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12 Cards in this Set

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In VTE Prophy -- If a patient's CrCl is <30 mL/min what drug_____
what dose_____
what freq_____ is preferred?
Heparin/5000 units sq q8-12hrs
Arixtra is contraindicated
A patient is going for Abdominal Surgery -- what is the proper VTE prophy dose for Fragmin?
See dosing card - Fragmin 2500 units SC starting 1-2 hours prior to surgery, then every 24 hrs
Lower dose than other indications
If a patient is having abdominal surgery *(*Malignancy or High risk) and the MD wants to use Fragmin -WHAT DOSE do you recommend?
Fragmin 5000 units SC q 24hrs, starting the evening prior to surgery, then q 24h
Abdominal Surgery, but Hi Risk or Malignancy - (higher dose)
What dose of Fragmin do you recommend for a pt needing VTE prophylaxis -- pt has resticted mobility/acute illness
Fragmin 5000 units SC q24hrs
Assuming CrCl >30, what dose do you recommend with FRAGMIN for DVT/PE TREATMENT, ?
Fragmin 200 Units/kg SC q24h

*If dose = 18K/24h, (pt >198lbs), consider divided; 100 Units/kg q12h
For the normal patient, nl renal; what DOSE of Fragmin for Therapeutic Anticoag for Unstable Angina/Non-Q-Wave MI?
Caveat?
120 Units/kg, SC, q12h
Pkg insert: cap dose @ 10K q12h but obese pts w/capped doses may risk higher event rates (2.5 vs 0.8% in FRISC)
* Cardiologists prefer Wt Based Heparin until ?PCI is answered (Percutaneous Coronary Intervention; most common = baloon angeoplasty & stenting)
Dose Fragmin in nl wt, nl renal pt for Unstable Angina/non-Q wave MI
What would Cardiology pref?
120 Units/kg q12h; pkg insert says cap at 10K q12h, but FRISC found >events in obese pts capped at 10K (2.5 vs 0.8%) ** Cardilogy would prefer unfractionated Heparin **
When answering a question related to a patient scenario (on the test and in your day-to-day work), consider the following:
-what's the indication?
-does the patient have renal impairment?
-is the patient very small (<50 kg) or very large?
Fragmin - for the very small patients (<60 kg) and for very large doses (>/= 19,000 units, with 2 exceptions) will we need to:
draw up doses from the multidose vials.
We shouldn't see very many doses of Fragmin >19,000 because:
We are encouraging physicians to split the highest weight based dose, 200 units/kg q24hrs, into 100 units/kg q12hrs if the dose exceeds 18,000.
What strengths? When?
The new, larger prefilled syringes of dalteparin :
(12,500 - 15,000 - 18,000) is scheduled for mid to late August 07
Which syringes do I expell the air bubble?
Arixtra - do NOT expel the air bubble
Fragmin:
- prefilled syringes: do NOT expel the air bubble
- prefilled, graduated 10,000 units/1 mL: EXPEL the air bubble and any medication necessary to achieve pt specific dose