Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NAPLEX review 2024 RXPrep Book > Anticoagulation & Blood Disorders: Anticoagulation > Flashcards

Anticoagulation & Blood Disorders: Anticoagulation Flashcards

1
Q

Two pathways pf coagulation cascade

A

Contact activation pathway (intrinsic) = minor pathway
Tissue factor pathway (extrinsic) = activated by tissue damage/trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Warren inhibits factors

A

2,7,9,10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DOAC work on factor

A

Xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Direct thrombin inhibitors (DTI) work on…

A

Thrombin IIa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

UFH and LMWH work on factors….

A

Xa and Thrombin IIa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DOACs vs Warfarin

A

Use warfarin if moderate-severe mitral stenosis or mechanical heart valve in stroke prevention for AF

Use warfarin if pt has antiphospholipid syndrome or mechanical heart valve in VTE treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

UFH antidote

A

protamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

UFH ppx VTE dose

A

5,000 units SubQ Q8-12h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

UFH txm VTE dose

A

80 units/kg IV bols, 18unit/kg/hr infusion

use TBW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

UFH txm ACS/STEMI dose

A

60/unit/kg IV bous, 12 unit/kg/hr inusion

use TBW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

UFH monitoring

A

aPPT
Platelets, Hgb, Hct baseline and daily ( dec platelets by 50% possible HIT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

LMWH boxed warnings

A

receiving epidural/spinal anesthesia or spinal puncture due to risk of hematomas and subsequent paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

LWMH CI

A

history of HIT
active major bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

LMWH ppx VTE dosing

A

30mg Q24hr or 40mg Q24hr

30mg Q 24hr if CrCl < 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

LMWH txm VTE, UA and NSTEMI

A

1mg/kg Q12hr
1.5mg/kg QD (in patient VTE only)

1mg/kg Q24hr if CrCl < 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

LMWH txm STEMI in pts < 75yrs of age

A

30mg IV bolus + 1mg/kg dose + 1mg/kg Q12 (max 100mg 1st 2 doses)

CrCl < 30 = 30mg IV bolus + 1mg/kg dose + 1mg/kg Q24hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

LMWH txm STEMI in pts > 75yrs old

A

0.75mg/kg Q12hr

CrCk < 30 = 1mg/kg Q24hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

LMWH antidote

A

protamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

LMWH monitoring

A

can monitor anti-Xa levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

4Ts score

A

probability of HIT calculated using this score

Thrombocytopenia = unexplained drop of > 50% in platelet count
Timing = HIT onset usually 5-10 days after start heparin
Thrombosis = new suspected/confirmed thrombosis, skin lesions

if HIT is likely, ELISA is done and thats confirmed with a serotonin release assay or heparin-induced platelet aggregation assay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

HIT management

A

If suspected or confirmed, stop all heparin/LMWH, if on warfarin then stop and admin Vitamin K.

rapid-acting non-heparin anticoagulant used (argatroban)

Dont restart warren until platelets > 150K

if urgent surgery or PCI required, bivalirudin preferred agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Apixaban nonvalvular AF (stroke ppx) dosing

A

5mg BID

2.5mg BID IF 2 of the following: > 80, < 60kg or SCr < 1.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Apixaban txm of DVT/PE dosing

A

10mg BID for 7 days, then 5mg BID

Extended phase (after > 3 months txm) - 2.5mg BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Apixaban ppx DVT (after hip/knee replacement)

A

2.5mg BID (12 days after knee or 35 days after hip)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Edoxaban has reduced efficacy in pts with CrCl that is

A

> 95

26
Q

Apixaban and Rivaroxaban antidote is

A

andexanet alfa (Andexxa)

27
Q

Rivaroxaban should be taken with…

A

food for doses > 15mg

10mg doses can be taken without regard to food

28
Q

Rivaroxaban nonvalvular AF (stroke ppx)

A

CrCl > 50 = 20mg QD w/ evening meal
CrCl 15-50 = 15mg QD w/ evening meal
CrCl < 15 = dont use

29
Q

Rivaroxaban txm fo DVT/PE

A

15mg BID X 21 days, then 20mg QD w/ food
Extended phase (> 3 months) 10mg QD

CrCl < 30 = dont use

30
Q

Rivaroxaban ppx DVT (after knee/hip replacement) and VTE (acute ill medical pts)

A

10mg X 12 days (knee), 35 days (knee), 31-39 days (acute ill medical patients)

CrCl < 30 = dont use

31
Q

Rivaroxaban reduction in risk of major CVD events in CAD/PAD

A

2.5mg BID in combo w/ low dose aspirin

CrCl < 15 = avoid use

32
Q

Edoxaban non valvular AF (stroke ppx)

A

CrCl > 95 = dont use
CrCl 51-95 = 60mg QD
CrCl 15-50 = 30mg QD
CrCl < 15 = dont use

33
Q

Edoxaban txm of DVT/PE

A

60mg QD, 5-10 days after parenteral anticoag

IF CrCl 15-50, BW < 60kg, on certain P-gp inhib = 30mg QD

Dont use CrCl < 15

34
Q

Time cut offs for DOAC and surgery

A

Apixaban = stop 48hrs before if mod-high bleeding risk, 24hrs if low

Rivaroxaban/Edoxaban = stop 24hr before

35
Q

Converting from warfarin to other anticoagulant

A

Rivaroxaban when INR < 3
Edoxaban when INR < 2.5
Apixaban when INR < 2
Dabigatran when INR < 2

36
Q

Fondaparinux ppx of VTE

A

> 50kg 2.5 mg QD
< 50 kg = CI

37
Q

Fondaparinux txm of VTE

A

< 50kg = 5mg QD
50 - 100kg = 7.5mg QD
> 100kg = 10mg QD

38
Q

Fondaparinux CrCl cut offs

A

CrCl 30-50 = use caution
CrCl < 30 = CI

39
Q

Dabigatran CI

A

treatment of pts with mechanical prosthetic heart valves

40
Q

Dabigatran Side effects

A

Dyspepsia
Gastritis like symptoms
Gi bleeding

41
Q

Dabigatran antidote

A

idarucizumab (Praxbind)

42
Q

Dabigatran nonvalvular AF (stroke ppx)

A

150mg BID

CrCl 15-30 = 75mg BID
CrCl < 15 = dont use

43
Q

Dabigatran txm of DVT/PE and reduction of recurrent DVT/PE risk

A

150mg BID, start 5-10 days after parenteral anticoag

CrCl < 30 = dont use

44
Q

Dabigatran ppx of DVT/PE following hip replacement

A

110mg Day 1, 220mg QD
CrCl < 30 = avoid use

45
Q

Dabigatran notes

A

have to dispense in OG container, and throw out after 4 months of opening

Swallow capsule whole, dont give in NG tube

46
Q

Argatroban notes

A

Safe for history of HIT or active HIT

No antidote

47
Q

Warfarin CI

A

Pregnancy, unless mechanical heart valve and high risk for TE

48
Q

Warfarin Warnings

A

tissue necrosis/gangrene
HIT
VKORC1 gene or CYP2C9*2/3 allele may inc bleeding

49
Q

Warfarin INR goal for most indications

A

2-3

50
Q

Warfarin INR goal of 2.5-3.5 for….

A

high risk indications such as mechanical mitral valve, 2 mechanical heart valves, or mechanical aortic valve with 1 additional risk factor

51
Q

Warfarin Antidote

A

Vitamin K

Kcentra can be used with vitamin K for rapid reversal

52
Q

Foods high in Vitamin K will do what to INR

A

decrease, so would ave to increase warfarin dose (Dark leafy greens)

important to keep consistent vitamin K balance in diet when on warfarin

53
Q

Using Vitamin K for over anticoagulation

A

INR > 4.5 w/o bleeding = reduce or skip dose, monitor INR
INR 4.5 - 10 w/o bleeding = hold 1-2 dose, monitor INR
INR > 10 w/o bleeding = hold warfarin, give Vitamin K
Major bleeding = hold warfarin, give Vitamin K & Kcentra

54
Q

Any VTE caused by surgery or reversible risk factor should be treated for….

A

3 moths

55
Q

If VTE is unprovoked, should be treated for….

A

longer than 3 months of low-mod risk of bleeding
keep at 3 months if high

56
Q

If 2 episodes of unprovoked VTE then consider….

A

long term treatment

57
Q

Medications CI in patients with hx of or current VTE

A

estrogen containing medications
selective estrogen receptor modulators

58
Q

pts w/o cancer, dabigatran or DAOC preferred over….

A

warfarin for 1st 3 months of txm for DVT in leg or PE

59
Q

pts w/o cancer, what is preferred over warfarin/LMWH?

A

DOACs

60
Q

CHA2DS2-VASc Score

A

C = CHF
H = HTN
A2 = Age > 75 = 2 pts
D = Diabetes
S2 = Prior stroke/TIA = 2 pts
V = Vascular Disease (prior MI, PAD, aortic plaque)
A = age 65-74 = 1 pt
Sc = Sex, Female = 1 pt

61
Q

HAS-BLED score

A

H = HTN > 160
A = abnormal liver or renal function = 1-2
S = prior stroke
B = Bleeding tendency or predisposition
L = labile INR if on warfarin
E = elderly > 65
D = Drugs (aspirin/NSAIDs) excess alc use = 1-2

62
Q

Anticoagulation in pregnancy

A

LMWH preferred

NAPLEX review 2024 RXPrep Book (77 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions