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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Notes:

Chapter complete - updated July 18

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02.08.01  Expand sub section  Parenteral anticoagulants
Anticoagulant Citrate Dextrose Solution (ACD-A)
 Track Changes
Restricted Drug Restricted

ACD-A is in a pre-made infusion bag and therefore does not have to be prepared in comparison to Heparin.

Reduced cost in comparison to Heparin Saline

Reduces human error as the product does not have to be prepared before use.

Reduces risk of needlestick injury

Can be used in patients where Heparin in contraindicated

Reduced risk of bleeding

Can be used in patients where systemic anticoagulationis contra-indicated

 

 
   
02.08.01  Expand sub section  Heparin
 note 

Heparin initiates anticoagulation rapidly but has a short duration of action. It is often referred to as 'standard' or heparin (unfractionated) to distinguish it from the low molecular weight heparins, which have a longer duration of action. Although a low molecular weight heparin is generally preferred for routine use, heparin (unfractionated) can be used in those at high risk of bleeding because its effect can be terminated rapidly by stopping the infusion.

Heparin
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Formulary
  • Available as injection
 
   
02.08.01  Expand sub section  Low molecular weight heparins
 note 

Low molecular weight heparins are usually preferred over heparin (unfractionated) in the prevention of venous thromboembolism because they are as effective and they have a lower risk of heparin-induced thrombocytopenia. The duration of action of low molecular weight heparins is longer than that of heparin (unfractionated) and once-daily subcutaneous administration is possible for some indications, making them convenient to use.

Enoxaparin (Clexane or Inhixa)
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Formulary
  • Available as injection
    • 20mg/0.2mL ££/10 injections
    • 40mg/0.4mL ££/10 injections
    • 60mg/0.6mL ££/10 injections
    • 80mg/0.8mL £££/10 injections
    • 100mg/1mL £££/10 injections
    • 120mg/0.8mL £££/10 injections
    • 150mg/1mL £££/10 injections
  • Clexane is the brand of choice, Inhixa a biosimilar is used when there are stock shortages of Clexane
 
   
02.08.01  Expand sub section  Heparin flushes
 note 

The use of heparin flushes should be kept to a minimum. For maintaining patency of peripheral venous catheters, sodium chloride injection 0.9% is as effective as heparin flushed. The role of heparin flushes in maintaining patency of arterial and central venous catheters is unclear.

Heparin
(flush)
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Formulary  
   
02.08.01  Expand sub section  Epoprostenol to top
 note 

Epoprostenol (protacyclin) can be given to inhibit platelet aggregation during renal dialysis when heparins are unsuitable or contra-indicated. It has a short half-life of approximately 3 minutes and therefore it must be administered via continuous IV infusion. 

Epoprostenol
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Formulary
Red SO
  • Available as injection 500mcg ££/1 vial
 
   
02.08.01  Expand sub section  Fondaparinux
 note 

Fondaparinux sodium is a synthetic pentasaccharide that inhibits activated factor X. It has been used occasionally when patients have been found to have an allergic reaction to LMWH.

Fondaparinux
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Restricted Drug Restricted
  • Available as injection
    • 1.5mg/0.3mL £££/10 injections
    • 2.5mg/0.5mL £££/10 injections
    • 7.5mg/0.6mL ££££/10 injections
  • To be used when Enoxaparin unsuitable/not tolerated
 
   
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red SO

SPECIALIST ONLY - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Green SI

SPECIALIST INITIATED - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patients GP following communication from the specialist.   

Green SA

SPECIALIST ADVISED Specialists may simply advise a patients GP to initiate these drugs themselves after they have made an initial assessment.   

Amber SC

SHARED CARE - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]   

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