Oral dvt agents
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This document summarizes several oral anticoagulant medications used to treat and prevent deep vein thrombosis. It discusses aspirin, warfarin, dabigatran, rivaroxaban, apixaban, and endoxaban. For each drug, it provides information on mechanisms of action, dosages, side effects, and contraindications. The document aims to concisely outline the key details of these common oral DVT agents for medical professionals.
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Reverse shoulder arthroplasty involves replacing the humeral head and glenoid fossa with prosthetics to alter the center of rotation and increase deltoid tension and function. It is indicated for rotator cuff tear arthropathy, proximal humeral fractures in the elderly, failed shoulder replacements, and other conditions. The procedure involves an deltopectoral approach to expose the joint, removal of the humeral head and shaping of the glenoid, then implantation of the glenosphere and humeral cup components. Outcomes are best for osteoarthritis and worse for trauma or revision cases. Complications can include infection, nerve injury, implant loosening or breakage.
Prolapsed intervertebral disc
The intervertebral disc consists of three main components: the cartilage end plates, the nucleus pulposus, and the annulus fibrosus. Degeneration of the intervertebral disc is a natural aging process but can be exacerbated by factors like poor nutrition, trauma from sports or injuries, and biomechanical factors related to posture and repetitive microtrauma. The degenerative process typically begins with softening of the nucleus pulposus and weakening of the annulus fibrosus, which can lead to protrusion or extrusion of the nucleus through tears in the annulus. Eventually fibrosis and calcification may occur as the body attempts to repair the degenerated disc.
Pre operative care
The document outlines the steps involved in pre-operative care, which includes conducting a pre-anaesthetic checkup of the patient's medical history and current health status. A series of blood investigations, imaging tests like ECG, ultrasound, and radiological tests are performed. The patient's medication needs and consent for the procedure are also addressed. The pre-operative preparation involves both physical and psychological preparation of the patient by explaining the procedure and potential complications to calm them before surgery.
Plantar fascitis
Plantar fasciitis is a painful condition caused by inflammation of the plantar fascia, a thick ligament connecting the heel to the toes. The pain is usually felt on the bottom of the foot near the heel and is worst upon waking or after long periods of sitting. Repeated microtears in the fascia from overuse can cause degeneration and inflammation. Risk factors include obesity, excessive running or prolonged standing, especially with inadequate foot support. Treatment focuses on reducing inflammation and strain through stretching, orthotics, night splints, and physical therapy exercises.
Pigmented villonodular synovitis
Pigmented villonodular synovitis is an idiopathic overgrowth and pigmentation of the synovial membrane that most commonly affects the knee joint. It presents with pain, swelling, stiffness, and recurrent atraumatic hemorrhaging in the joint. Diagnosis is made through arthroscopic biopsy showing characteristic chocolate-colored lesions. Treatment involves surgical synovectomy or radiation therapy, with recurrence being a potential complication.
Pes cavus
This document defines and describes cavus foot, including its causes, clinical features, diagnosis, and treatment options. A cavus foot has an abnormally high arch and accompanying toe deformities. Causes include neuromuscular conditions like Charcot-Marie-Tooth disease and polio. Clinical features include a high arch and clawing of the toes. Diagnosis involves physical exam and x-rays. Treatment depends on flexibility and severity but may include tendon lengthening, osteotomies, and joint fusions to correct deformities in the forefoot, midfoot, and hindfoot. The goal is to create a plantigrade foot.
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Oral dvt agents
- 3. Names • 1)Aspirin • 2)Warfarin • 3)Dabigatran • 4)Rivaroxaban • 5)Apixaban • 6)Endoxaban
- 4. Aspirin • Aspirin or acetyl salicylic acid is an Oral DVT agent used. Mechanism of action: Non selective cyclooxygenase enzyme inhibitor, cyclooxygenase enzyme is responsible to generate thromboxane A2 from arachadonic acid. Dose-75/150 mg once daily
- 6. Side effects • 1)Bleeding • 2)GI-Nausea, vomiting,Gi Bleeding • 3)Reyes syndrome-Encephalopathy and fatty liver • 4)Allergic reactions-Itching, urticaria,hives • 5) Tinnitus • 6) Hyperkalemia and respiratory alkalosis.
- 7. Warfarin/Coumadin • Mechanism of action-Vitamin K epoxide reductase so blocks carboxylation of factors 2,7,9,10 • Was used as rat poison in 1948 • Antidote-Vitamin K
- 9. Dosage • Standard dosage of 5-10 mg. • Initiate warfarin on day 1 or 2 of LMWH therapy • • Overlap warfarin and parenteral anticoagulant for atleast 5 days until desired INR(>2.0) maintained for 24 hours the discontinue heparin. • Check INR after 2 days and adjust dose according to results
- 10. Side effects of warfarin • 1)Bleeding • 2) Teratogenic-Avoid in pregnancy.Associated with spontaneous abortion,still births,preterm births • 3)Purple toes syndrome-Cholesterol deposits breaking lose causing embolisms in blood vessels of toes and feet. • 4)Fetal warfarin syndrome-Nasal hypoplasia, depressed nasal bridge,scoliosis, calcifications in vertebral column,heel. • 5) Brachydactyly-Short fingers and toes. • 6) Osteoporosis • 7)Warfarin necrosis
- 11. Precautions To be taken 1)Avoid Nsaids-Increases risk of GI bleed 2)Avoid macrolide antibiotics, methotrexate 2)Avoid alcohol consumption 3)Monitor INR of the patient.
- 12. Dabigatran/Pradaxa • Mechanism of action-Direct thrombin inhibitor
- 14. • -Dosage-150 mg orally BD • 75 mg twice daily in patients with impaired renal function. • Side effects • 1)GI bleeding-As Dabigatran capsules contain tartaric acid which lowers gastric pH required for absorption. • 2) Anaphylaxis • 3) Contraindication-Pregnancy • • Antidote-Idanicizumab
- 16. • Dosage-15 mg BD • Side effects-Bleeding • Anaphylaxis • Spinal haematoma • Black box warning-Drug Not to be discontinued before consulting doctor.
- 17. Apixaban/Eliquis
- 18. • Mechanism of action-Factor 10 a inhibitor • Dosage-10 mg BD for 7 days followed by 5 mg BD daily • Side effects-Bleeding • Anaphylaxis • GI upset • Contraindication-Pregnancy
- 19. Endoxaban/Lixiana • Factor 10a inhibitor-Mechanism of action • Dose-60 mg daily after 5 days of parenteral anticoagulation • Side effects-Bleeding, Haematuria, haemoptysis,rashes,headache, dizziness • • Contraindication-Pregnancy
- 20. • Thank you.