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37 Cards in this Set
- Front
- Back
- 3rd side (hint)
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In a patient with long term steroid use consider _______ and initiate |
-suppression of the HPA axis - prophylactic stress-dose steroids |
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What does prophylactic stress dose steroid mean? |
Steroid dose in addition to normal doses |
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Exogenous steroid use causes _________ by inhibition of ______ |
Adrenal Atrophy Corticotropin-Adrenocorticotropic hormone- corticosteroid loop |
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Anticoagulants to be aware of in elective surgery are: |
- anti platelet agents - vitamin K antagonists -oral anti- thrombin agents - oral anti-factor Xa agents |
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What is warfarin MOA? |
Disrupts vitamin K cycle and synthesis of clotting factors |
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Warfarin has a half life of |
40 hours |
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Apixaban MOA |
Direct Xa factor inhibitor |
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Apixaban has a half life of |
8-12 hours |
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Aspirin MOA |
- inhibits Cyclooxygenase |
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Aspirin has a half life of |
2.5-4 hours |
However consider platelet half life for this |
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Clopidogrel inhibits the |
ADP receptor P2Y12 receptor |
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Clopidogrel has a half life of |
6 hours |
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Short term steroid use is considered for less than _________ and low dose of__________. |
- 3 weeks - less than 5 mg/d |
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Stress dose steroids are not indicated for patients on: |
- less than 3 week steroid use - less than 5 mg/d - minor procedures |
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Inquire about anti- coagulation use for patients with the following conditions: |
- DVT - MI - cardiac stents - vascular stents - atrial fibrillation - stroke - TIA - peripheral vascular disease |
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Order a _______ as a screen for HPA axis suppression |
Early morning cortisol serum |
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An early morning random cortisol level of _______ indicates HPA axis _________. |
- less than 5mcg/dL - supression |
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__________ can cause further suppression of adrenal function and reduce serum __________ |
- Etomidate - cortisol level |
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Reversal of Warfarin |
- 4 factor Prothrombin Complex - Fresh Frozen Plasma - IV vitamin K - Prothrombin Complex is preferred |
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Prothrombin Complex composition |
- factor 2 - factor 7 - factor 9 - factor 10 |
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Name non vitamin K dependent Oral anticoagulants |
- Dabigatran - rivaroxaban - Apixaban |
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Dabigatran antidote |
- idarucizumab |
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Rivaroxaban antidote |
Andexanet alfa |
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Name anti platelet agents |
- aspiring - Clopidogrel - Prasugrel - Ticagrelor |
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Anti platelets agents are difficult to reverse due to __________. Can be partially reversed by _______ transfusion and ________. |
- irreversible binding - platelet - DDAVP |
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Stop Warfarin ________ before surgery |
5 days |
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Stop non vitamin K dependent oral anticoagulants _________ before surgical procedure |
48 hours before |
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____________ can be continued in most elective surgical procedure for patients with higher risk of thrombosis |
Aspirin |
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P2Y12 Inhibitors should be stopped_________ before elective surgery. |
5-10 days |
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In patients with coronary Bare metal stents |
- triple agent therapy for 4 weeks - delay elective procedure to prevent stent thrombosis |
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In patients with cardiac drug eluding stents |
- triple agent therapy for 6 months to prevent stent thrombosis |
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Adrenal Insufficiency Presentation |
- fever - hypotension - peripheral vasodilation |
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Assess warfarin via |
- PT - INR - Extrinsic pathway - factor X |
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Assess Heparin via |
- PTT - intrinsic factor - factor X |
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How long is Appropriate long term anti coagulation tx in a patient with DVT and inciting stimulus? |
12 weeks |
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How long is Appropriate long term anti coagulation tx in a patient with DVT without an inciting stimulus? |
6 months |
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Caprini Score 1 point |
- Age 41-60 - BMI > 25 - Minor Surgery - Edema in the LE - Varicose Veins - Pregnancy or post partum - OCP - sepsis
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