Anticoagulation

Question 1

What are anticoagulants commonly used for?

Answer 1

ACS
prevention of cardioembolic stroke
prevention/treatent of VTE (DVT/PE)

Question 2

When do you use DOACs?

Answer 2

when CHADSVASC score >2 in men or >3 women

Question 3

When would you use warfarin vs DOAC?

Answer 3

moderate to severe mitral stenosis or a mechanical heart valve

Question 4

Use DOACs for VTE treatment BUT if the patient has cancer use:

Answer 4

LMWH

Question 5

Which anticoagulants bind to antithrombin to indirectly inhibit Xa?

Answer 5

UFH equal Xa IIa inhibition
LMWH Xa>IIa
fondapurinox binds to AT to inhibit Xa

Question 6

What is the drug of choice in HIT?

Answer 6

injectable argatroban

Question 7

Binds to AT which then inactivates thrombin (Factor IIA) and factor Xa and prevents the conversion of fibrinogen to fibrin

Answer 7

UFH

ok in renal impairment

Question 8

What is the prophylaxis dose of UFH in VTE presentation?

Answer 8

UFH 5000u SC Q8-12H

Question 9

What is the treatment dose of UFH in VTE treatment?

Answer 9

80u/kg IV bolus; 18u/kg/hr infusion

TBW

Question 10

What is the treatment dose of UFH in ACS/STEMI

Answer 10

60u/kg IV bolus, infuse 12u/kg/hr

TBW

Question 11

Binds to AT which inactivates factor Xa >factor IIA

Answer 11

LMWH

Question 12

What is the prophylaxis dose of VTE for enoxaparin?

Answer 12

30mg BID or 40mg QD

<30mL/min = 30mg QD

Question 13

What is the treatment of VTE and UA/NSTEMI dose of enoxaparin?

Answer 13

1mg/kg BID

TBW

Question 14

What is the treatment for STEMI of enoxaparin?

Answer 14

<75 = 30mg IV bolus + 1mg/kg SC dose

> 75 no bolus

Question 15

Brand: Fragmin

Answer 15

generic: dalteparin

Question 16

When do you restart warfarin after HIT?

Answer 16

when platelets recover to >150

Question 17

What is Apixibans dose for nonvalvular Afib/stroke prophylaxis

Answer 17

5mg BID

Question 18

What is Apixibans dose for treatment of DVT/PE

Answer 18

10mg PO BID x 7 days

then 5mg PO BID

Question 19

The patient is receiving stroke prophylaxis but the patient >80 and bodyweight is <60kg /Scr >1.5. what’s her apixaban dose?

(only need two of these factors)

Answer 19

2.5mg BID

Question 20

Which DOAC is reduced efficacy when crcl>95

Answer 20

edoxaban

Question 21

Brand: Xarelto

Answer 21

generic: rivaroxaban

Question 22

Doses >___ of Xarelto require food

Answer 22

> 15mg

Question 23

What is the dose of Xarelto for treatment of DVT/PE

Answer 23

15mg PO BID x 21 days
then 20mg PO daily

<30ml/min = avoid use

Question 24

if the dose of Xarelto is missed how should it be taken

Answer 24

ok to double up to ensure 30mg is taken

*if taking 10, 15, 20mg once daily, immediately on the same day, otherwise skip

Question 25

When do you start edoxaban for the treatment of DVT/PE?

Answer 25

60mg daily | start after 5-10 days of IV anticoagulation

Question 26

What is the antidote for apixaban and rivaroxaban?

Answer 26

andexanet alfa (Andexxa)

Question 27

Brand: Arixta

Answer 27

generic: fondapurinox

Question 28

When a patient has HIT but is going in for a cardiac Cath lab what do you use?

Answer 28

bivalrudin (Angiomax)

Question 29

A patient is on an NG tube and is on dabigatran, what do you do?

Answer 29

can't administer, swallow capsules whole!

Question 30

What DOAC has side effects: | dyspepsia, gastritis-like symptoms

Answer 30

dabigatran

Question 31

When is the goal for warfarin 2.5-3.5?

Answer 31

high risk indications mechanical mitral valve or two mechanical heart valves (prosthetic)

Question 32

What are the tablet colors and strength?

Answer 32

PLGBBPTYW Please Let Greg Brown Bring Peaches To Your Wedding ``` pink-1 lavender-2 green - 2.5 brown/tan-3 blue-4 peach-5 teal-6 yellow-7.5 white-10 ```

Question 33

Foods high in vitamin K?

Answer 33

``` broccoli brussel sporouts cabbage spinach tea ```

Question 34

What drugs increase warfarin?

Answer 34

amiodarone fluconazle metronidazole bactrim

Question 35

what drugs decrease warfarin?

Answer 35

rifampin | carbamazepine

Question 36

SNRIs, SSRIs, NSAIDs how do they effect warfarin?

Answer 36

increase bleeding risk but the INR may not be increased

Question 37

In healthy outpatients, the initial starting dose of warfarin should be

Answer 37

10mg daily for the first two days then adjust per INR

Question 38

how do you bridge warfarin?

Answer 38

acute DVT/PE start warfarin on the same day at the IV AC (enoxaparin or UFH), and continue both anticoagulants for a minimum of 5 days until the INR >2 for at LEAST 24 hours

Question 39

1mg of Protamine sulfate will reverse how much heparin?

Answer 39

100units max dose 50mg 1mg per 1mg enoxaparin

Question 40

Brand: Mephyton

Answer 40

generic: vitamin K or phytonadione | PO/IV

Question 41

What do you administer with Kcentra?

Answer 41

vitamin K

Question 42

INR about therapeutic range but <4.5 without bleeding

Answer 42

reduce or skip warfarin dose, monitor INR

Question 43

INR of 4.5-10 without bleeding

Answer 43

hold 1-2 doses of warfarin

Question 44

INR >10 without leeding

Answer 44

hold warfarin, give PO vitamin K 2.5-5mg even if not bleeding

Question 45

MAJOR bleeding

Answer 45

give vitamin K 5-10mg by slow IV and four factor prothrombin complex concentrate (Kcentra)

Question 46

Discontine LMWH how many days before surgery

Answer 46

24 hours

Question 47

What are risk factor for DVT?

Answer 47

``` surgery major trauma immobility cancer previous VTE pregnancy SER ```

Question 48

Anticoagulation for patients with AFIB who will undergo cardio version Afib >48 hours or unknown duration:

Answer 48

anticoagulation (if warfarin target INR 2-3) for at least 3 weeks PRIOR to and 4 weeks AFTER cardio version when NSR is restored

Question 49

Anticoagulation for patients with AFIB who will undergo cardio version Afib <48 hours

Answer 49

start full therapeutic anticoagulation at presentation, do cardio version and continue full anticoagulation for at least FOUR weeks while patient is in NSR

Question 50

What is in the CHADSCASC score?

Answer 50

``` CHF HTN age >75 (2 points) diabetes prior stroke (2 points) prior MI, PAD age 65-74 female ```

Question 51

What is the AC of choice in pregnancy?

Answer 51

LMWH >UFH *anti Xa levels are recommended to monitor therapy

Question 52

Do you expel the air bubble in the syringe prior to injection?

Answer 52

no! & DO NOT RUB THE SITE OF INJECTION