmonary embolism prophylaxis or treatment those are the the two biggie’s and very common things there remember
With atrial fibrillation we’ve got that chance to vasque scoring to determine whether patients are at risk and how great is their risk in patients who have atrial fibrillation so important to always remember that now i did mention that there is fixed dosing with a pixiv and compared to warfarin however that does come with a caveat so the three big things i remember
With dosing is the patient if they have two out of the three following things that i’m going to talk about the dose and atrial fibrillation should be reduced to two point five milligrams twice per day now there’s other clinical factors and different things too like drug interactions that can impact what you might see or what you might do clinically but those three
Big factors you need to look out for age 80 so age greater than 80 very important one to remember kidney function so if their creatinine it’s greater than one point five that’s another one to remember and weight so very light patients less than 60 kilograms so i remember eighty 61.5 i just kind of put that at my head so if you’re taking you know pharmacology exam
Or preparing for boards or you know whatever you’re doing you’re preparing for eighty 61.5 is a good way that i try to remember those numbers okay creatinine 1.5 1.5 in the the wait 60 so definitely remember that if you’ve got two out of those three the dose should be reduced so kind of a unique dosing situation there so we’re gonna get into drug interactions but
I want to make note that i have updated nap plex bcps bc acp bc gp study material content so if your pharmacist pharmacy student looking ahead to 2019 i have historically updated my study material content in the september november timeframe so those are all up to date ready to go with your seeking board certification for a pharmacist in any way shape or form so
Now plex bcps bc acp and b c gp content is ready to go and you can find that at med ed 101 dot-com now let’s get into drug interactions and when i think about a pic seban and drug interactions i definitely feel a little bit more comfortable than i do with something like warfarin warfarin tends to have a lot more drug interactions however there definitely are some
Significant ones with a pic seban that you should think about and just a little tip you know maybe you’ve got a patient history or you know their medical background a little bit so what i think of is seizure disorder hiv and potential cardiac arrhythmias and things like that if you see any of those potential diagnoses and maybe potentially also an infection of
Some sort if you see any of those potential diagnosis in a patient that’s taking a pic seban definitely be sure to check their medication list so there’s hiv meds that can interact with a picc sub and you’ve got to remember that there’s an old enzyme inducers so like carbamazepine for example that can definitely increase or cause an interaction with a pic seban
And actually lower blood concentrations of the drug potentially leading you to a pro clotting type situation refampin is another kind of classic enzyme deucer st. john’s wort amiodarone can sip 3 a 4 inhibitor can increase concentrations you know making patients more prone to bleeding for example so those are kind of some of the drugs that that i think about when
I think of a patient on a picc seban that i’m keeping an eye out for again not a totally exhaustive list but definitely something you should think about and look up if you’re not sure of course any medication that increases the risk of bleeding that is going to be a potential concern or a monitoring sticking point that we should be paying attention to so you got a
Patient on aspirin you had a patient on plavix those are two commonly prescribed antiplatelet medications other things i think about over-the-counter nsaids classic classic example of a medication that could cause a gi bleed that it picks a man thinning the blood could even kind of ratchet up that risk so i think that gives you a good sense of some drug interactions
And some things to think about with a picc sub m i think that’ll wrap it up today remember got that free giveaway it’s a 31 page pdf on at real life pharmacology dot-com go check that out if you love the podcast leave us a rating and review on itunes or wherever you’re listening i’m incredibly incredibly important to us and and greatly appreciated certainly for
Those of you that have so we’ll wrap it up for today thanks for listening take care and have a great rest of your day
Transcribed from video
Apixaban Pharmacology By Eric Christianson
