Edrophonium and Atropine and Venclexta

• Generic Name: atropine / edrophonium
• Dosage Forms: n.a.
• Other Brand Names:

Reduction in the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.

Do not use in patients with Clcr >95 mL/minute. (See Boxed Warning.)

Noninferior to well-controlled (mean time in therapeutic INR range: 65%) warfarin therapy in preventing stroke and systemic embolism, and associated with lower rates of bleeding and cardiovascular death.

The American College of Chest Physicians (ACCP), American Stroke Association (ASA), ACC, AHA, and other experts recommend antithrombotic therapy in all patients with nonvalvular atrial fibrillation considered to be at increased risk of stroke, unless contraindicated.

Choice of antithrombotic therapy based on patient's risk for stroke and bleeding; in general, oral anticoagulant therapy recommended in patients who have a moderate to high risk for stroke and acceptably low risk of bleeding; consider aspirin or no antithrombotic therapy in patients at low risk. Patients at increased risk of stroke generally include those with prior ischemic stroke or TIA, advanced age (e.g., ≥75 years), history of hypertension, diabetes mellitus, or CHF. In addition, female sex considered an important risk factor for stroke in patients with atrial fibrillation, particularly in patients ≥75 years of age.

Although warfarin traditionally has been used for oral anticoagulation in patients with atrial fibrillation at increased risk of stroke, non-vitamin K antagonist oral anticoagulants such as edoxaban may be useful alternatives in selected patients at moderate to high risk of stroke who are unable to comply with warfarin monitoring requirements or in whom a consistent therapeutic response to warfarin cannot be achieved; warfarin may still be preferred in patients who are optimally managed and have well-controlled INRs.

Relative efficacy and safety of the non-vitamin K antagonist oral anticoagulants (e.g., apixaban, dabigatran, edoxaban, rivaroxaban) remain to be fully elucidated.

When selecting an appropriate anticoagulant, consider factors such as the absolute and relative risks of stroke and bleeding; costs; patient compliance, preference, tolerance, and comorbidities; and other clinical factors such as renal function and degree of INR control (if the patient has been taking warfarin).

Safety and efficacy of edoxaban not established in patients with mechanical heart valves or moderate to severe mitral stenosis; use not recommended in such patients.

Treatment of DVT and/or PE, following initial treatment with a parenteral anticoagulant for 5–10 days.

Noninferior to warfarin in reducing the risk of recurrent venous thromboembolism; associated with substantially reduced rates of clinically important bleeding.

• Generic Name: venetoclax
• Dosage Forms: tablets
• Other Brand Names: Venclexta, Venclexta Starting Pack

Venclexta (venetoclax) inhibits a certain protein in cancer cells (abnormal lymphocytes produced in chronic lymphocytic leukemia) that helps keep those cells alive and makes them resistant to chemotherapy. Venetoclax binds to this protein, which helps kill the cancerous lymphocytes in blood and bone marrow.

Venclexta is used to treat chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia (SLL) in adults with or without 17p deletion (a specific genetic marker). Venclexta is sometimes used in combination with rituximab to treat these conditions.

Venclexta is also used in combination with azacitidine, decitabine, or cytarabine to treat acute myeloid leukemia. This combination is for use in adults who are 75 years or older, or who cannot use standard chemotherapy due to other medical conditions.

Venclexta is sometimes given after other treatments have failed.