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Anticoagulation Flashcards

(61 cards)

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1
Q

Which factors does warfarin inhibit

A

2, 7, 9, 10

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2
Q

Which are the direct xa inhibitors?

A

DOACS

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3
Q

What does fondaparinux inhibit?

A

Antithrombin which indirectly inhibits xa

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4
Q

What does UFH inhibit

A

antithrombin which then inactivates thrombin (factor 2a) and 10a

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5
Q

what does LMWH inhibit

A

smaller so more xa than antithrombin but both

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6
Q

What are the direct thrombin inhibitors?

A

argatroban, bivalirudin, dabigatran

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7
Q

Heparin VTE tx and prophylaxis dosing

A

Prophylaxis: 5000 units q8-12h

Treatment: 80 units/kg bolus then 18 units/kg/hr

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8
Q

Heparin ACS/STEMI dosing

A

lower than vte; 60 units/kg IV bolus then 12 units/kg/hr

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9
Q

Which meds are dosed via IBW if obese

A

acyclovir, aminophylline, levothyroxine

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10
Q

Which meds are does via IBW regardless of obesity

A

theophylline

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11
Q

Which meds are does via adjusted body weight if obese

A

Aminoglycosides

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12
Q

What is HIT defined as?

A

Unexplained drop in platelet 50% from baseline

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13
Q

What is the warfarin tablet color pneumonic

A 
Please - pink 1
Let - Lavender 2
Greg- Green 2.5
Brown - Brown/Tan 3
Bring - Blue - 4
Peaches - Peach 5
To - Teal - 6
Your - Yellow 7.5
Wedding - White 10
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14
Q

Starting doses for warfarin

A

Healthy give 10mg for 1st 2 days, in elderly start less then 5

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15
Q

What is used to reverse UFH/LMWH and dosing

A

protamine.

  • UFH: 1 mg reverses 100 units with a max of 50mg. Reverse the amount given in the last 2 hours.
  • LMWH - 1 mg per 1 mg of lovenox
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16
Q

dabigitran reversal agent

A

praxbind/Idrucizumab

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17
Q

Apixaban and rivaraxoban reversal agent

A

andexanet alpha/Andexxa

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18
Q

Warfarin reversal

A

vitk or phytonadione (Mephyton), Kcentra (four factor prothrombin complex concentrate, novosevenRT/Factor VIIa recombinant

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19
Q

CHA2DS2VASC meaning

A 
C- CHF
H - HTN
A - Age > 75 --2
D - Diabetes
S2 - Stroke/TIA -2
V - Vascular Disease
A - Age 65-74
S - Sex = female
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20
Q

CHADS2 interpretatioin

A

No anticoag recomended if 0 in males or 1 in females. Maybe give anticoag if 1 in males or 2 in females. If greater than that for sure give oral coag.

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21
Q

What anti coag can you give in pregnancy

A

LMWH over UFH

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22
Q

Lovenox generic and MOA

A

Enoxaparin

  • low molecular weight heparin
  • binds to Antithrombin which inactivates xa and IIa but prefers xa
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23
Q

eliquis

A

apixaban

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24
Q

xarelto

A

rivaroxaban

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25
apixaban dosing
afib: 5mg bid UNLESS older than 80, BW <60kg, or SCR >1.5 then half dose DVT tx: 10mg po bid x 7 then 5mg po bID
26
Rivaroxaben dosing
take with food, if for afib with evening meal DVT tx: 15mg PO BID x 21, then 20mg PO daily
27
Which DOACS have renal function contraindications?
Rivaroxaban: If CrCL < 30 then avoid use Edoxaban: If CrCL <95 then avoid use
28
Heparin monitoring and frequency of labs and interpretation of monitoring labs
aptt or antixa 6 hours after initiation then every 6 hours until therapeutic aptt is 1.5 - 2.5 control
29
What to stop if HIT occurs
warfarin, all heparins
30
what platelet count may you resume warfarin if HIT occurs?
>150,000
31
What is a good choice for HIT?
Argibotran, Bivalirudin direct thrombin inhibitors
32
Pradaxa
dabigitran
33
Angiomax
Bivalirudin
34
What should be used in prosthetic heart valve
warfarin
35
Which is the SUBQ 10a inhibitor
Fondaparinux
36
Dabigitran Side effects
Dyspepsia, gastritis like symptoms
37
dabigatran storage
original container, must use within 4 months
38
dabigitran administration 1) take within how many hours of next dose 2) how long after iv anticoag 3) can you crush?
must take within 6 hours of next scheduled dose, start 5-10 days after parenteral (IV) anticog, swallow capsules whole no NG tube
39
warfarin contraindications and warnings
contraindications: Pregnancy (unless mechanical heart valve) warnings: tissue necrosis/gangrene
40
3a4 inducers
PS PORCS | phenytoin, smoking, phenobarbital, oxcarbazepine/triptal, rifampin, carbamexapine/tegratol, st. john's wort
41
3a4 inhibitors
PACMAN G PI, azoles, cyclosporine/neoral, cimetidine, cobistat, macrolides (clarithromycin and arithromycin), amiodarone, nondhp CCB (diltiazem and verapamil)
42
CYP 1A2 substrate
warfarin R (also 3a4), theophylline
43
CYP 2c9 substrate
warfarin s
44
important c29 inducer
rifampin (pretty much PSPORCS works here too)
45
Important 2c9 inhibitors
M - Metranidazole, macrolides A - Amiodarone, Azoles T - TMP/SMX
46
apixaban and rivaroxaban are substrates of what
pgp and cyp3a4
47
coumadin
warfarin (1/2)
48
Jantoven
Warfarin (2/2)
49
what drug to drop warfarin dose
amiodarone, decrease dose by 30-50%
50
How long do you bridge warfarin for
5 days and then until inr >2 for 24 hours
51
Once INR is stable how often do you test?
every 12 weeks
52
phytodione
vit k
53
mephyton
vitamin k or phytonadione
54
vitamin k boxed warning and side effects
hypersensitivity reactions, possible anaphylaxis
55
If the INR is <4.5 but above therapeutic range what do you do
skip or reduce dose and monitor
56
If INR is between 4.5 and 10 but there is no bleeding what do you do
give oral vitamin k and hold
57
If patient is bleeding regardless of INR
give slow IV warfarin and PCC
58
How long to stop warfarin before surgery and after
5 days before, 12-24 hours after, may bridge
59
how long to treat for VTE
3 months if caused by any of the reversable risk factors
60
preferred tx in cancer patients
LMWH
61
If someone has had afib for more than 48 hours give anticoag for how long before and after cardioversion
3 weeks prior to, 4 weeks after while in NSR

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