00 Anticoagulation

Question 1

What are the indications for Unfractionated Heparin?

Answer 1

ACS, VTE Treatment, VTE Prophylaxis

Question 2

What is Unfractionated Heparin dosing like for ACS?

Answer 2

Bolus: 60 units/kg IV. Drip: 12 units/kg/hr IV. Use actual body weight

Question 3

What is Unfractionated Heparin dosing like for VTE Treatment?

Answer 3

Bolus: 80 units/kg IV. Drip: 18 units/kg/hr IV. Use actual body weight

Question 4

What is Unfractionated Heparin dosing like for VTE Prophylaxis?

Answer 4

5000 units SQ BID-TID

Question 5

What are the goal levels for Unfractionated Heparin?

Answer 5

Adjust per PPT goal (~1.5-2.5x baseline)

Question 6

How are the effects of Unfractionated Heparin reversed?

Answer 6

Protamine (1mg ~100 units heparin; max 50mg, give over 10 minutes)

Question 7

What is the generic name of Lovenox?

Answer 7

Enoxaparin (LMWH)

Question 8

What are the indications for Lovenox?

Answer 8

DVT prophylaxis, DVT treatment, STEMI, Non-STEMI

Question 9

What is a usual dose for Lovenox when being used for a DVT prophylaxis?

Answer 9

Usually 30mg SQ Q12h OR 40mg SQ daily

Question 10

What is Lovenox dosing like for DVT Treatment?

Answer 10

1mg/kg SQ Q12h OR 1.5mg/kg SQ daily

Question 11

When do you need to adjust the Lovenox dose?

Answer 11

For renal impairment. Once CrCl < 30 you need to go do the daily dosing (30mg SQ daily for prophylaxis or 1mg/kg SQ daily for treatment)

Question 12

What are the contraindications to Lovenox use?

Answer 12

History of HIT. Active bleed. Allergy to pork

Question 13

What is the generic name of Innohep?

Answer 13

Tinzaparin (LMWH)

Question 14

When is Innohep (Tinzaparin) contraindicated?

Answer 14

Sulfite allergy

Question 15

What is the generic name of Fragmin?

Answer 15

Dalteparin (LMWH)

Question 16

What is the generic name of Arixtra?

Answer 16

Fondaparinux (Factor Xa Inhibitor)

Question 17

What is Arixtra (Fondaparinux) approved for?

Answer 17

DVT prophylaxis. DVT/PE Treatment

Question 18

What is the dosing of Arixtra (Fondaparinux) for DVT prophylaxis?

Answer 18

2.5mg SQ daily

Question 19

What is the dosing of Arixtra (Fondaparinux) for DVT/PE prophylaxis?

Answer 19

< 50kg: 5mg SQ daily
50-100kg: 7.5mg SQ daily
> 100kg: 10mg SQ daily

Question 20

When is Arixtra (Fondaparinux) contraindicated for DVT prophylaxis?

Answer 20

In patients < 50kg

Question 21

What dose adjustment is required for Arixtra (Fondaparinux)?

Answer 21

If CrCl < 30: USE IS CONTRAINDICATED

Question 22

What is the only non-PO Factor Xa Inhibitor?

Answer 22

Arixtra (Fondaparinux, given SQ)

Question 23

What is the generic name of Xarelto?

Answer 23

Rivaroxaban (Factor Xa Inhibitor)

Question 24

What is the generic name of Eliquis?

Answer 24

Apixaban (Factor Xa Inhibitor)

Question 25

What is the BBW with Xarelto (Rivaroxaban)?

Answer 25

D/c of Rivaroxaban in patients with non-valvular A.fib can put patients at increased risk of thrombotic events, like stroke

Question 26

What is the BBW with Eliquis (Apixaban)?

Answer 26

If Apixaban is being used to prevent stroke in A.fib patients, an increased risk of stroke may occur upon Apixaban d/c

Question 27

What is the generic name of Pradaxa?

Answer 27

Dabigatran (Direct Thrombin Inhibitor)

Question 28

What is an ADR you need to be cautious about with Pradaxa (Dabigatran)?

Answer 28

Gastritis and GI bleeding

Question 29

Which DTI requires hepatic adjustment?

Answer 29

Argatroban

Question 30

What is the generic name of Angiomax?

Answer 30

Bivalirudin (DTI)

Question 31

Which factors does Warfarin inhibit?

Answer 31

SNOT: 7, 9, 10, 2

Question 32

What are the normal goals with Warfarin dosing?

Answer 32

Most indications: 2-3. | Mechanical mitral valve replacement: 2.5-3.5

Question 33

When is Warfarin contraindicated?

Answer 33

Pregnancy Category X

Question 34

What pharmacologic considerations should be made with Warfarin?

Answer 34

VKORC1 and CYP2C9

Question 35

What are the Warfarin colors/doses?

Answer 35

Please Let Greg Brown Bring Peaches To Your Wedding: Pink (1), Lavender (2), Green (2.5), Brown (3), Blue (4), Peach (5), Teal (6), Yellow (7.5), White (10). All in mg

Question 36

When does vitamin K need to be administered?

Answer 36

Supra-therapeutic INR > 10 (2.5mg PO x1). Any signs of bleeding (5-10mg IV + PCC/Factor 7)