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25 Cards in this Set
- Front
- Back
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what are the direct thrombin inhibitors? |
bilavlirudin, argatroban, lepirudin, dabigatran |
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what is aPTT? what does it tell you |
activated partial thromboplastin time, detects abnormalitities in blood clotting |
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how do you dose UFH in the treatment of a VTE? |
continuous infusion based on aPTT |
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what dose of enoxaparin is used for treating a VTE? |
1 mg/kg sc q12h |
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what is the dose of UFH for prohphylaxis of VTE? enoxaparin? |
5000 units sc q 8-12hrs 40 mg sc qd |
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what is the dose for prophylaxis of enoxaparin if major tramua? |
30 mg sc q12h |
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what unique non pharm thing can you do to prevent VTE if you are contraindicated to anticoagulants? |
vena cava filters and stockings |
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how long should you wait until you give LMWH post op? why not sooner? |
12-24 hours, more bleeding, and later would increase risk of clots |
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when is it okay to d/c the injectable anticoagulant for prophylaxis? |
after 5 days of combo anti coag with warfarin and INR is 2-3 |
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what are some of the disadvantages of UFH? advantages? |
unpredictable clearance and efficacy, need to monitor aPTT, higher chance of HIT, requires continous infusion, short half life completely reversed by protamine, cheap |
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what are the advantages of LMWH? disadvantages |
predictable efficacy and clearance, dont need to look at aPTT, less HIT, better for ambulation/going home long half life, renal adjust, expensive, now completely reversible |
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how long does it take to form HIT antibodies? how long till these dissapear after you d/c the drug? |
5 days 3 months |
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when should you suspect HIT? how long until you see this what are you at risk for when you have it? |
platelet drops by greater than 50% or is less than 120 and continues to fall with more use 5-14 days from start of anticoag both clotting and bleeding |
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how is HAT different than HIT? how long until you can tell can you continue the anticoag? |
platelet count does not continue to fall with continued use less than 5 days yes |
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what tests are done to diagnosis HIT? |
platelet activation using a serotonin release asssay and HIT antibody by ELISA |
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what does a negative ELISA test tell you? a positive test? what can you do to avoid the costs of these tests? |
neg makes HIT unlikely positive does confirm HIT determine if you really need them by doing a 4t score |
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how do you treat HIT? |
d/c the LMWH or UFH and use a DTI but not bilavuriduin start warfarin once platelets are above 150 |
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if your platelet count is low due to HIT, should you still anticoagulate? |
yes, still have a high chance of clotting |
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how soon should you start the drug therapy when switching from UFH to LMWH and LMWH to UFH |
asap because of the short half life wait to start b/c of the long half life |
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when should you use IV vitamin K? |
only in patients with life threatening bleeding, lots of anaphylaxis |
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what is the problem with IM vitamin K |
less predictable and can cause hematoma and warfarin resistance for a week |
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what is the best route for vitamin k reversal? what is the dose? |
oral, 2.5-5mg |
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if there is a drug interaction with warfarin, what should you do? |
possible reduce warfarin dose, switch the other drug, or d/c warfarin and add aspirin |
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how do you monitor efficacy for the anticoags? |
look for evidence of thrombosis, symptoms of DVT like swelking pain warmth in lower exteremeties or PE, chest pain SOB hemopysis |
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how do you monitor safety for the anticoags? |
bleeding, hematocirt, hemoglobin, BP, Platelt, aPTT/INR, kidney and liver function |
