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naplex > anticoagulation > Flashcards

anticoagulation Flashcards

1
Q

what are the intrinsic pathway and which drug inhibits the intrinsic pathway

A

XII-XI-IX-X–> XA

warfarin blocks X
also blocks IX, VII, II

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2
Q

what is the extrinsic pathway

A

VII–>VII—–> X->Xa
warfarin blocks this too

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3
Q

what are the factor Xa inhibitors

A

Apixaban
rivaroxaban
edoxaban

UFH and LMWH also block XA and IIa

fondaparinux

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4
Q

which factor is thrombin and what meds can block thrombin

A

factor IIa is thrombin

Direct thrombin inhibitors are
PO- Dabigatran
IV- Argatroban bivalirudin

UFH and LMWH also block XA and IIa

Warfarin blocks prothrombin

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5
Q

DOACS are preffered in

A

stroke prophylaxis in AFIB
** if mitral stenosis or mechanical heart valve use warfarin
VTE
** cancer use LMWH
antiphospholipid syndrome use warfarin

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6
Q

what are some bleeding symptoms

A

nose bleed or epistaxis
gums
bruising
blood in vomit
blood in feces
uti

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7
Q

MOA of heparin

A

antitrombin binding which blocks IIa activation
- short half life
- can cause HIT, hyperkalemia and osteoporosis
monitor APTT antiXa level
antidote Protamine

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8
Q

what is the heparin dose for prophylaxis VTE

A

5000 q8-12

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9
Q

what is the treatment dose for VTE for heparin

A

80u/kg/ IV + 18u/kg/hr

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10
Q

treatment dose for ACS with heparin

A

60u/kg bolus+ 12 u/kg/hr

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11
Q

what is the treatment dose for prophylaxis VTE with enoxaparin

A

30mgSC Q12 or 40mg SC daily
<30 CRcl = 30

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12
Q

what is the treatment dose for VTE and NSTEMI with enoxaparin

A

1mg/kg q12 or 1.5mg/kg daily
<30 CrCL 1mg/kg SC daily

TBW

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13
Q

what is the treatment dose for STEMI

A

<75 years 30mg IV bolus + 1mg/kg SC q12
CRCL <30 30mg IV + 1mg SC Qdaily
>75years 0.75mg/kg SC q12
CRCL <30 1mg/kg SC daily

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14
Q

LMWH MOA

A

same as heparin + XA inhibition
cant use in HIT, monitor anti XA not APTT
protamine is the antidote

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15
Q

HIT

A

unexplained drop of plt by 50% after 5-14 days of heparin used
Bivalidurin is preffered in HIT
no warfarin use until ptl is >150k

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16
Q

DOAC

A

apixaban eliquis
rivaroxaban xarelto
dabigatraan pradaxa
argatroban
bivalirudin angiomax

17
Q

what is the dose for treating DVT with apixaban or eliquis

A

10mg PO BID for 7 days
then 5mg BID

18
Q

what is the dose for treating prophylaxis DVT with apixaban or eliquis

A

2.5mg BID for 12 days if knee
ofr 35 days if hips sx
1st dose after 12-24 hours of sx
andexa andexanet alfa for antidote

19
Q

what is the dose for treating afib with apixaban or eliquis

A

5mg BID unless
age is >80, BW <60kg SCR >1.5
any of the aboce 2 then dose is 2.5 mg BID

20
Q

what is the dose for treating afib with rivaroxaban or xarelto

A

** any dose above 15 should be taken with food
CRcl >50 20mg daily with food
CRCL 15-50 15mg
crcl <15 avoid

21
Q

what is the dose for treating DVT with rivaroxaban or xarelto

A

15mg BID for 21 days the n 20mg daily
CRCL <30 avoid

22
Q

what is the dose for treating prophylaxis DVT

A

10mg daily for 12 days or 35 days
CRCL<30 avoid

23
Q

what is the dose for treating Afib with Dabigatran or pradaxa

A

150mg BID
CRCL 15-30 75mg BID
<15 avoid
antidote- idarucizumab (praxbind)

24
Q

what is the dose for treating DVT with dabigatran

A

150mg BID 5-10 days after IV anticoags
avoid CRCL<30

25
Q

which doacs used for HIT

A

argatrroban and bivalirudin

26
Q

how does bridging works with warfarin to doac

A

warfarin to rivaroxaban, edoxaban, apixaban, dabigatran
INR is <3,2.5,2,2
READ

27
Q

how does bridging work from doacs to warfarin

A

overlap until INR is therapeutic
for dabigatran start 1-3 days before stopping dabigatran

28
Q

what is the starting dose for warfarin

A

10mg daily for 2 days then with INR change doses
Please Let Greg Brown Bring Peaches To Your Wedding
1 2 2.5 3 4 5 6 7.5 10

29
Q

what are some drug interactions of warfarin

A

CYP2C9 sybstrate
CYP2C9 inhibitors- amiodarone, fluconazole , bactrim metronidazole
CYP2C9 inducers- rifampin, carbamazepine, phenytoin

30
Q

what does the CHA2DS2VAS score

A

chf
HTN
AGE >75
Diabetes
Stroke TIA
Vascular disease
Age 65-74
SEX female

31
Q

when is oral anticoag recommended with CHA2DS2VAS

A

male 0 no
male 1 maybe
male 2 must NON warfarin DOAC

Female 1 no
F 2 maybe
F3 must

32
Q

which anticoag should not be used in CrCL >95

A

edoxaban

33
Q

pradaxa bottle is good for

A

120 days

naplex (78 decks)

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