Rivoroxaban

Good knowledge of drug pharmacology forms the basis of good clinical practice. While discussing each and every drug there is out there is out of the scope of this blog, today we shall talk briefly about Rivoroxaban.


Rivoroxaban

• Direct anti-Xa inhibitor
• Administered orally and has good bioavailability
• Unlike warfarin, it does NOT require regular monitoring, and the dose remains the same to achieve adequate anti-coagulation
• It is currently approved for use in Atrial fibrillation (ROCKET-AF)
• It is also useful in prevention of venous thromboembolism

From an MRCP point of view, clinical pharmacology forms a reasonable proportion of the exam. Make sure you get a good book with questions, rather than read a textbook. There are not many out there, here are a few:

There are more books available, but they all remain rather ancient, with no recent editions in the last 5 years.  The books listed about are cheap and affordable. Definitely spend a lot of time with clinical pharmacology. It is as important as basic sciences (see our basic sciences post), so find a study partner, and study hard! Its well worth studying pharmacology this way rather than reading a huge textbook with a lot of unnecessary information - well, from an exam point of view.

All the best! Next exam 11th September (kind of a jinxed date, isn't it!)

Clinical scenario - as promised!

Today's question is courtesy of Dr Ramachandra, senior SpR Cardiology, Leeds.

A 60 year old Asian man with a history of type 2 diabetes on insulin and hypertension presents with deteriorating renal function and is referred by his GP to the renal clinic. In the renal clinic, he is found to have leg oedema, elevated JVP with rapid x-descent, ascites, mild jaundice and bi-basal dullness. Chest X-ray shows cardiomegaly. ECG shows left ventricular hypertrophy with strain.  Resting heart rate was 100 bpm and BP of 90/70. The definitive cardiac diagnosis can be obtained by -

a. Cardiac MRI
b. CT pulmonary angiography
c. Ventilation-perfusion scan
d. Transthoracic echocardiography
e. Right and left heart catheterisation

In the patient above, which of the following observation is likely to be true?

a. Absent contrast reflux into the hepatic vein on CTPA
b. Pulsus paradoxus of 30 mmHg on clinical examination
c. Paradoxical septal motion on transthoracic echocardiography
d. Myocardial speckling on CMR
e. Pulmonary capillary wedge pressure of 15mmHg on cardiac catheter

Put your thinking caps on! Answer in a week!

Cardio4mrcp team.