IV Anticoagulants

Question 1

Heparin MOA

Answer 1

Binds with antithrombin to inactivate factor II and X

Also inactivates IX, XI, and XII

Question 2

Heparin onset

Answer 2

SQ-20-30 minutes

IV- immediately

Question 3

Heparin PK/PD

Answer 3

No renal dose adjustment

Recommended anticoagulant in dialysis patients

Question 4

Heparin VTE Treatment dose

Answer 4

80 units/kg IV, then 18 units/kg/hr IV

Question 5

Heparin ACS treatment dose

Answer 5

60 units/kg IV, then 12 units/kg/hour IV

Question 6

Heparin is dosed based on:

Answer 6

Total body weight

Question 7

Heparin Titration

Answer 7

Stop at Q6 hour aPTT check after 2 aPTTs in range –> daily aPTT checks

Question 8

Therapeutic heparin indications, monitoring of efficacy and monitoring of AE?

Answer 8

VTE, afib, ACS
aPTT/anti-Xa per protocol
Platelets, Hgb/Hct

Question 9

Prophylaxis heparin indications, monitoring of efficacy and monitoring of AE?

Answer 9

VTE prevention
None
Platelets, Hgb/Hct

Question 10

Lovenox (enoxaparin) MOA

Answer 10

Binds with antithrombin to inactivate X and II (mainly X)

Question 11

Lovenox Onset and duration

Answer 11

Peaks 3-5 hrs

Last ~12 hours

Question 12

Lovenox requires ____ and is dosed on ____

Answer 12

Renal adjustment

Total body weight

Question 13

Lovenox Therapeutic used when and dose

Answer 13

ACS, VTE (PE/DVT)

1mg/kg SQ q12h

Question 14

Lovenox Alt Dose

Answer 14

1.5 mg/kg SQ daily

Question 15

Lovenox prevention of VTE dose for medical/surgical if CrCl greater than 30

Answer 15

40 mg SQ daily

Question 16

Lovenox prevention of VTE/propylaxis dose for knee replacement if CrCl greater than 30

Answer 16

30 mg SQ BID

Question 17

Lovenox therapeutic dose for medical/surgical if CrCl less than 30
What if CrCl greater than 30?

Answer 17

1 mg/kg SQ daily

1 mg/kg SQ Q12h

Question 18

Lovenox prevention of VTE/propylaxis dose if CrCl less than 30

Answer 18

30 mg daily

Question 19

Lovenox monitoring

Answer 19

Anti-Xa

Question 20

Monitoring is indicated when used in:

Answer 20

Pregnancy
Extremes of weight (less than 45 or greater than 190 kg)
CrCl less than 30
High risk of bleeding or VTE

Question 21

**Anti-Xa monitoring is ordered

Answer 21

4 hours after dose for peak concentration

dose adjustments = order after 4 hrs

Question 22

Fragmin (dalteparin) MOA

Answer 22

Binds with anti-thrombin to inactivate factor X and II

Question 23

Fragmin Onset and excretion

Answer 23

Peaks 1-2 hrs

Renally excreted

Question 24

Fragmin Onset and excretion

Answer 24

Peaks 1-2 hrs

Renally excreted

Question 25

Fragmin VTE Prophylaxis during acute illness dose

Answer 25

5000 units SQ daily

Question 26

Reversal of Heparinoids Agent =

Answer 26

Protamine sulfate

Question 27

Protamine sulfate dose to reverse Heparin

Answer 27

1 mg neutralizes ~100 units of heparin | MAX = 50 mg

Question 28

Protamine sulfate dose to reverse Enoxaparin

Answer 28

Anti-Xa activity will never be completely neutralized | Dependent on last dose administered

Question 29

Thrombocytopenia includes:

Answer 29

Thrombocytopenia (50% platelet fall or less than 150) Timing (5-10 days after heparin use) Thrombosis

Question 30

Arixtra (fondaparinux) MOA

Answer 30

Inhibit Factor Xa Can be used in HIT Must be renally adjusted

Question 31

Arixtra Prophylaxis Dosing

Answer 31

2.5 mg SQ daily

Question 32

Arixtra Treatment Dosing

Answer 32

Less than 50 kg: 5 mg SQ daily 50-100kg: 7.5 mg SQ daily Greater than 100: 10 mg SQ daily

Question 33

Argatroban MOA

Answer 33

Direct thrombin inhibitor

Question 34

Agratroban Indication

Answer 34

Prevention/treatment of thrombosis in HIT pts | PCI intervention pts with HIT or history of HIT

Question 35

Agratroban Monitoring and other considerations

Answer 35

aPTT Prolongs INR Renal dose adjustment

Question 36

Warfarin + Argatroban

Answer 36

For at least 5 days before discontinuation of argatroban

Question 37

D/C Less than 2 mcg/kg/min infusion of argatroban if

Answer 37

INR greater than 4 | Repeat INR 4-6 hrs later and restart if INR is less than 2

Question 38

D/C Greater than 2 mcg/kg/minute infusion of argatroban if:

Answer 38

Reduce dose to 2 mcg/kg/min Check INR 4-6 hrs after adjustment (stop if INR greater than 4) Then recheck 4-6 hrs and restart if INR is less than 2.

Question 39

Angiomax (bivalirudin) MOA

Answer 39

Direct thrombin inhibition | Renal adjust for CrCl less than 30

Question 40

Angiomax Monitoring

Answer 40

HIT- aPTT | PCI- ACT