Anticoagulation

Question 1

At one point do you start to get concerned about troponin levels?

Answer 1

• in the 100s

Question 2

____ failure will increase the troponin levels

Answer 2

renal

Question 3

How long after an MI does the troponin stay positive?

Answer 3

• stays positive for the first 5-7 days

Question 4

What is a type 2 MI?

Answer 4

• when you’ve worked harder than your coronary arteries can delivery oxygen - this can happen to marathon runners even
• when your myocardial cells die they release troponin - released when not enough oxygen gets to your heart

Question 5

ST segment elevation is indicative of what?

Answer 5

• STEMI

Question 6

What do STEMIS need?

Answer 6

• bypass surgery or emergency PCI

Question 7

STEMIs have _____ thickness myocardial walls

Answer 7

full

Question 8

NSTEMI has ____ thickness myocardial walls

Answer 8

partial

Question 9

Is creatinine clearance ever set?

Answer 9

NO

• if the creatinine is increasing, then we say the creatinine clearance is decreasing (BAD)
• if the creatinine is decreasing, then we say that the creatinine clearance is increasing (GOOD)

Question 10

If you are producing zero urine, what is your GFR?

Answer 10

you don’t have a GFR

you need to have urine production to have an active GFR

Question 11

Apixiban right now is not recommended under what?

Answer 11

25 mL/min

Question 12

What is the major question to be asked when thinking to start someone on ticagralor?

Answer 12

• if they have a bleed risk

- also if they can afford it

Question 13

What is heparin reversed by?

Answer 13

• protamine

Question 14

Are there any agents that are reversals for asa or clopridogrel?

Answer 14

NO

- have to let it wash out of the body

Question 15

When would you not give a statin?

Answer 15

if you saw that the CKs were elevated

Question 16

What are 2 things you should watch when you add an ACE inhibitor?

Answer 16

• watch kidney function and watch K

Question 17

81 mg ASA will never cause a reduction in _________

Answer 17

renal prostagladins

- these have an effect on dilating the renal arteries

Question 18

If you see a change in the Cr, get rid of ______

Answer 18

ACEI

Question 19

When would you not give someone rosuvastatin?

Answer 19

• if you saw CKs elevated, you would not give a statin

Question 20

With an ACE inhibitor, watch what?

Answer 20

• watch K and watch kidney function

Question 21

What is the main risk behind using ASA alone?

Answer 21

have a higher risk of stent thrombosis

Question 22

______ does nothing to prevent stent thrombosis

Answer 22

Clopridogrel

Question 23

Leg clots are made up mostly of ______

Answer 23

fibrin

Question 24

Why could you not use 2 anti platelets for a DVT?

Answer 24

• because leg clots are made up mainly of fibrin with little/no platelets

Question 25

How long should a DOAC be used for after a STEMI?

Answer 25

- 3 months

Question 26

How long should a DOAC be used for a.fib?

Answer 26

for LIFE

Question 27

What would the benefit be of adding a PPi onto a DOAC?

Answer 27

- reducing the bleed risk | - need to be careful however, because the PPis inhibit the 2C19 enzyme and stop the metabolism of clopridogrel

Question 28

How long would you keep someone on a PPi for?

Answer 28

- the duration that they are on triple therapy, and then you stop the PPi after that

Question 29

What is the reversal agent for dabigitran?

Answer 29

- praxbind (idrucizumab)

Question 30

What is andexante alpha?

Answer 30

- the Xa receptor binder that will replace the binding site for the DOAC - should be able to have an anti-Xa monitoring agent

Question 31

What DOAC has the least amount of bleeding risk of all?

Answer 31

apixiban

Question 32

What DOAC has the higher risk of bleeding?

Answer 32

- rivaroxaban

Question 33

What are the positive endpoints associated with tripe therapy

Answer 33

- resolution of and no chest pain

Question 34

What are the negative endpoints that are associated with triple therapy?

Answer 34

- presence of blood in the stool or urine, nose bleeds, bruising, cuts that take a long time to heal, or headache that is worse than normal

Question 35

What lab tests do we need to measure when giving someone triple therapy?

Answer 35

- platelets, hemoglobin, and creatinine, urea and WBC

Question 36

How does renal failure cause bleeding

Answer 36

increase in urea makes platelets dysfunctional and can make the person bleed severely

Question 37

What are very important counselling points to educate a patient on when they're using triple therapy?

Answer 37

- avoid use of NSAIDs - inform all HCPs that you are using an anticoagulant/ anti platelet - educate on s/s of bleeding - avoid contact sports - monitor alcohol intake (can increase risk of bleeding) - avoid herbal products that exacerbate the bleeding (St. John's Wort for example) - don't miss a dose, and don't double dose if you forget