Prescription: Apixaban & Dalteparin: Non-Valvular AF

PLAB 2 CaseBank
1

You are FY2 in medicine Department
Mr. john, 82 years old, has admitted in hospital with COPD. Now he has been diagnosed with non-valvular AF.

Other information
Pt had CABG 10 years ago.
His serum creatinine is 135 micromole/liter.

Pt has already been prescribed with dalteparin. Now consultant has asked you to give apixaban and atenolol.

Write down prescription for above medications.

Special note
none

(In this prescription doxycycline and dalteparin will be prefilled)

Shortcut:

  1. Regular: Apixaban 2.5 mg PO BD
  2. Regular: Atenolol 50mg PO OD
  3. Stop Dalteparin: In date section: Stopped on (exam date) by Dr (last name) GMC number

Explanation:

  1. For prophylaxis of stroke in Non-valvular AF
    – Apixaban Normally 5 mg BD
    – Reduce dose to 2.5 mg BD in pt with at least two of the following criteria:

    1. Age- more or equal to 80
    2. Weight- equal or less to 60
    3. S. Creatinine- equal or more to 133 micromole/liter.

  2. For arrhythmia
    – Atenolol: Starting dose is 50 mg OD, If eGFR greater than 15.
    – If eGFR is less than 15, we reduce dose to 25 mg OD.
    – If we dont know the GFR , we can prescribe 50 mg OD as this is the usually starting dose.

Note: Hold Aspirin and Dalteparin, while on Apixaban due to drug interactions.

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