Drug Dosing Flashcards
Length of VTE Treatment for Provoked w/ cancer
Forever
Length of VTE Treatment Provoked, Others
3 months
Length of VTE Treatment, Unprovoked, PE
Forever
Length of VTE Treatment, Unprovoked, Recurrent (2nd) DVT
Forever
Length of VTE Treatment, Unprovoked, 1st DVT, DISTAL
3 months
Length of VTE Treatment, Unprovoked, 1st DVT, PROXIMAL
Forever
STROKE/A. FIB.
Dosing and Exceptions for: Dabigatran [Pradaxa]
Counseling points?
Dosing: 150 BID
If CrCl 15-50 mL/min : 75 mg BID
No pill box
May cause dyspepsia/gastritis
STROKE/A. FIB.
Dosing and Exceptions for: Apixaban [Eliquis]
Counseling Points/Notes?
Dose: 5 mg BID
If (2 out of 3) Scr >1.5, Age > 80 yrs, or Wt. < 60 kg: 2.5 mg BID
Best for patients on dialysis, end stage CKD,]/ poor renal function (no dose adjustment required)
STROKE/A. FIB.
Dosing and Exceptions for: Rivaroxaban [Xarelto]
Counseling points?
Dose: 20 mg QD
If CrCl 15-50 mL/min: 15 mg QD
TAKE WITH LARGEST FATTY MEAL
STROKE/A. FIB.
Dosing and Exceptions for: Edoxaban [Savayxa]
Dose: 60 mg QD
If CrCl 30-60 mL/min (Stroke) or 15-50 mL/min (Afib): 30 mg QD
AVOID: in patients with CrCl > 95 mL/min and in patients with <15 mL/min
STROKE/A. FIB.
Dosing and Exceptions for: Betrixaban [Bevyxxa]
Counseling points?
Tricked ya! DO NOT use in stroke/Afib.
Take with food tho…
ACUTE VTE:
Dosing and Exceptions for: Dabigatran [Pradaxa]
Counseling points?
Dose: 5 days parenteral AC, 150 mg PO BID
D/C if CrCl < 30 mL/min
No Pill Box
discard 4 months after opening
ACUTE VTE:
Dosing and Exceptions for: Apixaban [Eliquis]
Counseling points?
Dose: 10 mg PO BID x 7 days, then 5 mg PO BID
D/C if CrCl < 25 mL/min OR Scr > 2.5 mg/dL
ACUTE VTE:
Dosing and Exceptions for: Rivaroxaban [Xarelto]
Counseling points?
Dose: 15 mg PO BID x 21 Days, then 20 mg po ONCE DAILY
D/C if CrCl < 30 mL/min
Take with LARGEST meal of the day
ACUTE VTE:
Dosing and Exceptions for: Edoxaban [Savaysa]
Counseling points?
WEIGHT BASED
Dose: 5 days of parenteral AC then,
If > 60 kg: 60mg QD
If ≤ 60 kg: 30 mg QD
D/C if CrCl < 15 mL/min
ACUTE VTE:
Dosing and Exceptions for: Betrixaban [Bevyxxa]
Counseling points?
Dose: None
Which Drug(s) are only used for: EXTENDED VTE TREATMENT?
Dosing?
Eliquis: 2.5 mg PO BID
Xarelto: 10 mg PO QD
Note: half of maintenance dose
Which Drug(s) are only used for: VTE PROPHYLAXIS?
Dosing?
Dabigatran
Apixaban
Rivaroxaban
Betrixaban [Bevyxxa]: 160 mg PO as single dose on day 1, then 80 mg daily
ALL DOACs EXCEPT Savaysa
Monitoring Parameters for DOACs?
SCr, Renal Function, LFT, Hgb/Hct/Plt
But No Routine for DOACs
Monitoring Parameters for UFH?
aPTT, Scr, Hgb/Hct/Plt
CYP3A4 Inducers
Carbamazepine, Rifampin, St. John’s Wart, Phenytoin
CYP3A4 Inhibitors (VAPED)
Verapamil Amiodarone/Azoles Protease Inhibitors Erythromycins Diltiazem
When do you initiate VTE prophylaxis post-operatively in orthopedic surgery?
What is the drug of choice?
Dose?
12 hours post-operatively
Drug of choice: Enoxaparin [Lovanox]
Dose: 30 mg SC BID
List Direct Thrombin Inhibitors
Bivalirudin [ Angiomax]
Argatroban
List Direct Thrombin Inhibitor(s)
Dabigatran [Pradaxa]
List Vitamin K antagonist(s)
Warfarin [Coumadin, Jantoven]
What clotting factors does Jantoven inhibit?
II, VII, IX, X
+ Protein C and S
Unfractionated Heparin Dosing
Prophylactic Dose?
Treatment Dose?
Prophylaxis Dose: 5000 IU SC BID/TID
TRM Dose: 80 units/kg IV Loading Dose, then 18 units/kg/hr continuous infusion use ABW
Unfractionated Heparin Reversal:
What drug?
What dose?
Protamine: 1 mg/ 100 units
MAX DOSE is 50 mg IV Bolus over 15 minutes
Dosing for Lovenox
prophylaxis dosing?
Treatment dosing?
Prophylaxis Dose: 40 mg SC daily
if CrCl < 30 mL/min: 30 mg SC daily
TRM dose: 1mg/kg SC BID
if CrCl < 30 mL/min: 1mg/kg SC daily
LMWH is eliminated __________
RENALLY!
Monitoring Parameters for Argatroban and Bivalirudin
aPTT
Max dose of Simvastatin with Amlodipine
Simvastatin 20 mg
Max dose of Simvastatin with Amiodarone
Simvastatin 20 mg
Max dose of Lovastatin with Amiodarone
Lovastatin 40 mg
Max dose of Lovastatin with Non-DHP CCBs
Lovastatin 20 mg
Max dose of Simvastatin with Ranolazine
Simvastatin 20 mg
Max dose of Non-DHP CCBs with Simvastatin
Simvastatin 10 mg
Absolute Contraindication with cilostazol
Heart Failure
Contraindication with Prasugrel
TIA/STROKE
HEART FAILURE
Dosing for: Hydralazine/Isosorbide dinitrate [BiDil]
Is it treating symptoms/ morbidity & mortailty / both?
Starting Dose: 37.5/20mg (1 tablet) po TID
Target Dose: 2 tablets po TID
Treats Both
What are the compensatory responses to myocardial damage?
SNS Activation
RAAS Activation
Increase Vasopressin
Right Ventricular Failure
Peripheral Edema
Weight Gain
JVD
Hypervolemic Hyponatremia
Target Digoxin Level in HF
0.5 - 0.9
Target Digoxin Level in A fib
0.8 - <2.0