DRUGS: Test 3 Flashcards
warfarin dosing must be ____ at the start
bridged, due to peak effect occurring 4-5 days after beginning treatment
how is warfarin metabolized
cyp
warfarin AE
bleeding skin necrosis purple toe, pregnancy category X
what is the initial dose of warfarin
5-10 mg
if pt is elderly, malnourished, has liver disease, start with <5
how often should warfarin be monitored
baseline
initial: 1 week then 1-2 weeks
once stable: 6-12 weeks
out of range INR recheck within 4 weeks (usually 1-2)
general mechanisms for warfarin interactions
decrease vit K displace warfarin inhibit or induce increase procoag factors additive coag response increased bleeding risk
highly significant drug interactions
fluconazole Amiodarone Bactrim Flagyl (FABFour) herbals, nsiads, alc, phenytoin*, rifampin* (*PB and induce met)
dabigatran dosing
DVT / PE treatment: 150 mg PO BID after 5-10 days of parenteral anticoag
prevention of recurrent DVT/PE: 150 PO BID
rivaroxaban dosing
DVT / PE treatment: 15 mg BIG with food for 21 days then 20 mg PO daily with food
prevention of recurrent DVT/PE: 10 mg PO daily after 6 months of initial treatment
apixaban dosing
DVT/PE treatment: 10 mg BID for 7 days then 5 mg PO BID
prevention of recurrent DVT/PE: 2.5 mg PO BID after 6 months of initial treatment
idarucizumab
Praxbind; moAB fragment that binds and inhibits dabigatran
andexanet alfa
modified human factor Xa molecule high affinity and specificity for factor Xa inhibitors
UFH
hospitialzied with acute illness at moderate and high risk: 5000 units SC q 8-12 h
VTE treatment: 80 units/kg (5000 units) IV bolus followed by 18 units/kg/h or (1000 units) continuous infusion
protamine sulfate
1 mg/100 units of UFH
LMWH
hospitialized wih acute illness at mod or high risk of VTE: 40 mg SC daily OR 30 mg SC bid, if crcl <30: 30 mg SC daily
VTE treatment: 1 mg/kg SC q 12 h
