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Pharmacy Practice 5 > Anticoags > Flashcards

Anticoags Flashcards

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1
Q

identify each scoring category of a CHADS-VASc score

A

CHF: 1
HTP: 1
75 or over: 2
Diabetes: 1
Stroke/transient ischaemic attack/thromboembolism: 2
vascular disease (prior MI, peripheral artery disease or aortic plaque): 1
age 65-74: 1
if female: 1

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2
Q

what is HAS-BLED used for?

A

risk of treating with an anticoagulant
HTP (non-controlled)
Abnormal renal function
abnormal liver function
stroke
bleeding tendency
labile INRs
elderly (over 65)
drugs
alcohol:

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3
Q

what is a reversal agent of warfarin?

A

give vitamin K

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4
Q

what is a reversal agent for Savaysa, Eliquis, and Xarelto?

A

Endexa

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5
Q

what is a reversal agent for Pradaxa?

A

praxbind

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6
Q

what is “bridging” and how does it relate do warfarin treatment?

A

bridging is when you put a pt on another drug until the first drug reaches full effect. Warfarin takes time to reach full effect, so another anticoag can be given until it does

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7
Q

what is Pradaxa’s dosage for nonvalvular a fib? what about venous thromboembolism (VTE)? VTE prophylaxis?

A

150mg bid
parental anticoag for 5-10 days, then 150mg bid
110mg for 1st day, then 220mg qd

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8
Q

what is Eliquis’s dosage for nonvalvular a fib? what about venous thromboembolism (VTE)? VTE prophylaxis?

A

5mg bid
10mg bid for 1 wk, then 5mg bid
2.5mg bid

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9
Q

what is Xarelto’s dosage for nonvalvular a fib? what about venous thromboembolism (VTE)? VTE prophylaxis?

A

20mg qd with evening, fatty meal
15mg bid with food for 3 wks, then 20mg qd with food
10mg qd with largest meal of the day

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10
Q

what is Savaysa’s dosage for nonvalvular a fib? what about venous thromboembolism (VTE)? VTE prophylaxis?

A

60mg qd
parental coag for 5-10 days, then 60mg qd
not used

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11
Q

when should we not use Savaysa and why?

A

in pts with a CrCl less than 95 because of increased risk of ischemic stroke

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12
Q

Which anticoags require renal dose adjustment?

A

pradaxa and xarelto

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13
Q

when does dose of eliquis require reduction?

A

patients 80 or older, body weight 60kg or less, or serum creatinine 1.5 or more

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14
Q

what is pradaxa’s generic name?

A

dabigatran

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15
Q

what is eliquis’s generic name?

A

apixaban

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16
Q

what is Xarelto’s generic name?

A

rivaroxaban

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17
Q

what is Savaysa’s generic name?

A

edoxaban

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18
Q

what are the FAB Four drug-drug interactions with Warfarin?

A

Flagyl, amiodarone, bactrim, and fluconazole

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19
Q

what is warfarin’s therapeutic range?

A

usually 2-3

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20
Q

what is INR?
what is normal INR?

A

it is a calculation based on prothrombin time which measures how long it takes for a clot to form
INR=1

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21
Q

for a patient with A-fib starting on Warfarin, what is the duration of treatment? what is goal INR range?

A

lifetime
2-3

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22
Q

for a patient with a bioprosthetic valve replacement starting on Warfarin, what is the duration of treatment? what is goal INR range?

A

3 months
2-3

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23
Q

for a patient with a mechanical valve replacement starting on Warfarin, what is the duration of treatment? what is goal INR range?

A

lifetime
2.5-3.5

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24
Q

T/F valve replacement drug treatment includes Warfarin, DOACs, and/or aspirin

A

False, only Warfarin

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25
for a patient with VTE (DVT or PE) starting on Warfarin, what is the duration of treatment? what is goal INR range?
usually 3 months 2-3
26
for warfarin dosing, what does it mean when INR is too low and what do we do?
it means blood is clotting too fast and the risk of clotting is too high, so warfarin dose needs to be increased
27
for warfarin dosing, what does it mean when INR is too high and what do we do?
it means blood is clotting too slow and the risk of bleeding is too high, so warfarin dose needs to be decreased
28
If a pt is on warfarin, what is the adjustment/period to recheck INR for the following INR values: <1.5 1.5-1.9 2-3 3.1-3.9 4-4.9 5 or higher
<1.5: inc weekly dose 10-20%, consider extra dose, check back in 4-8 days 1.5-1.9: increase weekly dose by 5-10%, check back in 7-14 days 2-3: no change required, check number of consecutive in-range INRs for 1 week for up to 6-8 weeks 3.1-3.9: decrease weekly dose by 5-10%, check back in 7-14 days 4-4.9: hold 0-2 doses, decrease weekly dose by 10-20%, check back in 4-8 days 5 or higher: assess risk of bleed
29
if a patients INR on warfarin is 1.8-1.9, what is the recommendation? what about 3.1-3.2?
for both situations: consider no change and repeat INR in 7-14 days
30
Vitamin K can be used to manage warfarin-associated bleeding or bleeding risk. what do we do in regards to vitamin K administration in the following situations: Serious or life-threatening bleeding INR > 10 without bleeding INR 4.5-10 without bleeding INR < 4.5 without bleeding
Serious or life-threatening bleeding: 10mg IV vit K INR > 10 without bleeding: 2.5-5mg oral vit K INR 4.5-10 without bleeding: optional: 1-2.5mg vit K INR < 4.5 without bleeding: no vit K indicated
31
if INR over 5 with warfarin, when should the pts INR be rechecked?
within 3 days
32
when should INR be rechecked after administering vit K?
the next day
33
if pt is using warfarin and a parenteral anticoag, when should INR be checked and for how long?
daily starting the 3rd day until INR is 2 or more
34
for the first 3 months of warfarin therapy, routine INR monitoring should not be longer than?
6 weeks
35
for pts stable on warfarin for at least 3 months, we can check INR at intervals of?
6-8 wks
36
what is Virchow's triad describing risk factors for VTE?
reduced blood flow, blood vessel injury, and increased coaguability
37
what are the effects of a pulmonary embolism?
chest pain, SOB, tachypnea (rapid breathing), tachycardia, hemoptysis (coughing up blood), and cyanosis (lack of oxygenation)
38
how do we diagnose a pulmonary embolism?
-positive D-dimer test (degradation product formed when cross-linked fibrin is broken down by plasmin - CTPA -compression ultrasound -ventilation-perfusion scans
39
what is the PERC criteria?
pulmonary embolism rule-out criteria: 8 variables used, if none are positive its likely pt doesn't have a PE
40
what is the Wells Criteria?
used to assess the likelihood of PE or DVT,
41
what are the pharmacologic treatments of VTE?
heparin/low molecular weight heparin fondaparinux warfarin DOACs
42
*** know how to calculate a heart rate using the box method!
43
what does INR stand for?
international normalized ratio
44
what does PT stand for?
prothrombin time
45
what does PTT stand for?
partial thromboplastin time
46
what does SVT stand for?
supraventricular tachycardia
47
what does CABG stand for?
coronary artery bypass graft
48
what does PCI stand for?
percutaneous coronary intervention
49
what does PAD stand for?
peripheral artery disease
50
what does PVD stand for?
peripheral vascular disease
51
what does VTE stand for?
venous thromboembolism
52
define cardiac output
mount of blood pumped out by the ventricles within a given time
53
define stroke volume
volume of blood ejected with each heartbeat
54
define preload
volume of blood in that stretches ventricles at the end of diastole and just before systole
55
define afterload
amount of vascular resistance to ventricular contraction
56
define atherosclerosis
Hardening of the arteries caused by a buildup of plaque
57
define erythrocytes
RBCs
58
define Erythrocytopenia
Low red blood cell count
59
define Erythrocytosis
High red blood cell count
60
define Thrombocytes
platelets
61
define Thrombocytopenia
Low platelet count
62
define Thrombocytosis
High platelet count
63
define Leukocytes
White blood cells
64
define Leukocytosis
High white blood cell count
65
define Leukocytopenia
Low white blood cells
66
define Hematology
The study of blood & blood disorder
67
define embolus
A moving blood clot

Pharmacy Practice 5 (8 decks)

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