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12 Cards in this Set
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- Back
- 3rd side (hint)
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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
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Arixtra is contraindicated
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A patient is going for Abdominal Surgery -- what is the proper VTE prophy dose for Fragmin?
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See dosing card - Fragmin 2500 units SC starting 1-2 hours prior to surgery, then every 24 hrs
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Lower dose than other indications
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If a patient is having abdominal surgery *(*Malignancy or High risk) and the MD wants to use Fragmin -WHAT DOSE do you recommend?
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Fragmin 5000 units SC q 24hrs, starting the evening prior to surgery, then q 24h
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Abdominal Surgery, but Hi Risk or Malignancy - (higher dose)
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What dose of Fragmin do you recommend for a pt needing VTE prophylaxis -- pt has resticted mobility/acute illness
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Fragmin 5000 units SC q24hrs
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Assuming CrCl >30, what dose do you recommend with FRAGMIN for DVT/PE TREATMENT, ?
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Fragmin 200 Units/kg SC q24h
*If dose = 18K/24h, (pt >198lbs), consider divided; 100 Units/kg q12h |
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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) |
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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 **
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When answering a question related to a patient scenario (on the test and in your day-to-day work), consider the following:
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-what's the indication?
-does the patient have renal impairment? -is the patient very small (<50 kg) or very large? |
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Fragmin - for the very small patients (<60 kg) and for very large doses (>/= 19,000 units, with 2 exceptions) will we need to:
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draw up doses from the multidose vials.
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We shouldn't see very many doses of Fragmin >19,000 because:
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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.
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What strengths? When?
The new, larger prefilled syringes of dalteparin : |
(12,500 - 15,000 - 18,000) is scheduled for mid to late August 07
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Which syringes do I expell the air bubble?
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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 |
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