Naplex - Anticoag

Front 1

What enzyme does warfarin inhibit?

Back 1

VKOR

vitamin k oxide reductase

Prevents oxidized vit k from getting reduced. need reduced vitamin k to activate clotting factors. when the factors are activated the vitamin k becomes oxidized again, and the cycle continues.

Front 2

How does Xarelto work?

Back 2

Hint its moa is in its name... "Xa"(relto) inhibitor

Front 3

Heparin PPx dose?

Back 3

5000 units sc q8-12h

Front 4

What body weight should be used to dose heparin?

Back 4

Actual

Front 5

Does heparin have a predictable anticoagulant response?

Back 5

no

Front 6

How many units of heparin will 1 mg of protamine reverse? what is the maximum dose of protamine?

Back 6

100 units

50 mg

Front 7

Treatment of VTE dosing for heparin?

Back 7

80 U/kg bolus then 18 U/kg/hr

if outpatient 333 U/kg sc then 250 U/kg BID

Front 8

Treatment of ACS with UFH?

Back 8

60 u/kg (max 4000) then 12 u/kg/hr (max 1000)

Front 9

Long term use of UFH hyper or hypo kalemia?????

Back 9

HYPER!!!!!

Front 10

How can heparin be monitored?

Back 10

aptt or anti-xa level

Front 11

What anti-10a level are we looking for

Back 11

1.5-2.5x control

Front 12

Heparin MOA

Back 12

binds to ATIII, which blocks factors 2a & 10a mainly

Front 13

Fragmin

Back 13

Dalteparin

Front 14

PPx of VTE with lovenox dosing

Back 14

30 mg/kg BID or 40 mg/kg qday

SC

Front 15

Tx of VTE w/ lovenox dosing

Back 15

1 mg/kg BID or 1.5 mg/kg Qday

Front 16

What is the Crcl were worried about with lovenox? What do you do if your looking to ppx someone? tx someone?

Back 16

30

30 mg SC qd

1 mg/kg SC qd

Front 17

Treatment of STEMI with lovenox dosing?

Back 17

1. below 75 (think aggressive)

30 mg IV bolus. 1 mg/kg STAT. 1 mg/kg q12 thereafter

MAX 100 mg for 1st 2 doses

2. Above 75 (much less aggressive)

NO IV. Simply 0.75 mg/kg q12h SC (MAX 75 mg)

Again if CRcl is < 30, 1 mg/kg SC daily

Front 18

BBW LMWH

Back 18

Epidural/ spinal - risk of hematomas/ paralysis

Front 19

Contraindications to LMWH

Back 19

active bleed

pork allergy

HIT hx

Front 20

Pregnancy category of LMWH vs UFH?

Back 20

B vs C

Front 21

MOA of LMWH

Back 21

Same as UFH, binds and potentiates ATIII however more 10a inhibition than 2a inhibition

Front 22

Arixtra

Back 22

Fondaparinux

Front 23

How does arixtra work?

Back 23

Selectively inhibits Xa via ATIII HOWEVER it's not a LMWH

Front 24

How is arixtra administered?

Back 24

SC

Front 25

Dosing of arixtra for DVT ppx?

Back 25

2.5 mg SC qd

Front 26

Dosing of arixtra for VTE tx?

Back 26

depends on BW

<50 kg: 5 mg SC qd

50-100 kg: 7.5 mg SC qd

>100 kg: 10 mg SC qd

Front 27

BBW for arixtra?

Back 27

Same as lovenox

Front 28

Contraindications arixtra?

Back 28

<30 ml/min crcl

no using it for ppx if bw is <50 kg

Front 29

Argatroban MOA

Back 29

DTI: IIa!

Front 30

Angiomax

Back 30

Bival

Front 31

Refludan

Back 31

Lepirudan

Front 32

Is there an antidote for arixtra?

Back 32

NO

Front 33

What is arixtra's pregnancy category?

Back 33

b

Front 34

What are the iv-DTI's pregnancy category?

Back 34

B

Front 35

Which IV-DTI needs adjustment in renal impairment defined as 60 mL or less?

Back 35

Lepirudin

Front 36

Which IV DTI needs adjustment when the renal is <30 ml/min?

Back 36

Bival

Front 37

Which DTI needs adjustment in liver dysfuxn?

Back 37

Argatroban

Front 38

Ipravask

Back 38

Desirudin

Front 39

Ipravask indication?

Back 39

VTE ppx after hip replacement sx

Front 40

Ipravask route?

Back 40

SC

Front 41

Is it okay to open pradaxa caps?

Back 41

no

Front 42

When do you dose reduce pradaxa?

Back 42

crcl 15-30

Front 43

Missed dose rules for pradaxa?

Back 43

6 hours before next dose limits.

Front 44

Once the bottel is opened, when does the pradaxa expire?

Back 44

4 months

Front 45

When do pradaxa blister packs expire?

Back 45

good until the date on the package

Front 46

Switching from warfarin to dabigitran. how?

Back 46

dc jantoven and wait until inr is less than 2 then you start the pradaxa

Front 47

switching from lovenox to pradaxa. how?

Back 47

Pradaxa 0-2 hours before next scheduled dose

Front 48

Im having invasive surgery and im taking pradaxa and my crcl is 44. what do i do?

Back 48

d/c the pradaxa 3-5 days before sx.

Front 49

Im having invasive surgery and im taking pradaxa and my crcl is good. what do i do?

Back 49

d/c pradaxa 1-2 days before sx .

Front 50

What 3 drugs are we worried about with pradaxa?

Back 50

rifampin
ketoconazole
dronedarone

Front 51

HIT: when do you start warfarin.

Back 51

when plts >150k. overlap w/ non heparin anticoag x 5 days until inr is therapeutic x 24 horus

Front 52

HIT hx when pts need PCI?

Back 52

Use bival

Front 53

Xarelto

Back 53

riva

Front 54

3 indications for xarelto & doses for each?

Back 54

non valv afib stroke prevention

ppx of dvt after tka/tha

tx of dvt/pe

Front 55

Whats the rule with xarelto and taking it with food?

Back 55

anything at or above 15 mg = with food

Front 56

Whats the crcl we care about with riva? and what do we do in each situation?

Back 56

depends

afib it's 50 and 15
>50 20 mg qd
<50 15 mg qd
<15 dont use

ppx of the DVT

>30 10 mg qd
dont use if less than that

tx of dvt

again dont use if its less than 30
15 mg BID x 21 days then 20 mg po qd

Front 57

What are the BBWs for xalrelto?

Back 57

epidural spinal thing

abruptly d/cing can throw clots

Front 58

Whats the antidote for xalrelto

Back 58

there isnt any

Front 59

Elquis

Back 59

apixiban

Front 60

pregnancy category of elquis?

Back 60

B

Front 61

dosing for elquis?

Back 61

5 mg BID

Front 62

elquis indication?

Back 62

just AF right now

Front 63

What enzymes does warfarin inhibit?

Back 63

2 7 9 10 c s

Front 64

Which is more potent r or s warfarin?

Back 64

S

Front 65

Name the doses and colors of warfarin

Back 65

Please - pink - 1
Let - lavender - 2
Greg - green - 2.5
Tan - tan - 3
Bring - blue - 4
Peaches - peach - 5
to -teal - 6
Your - yellow - 7.5
Wedding - white - 10

Front 66

Preganacy category of warfarin?

Back 66

X

Front 67

What does ginsing do to the INR?

Back 67

decrease

Front 68

What does coq 10 do to the INR

Back 68

decrease

Front 69

What does green tea do to the INR?

Back 69

decrease

Front 70

What does ginkgo do to the inr?

Back 70

nothing but it increases bleeding risk

Front 71

What does willow bark do to the inr?

Back 71

increase. its a salycilate

Front 72

What does grapefruit do to the inr?

Back 72

increase

Front 73

What does wintergreen oil do the the inr?

Back 73

increase

Front 74

What is a *3 or *2 allele with 2c9?

Back 74

the 2c9 doesnt work as well so youre more likely to bleed and need lower doses of warfarin

Front 75

How should warfarin be started in healthy outpatients?

Back 75

10 mg x 2 days then adjust per inr

Front 76

If a patient has stable INRs for months when can testing occur?

Back 76

every 12 weeks

Front 77

Stable INRs historically but presents today with a single out of range reading that <=0.5 outside the range. whaddaya do?

Back 77

have them come back in a week or 2

Front 78

Start warfarin the same day as parentaral and continue parentaral x ______ and until _______

Back 78

5 days
24 hours INR >2

Front 79

INR < 4.5, no bleed

Back 79

hold warfarin or reduce dose

restart when inr is therapeutic again

Front 80

inr 4.5-10 but no bleed

Back 80

hold 1-2 doses. watch inr & start again at a lower dose when inr is in range

Front 81

INR > 10 w/o bleeding

Back 81

hold jantoven
give VK 2.5-5 oral and whatnot

Front 82

Major bleeding while on warfarin

Back 82

VK 5-10 mg IV + PCC

pcc>>>ffp

Front 83

When to stop warfarin before elective sx?

Back 83

5 days

Front 84

How to determine to bridge warfarin with lmwh before surgery?

Back 84

high risk patients

Front 85

When should lmwh be stopped before sx?

Back 85

24 hours

Front 86

when should IV ufh be stopped before sx?

Back 86

4-6 hours

Front 87

What if inr is elevated 1-2 days before sx?

Back 87

vit k low low low dose 1-2 mg

Front 88

what if you need emergency sx and youre on jantoven?

Back 88

vit k 2.5-5

Front 89

when do you start warfarin after sx?

Back 89

12-24 horus given hemostasis

Front 90

minor dental procedure, whart do you do with warfarin?

Back 90

continue warfarin

Front 91

what do you do with dermatolgic surgery & warfarin?

Back 91

just continue

Front 92

what do you do with eye surgery and warfarin?

Back 92

just continue

Front 93

Patient is recieving bridge therapy with LMWH before sx. when can this be started after sx?

Back 93

24 hours if low bleeding risk
48-72 if higher

Front 94

when to stop anti-platelets wrt surgery?

Back 94

5-10 days

Front 95

CHADS2

Back 95

CHF
HTN
Age >= 75
DM
Stroke or TIA x 2

Front 96

A fib > 48 hours or unknown duration

Back 96

3 weeks anticoag before and 4 weeks after NSR

Front 97

Afib <48 hours

Back 97

Anticoag at presentation then x 4 wks after

Front 98

Who gets ASA w/ afib?

Back 98

Chads 2 of 0 and only if the patient wants it. every one else gets dabigitran. ASA + plavix for peeps who cant take oral anticoag.

Front 99

SHould you rub the lovenox injection site?

Back 99

no

Front 100

How can you inject heparin?

Back 100

sc or iv

NO IM

Front 101

name the enzymes that affect warfarin metabolism

Back 101

2c19
2c9
3a4
1a2