Misc. Problems Flashcards
when is the full antithrombotic effect of warfarin seen?
5-7 days
what should be used in place of warfarin in pregnant women?
heparin
benefit of LMWH
doesn’t require coontinuous monitoring of the PT time
when can heparin be d/c (when overlapped with warfarin)
once the INR is >2.0 on at least 2 consecutive days
when is warfarin best taken
on an empty stomach at a specific time each day , administration at bedtime works well
once stabilized how often an INR be checked
every 3-4 weeks
what is the target INR for most patients
2.0-3.0
how to reverse INS of less than 10 rapidly
oral vitamin K (faster than subQ vitamin K) about same speed as IV vitamin K
how to reverse and INR of >20
fresh frozen plasma
how to change warfarin dose before elective surery
have them stop 4 days before so INR drops to around 1.5
what should be avoided w/ warfarin
NSAIDs and excessive amounts of alcohol
when is biopsy appropriate in LAD
if an abnormal node hasn’t resolsved after 4 weeks and patient has other findings w/ malignancy- fever, night sweats, weight loss
what does left supraclavicular adenopathy suggest (Virchow’s node)
abdominal malignancy
what does right supraclaviular adenopathy suggest
cancer in the mediastinum, lungs, esophagus
what are common causes of axillary LAD
cat scartach dz, infections, breast cancer , silicone breast inplants
causes of generalized LAD
HIV, tuberculosis, mono, LE
common causes of edema
heart failure, cirrhosis, nephrotic syndrome
PE with pulmonary edema
tachypneic, diaphoretic patient with wet rales, and possibly a diastolic gallop (s3) and heart murmurs
patient with nephrotic syndrome may havew hat kind of edema?
periorbital
what does nonpitting peripheral edema suggest
lymphatic obstruction or hypothryoidism
causes of nonpitting edema
lyphemedma, pretibial myxedema (thyroid dz)
presents with decrease platelet levels and is mediated by the production of IgG autoantibodies directed against platelets. PE findings are normal, may have slightly enlarged spleen
Idiopathic thrombocytopenic purpura
disorder that results in clotting of the small blood vessels from spontaneous platelet aggregation. The clots formed can be damaging since they can interfere with the proper flow of blood to the body’s vital organs. People with this type of disorder have insufficient amounts of enzymes necessary in inhibiting a blood clotting protein.
thrombocytic thrombocytopenic purpura
symptoms with TTP
confusion, tachy, weakness, fever
