More Guidelines Flashcards Preview

ACNP REVIEW > More Guidelines > Flashcards

Flashcards in More Guidelines Deck (42)
Loading flashcards...
1
Q

In patients requiring Vitamin K antagonists before surgery it should be stopped

A

5 days prior to surgery

2
Q

In patients with mechanical valves, atrial fibrillation, or at high risk of VTE in regards to bridging

A

Bridging anticoagulation is recommended

3
Q

Low risk VTE patients and bridging

A

No bridging indicated

4
Q

dental procedure and vitamin K antagonists

A

Continue them with coadminstration of prohemostatic agent or stop 2-3 days before procedure

5
Q

In mod-high risk patients taking ASA requiring non-cardiac surgery

A

continue ASA

6
Q

In patients with a bare metal stent or drug eluding stent must wait how long before surgery

A

More than 6 weeks for bare metal

More than 6 months for drug-eluding

7
Q

If surgery is indicated and time is less than that indicated for stents, what to do with anticoagulants

A

continue dual antiplatelet therapy perioperatively

8
Q

When to restart vitamin K antagonists if stopped prior to surgery

A

12 to 24 hours after surgery and adequate hemostasis

9
Q

In patients with derm procedures Vitamin K antagonists should be

A

continued perioperatively

10
Q

In patients at low risk for CV events who are taking ASA anticipating surgery

A

stop 7-10 days prior to surgery

11
Q

ASA and clopidogrel/prasugrel in regards to CABG

A

continue ASA

stop clopidogrel/prasugrel 5 days prior

12
Q

Patients receiving heparin infusion in regards to anticipated surgery

A

stop 4-6 hours prior to surgery

13
Q

Dosing of LMWH in regards to anticipated surgery

A

last dose should be administered 24 hours prior to surgery

Not 12 hours

14
Q

Patients at high risk of bleeding surgery and resuming LMWH postoperatively

A

resume 48-72 hours after surgery

15
Q

Increased risk of bleeding surgeries

A
Urologic
PPM/ICD placement
Colonic polyp resection
High vascularized organs (spleen, kidney, liver)
bowel resection
Cardiac, spinal, cranial surgery
16
Q

Healthy outpatient regimen for starting VKA (warfarin)

A

10 mg for first 2 days

17
Q

Recommendations are _____ routine use of pharmacogenetic testing for guiding doses of VKA

A

against

18
Q

Patient with acute VTE should start VKA when

A

day 1-2 of LMWH or UFH

19
Q

For patients with stable INR, lab testing frequency

A

every 12 weeks

20
Q

For patient with stable INR with single out of range INR less than 0.5 above/below range

A

continue current dose and recheck in 1-2 weeks

21
Q

In patients with stable INR with single sub therapeutic INR

A

do not give bridging therapy

22
Q

Patients taking VKA should _____ use vitamin K supplementation

A

not

23
Q

Best practice of providers managing patients on Warfarin

A
  1. systematic and coordinated fashion
  2. patient education
  3. systematic INR testing
  4. tracking
  5. follow-up
  6. good patient communication of results and dosing decisions
24
Q

Patients who can demonstrate competency in self-management with VKA

A

should be allowed to do so without usual outpatient monitoring

25
Q

When deciding dosages for VKA use

A

nomograms

26
Q

Patients taking VKA should avoid what meds due to drug interactions

A
NSAIDs
ASA
Clopidogrel
Cephalexin
cefradine
Cephalosporins
Metronidazole
Ciprofloxacin
Levofloxacin
Norfloxacin
Amoxicillin
Augmentin
Fluconazole
SSRI
Co-Enzyme 10
3 G (ginko biloba, ginseng, garlic)
27
Q

Therapeutic range for VKA

A

INR 2-3

28
Q

Patient who are able to discontinue to VKA should

A

abruptly discontinue

unnecessary to taper

29
Q

dose for UFH

A

bolus and maintenance are weight adjusted
VTE
bolus 80 units/kg
maintenance 18 units/kg

Cardiac or stroke
70 followed by 15
or 5000 units bolus followed by 1000 units/hr

30
Q

outpatient subq UFH dose

A

333 units/kg once then 250 units/kg without monitoring

31
Q

Patients with severe renal insufficiency (CrCl

A

decrease dose

32
Q

Patients over 100 kg on fodaparinux dose

A

increase from usual dose of 7.5 mg to 10 mg daily

33
Q

Supratherapeutic INR treatment

A

INR 4.5-10 no evidence of bleeding = no Vit K

INR over 10 with no evidence of bleeding= give Vit K

34
Q

Criterion of prediction for bleeding on VKA

A

Should NOT solely be judged on clinical prediction

35
Q

For patients with VKA-associated major bleed should be given

A

reversal with four-factor prothrombin complex concentrate (PCC) rather than plasma

36
Q

Use of Vitamin K as a reversal

A

should be used additionally with reversal coagulation factors

37
Q

management of purulent skin/soft tissue infection

A

I and D with culture and sensitivity

Severe- Vancomycin to start until cultures return
Moderate- Bactrim or doxycycline
Mild- JUST I and D

38
Q

Management of Nonpurulent skin/soft tissue infection

A

Mild- oral abx, PCN VK or Cephalosporin
Moderate- IV PCN, or IV cefazolin/ceftriaxone
Severe- rule out necrotizing process
Empiric- Vancomycin plus Zosyn; culture and narrow

39
Q

Systemic symptoms of open wound of surgical site infection

A

Fever more than 4 days after operation
temp over 38 C
WBC over 12K
Erythema over 5 cm

40
Q

Management of open wound without systemic symptoms of surgical site infection

A

dressing changes WITHOUT antibiotics

41
Q

Management of open wound WITH systemic symptoms of surgical site infection

A

dressing changes with antibiotics

clean wound, trunk, head, neck, extremity
Cefazolin or Vancomycin until MRSA ruled out

wound of perineum, GI tract, or female GU
Cephalosporin plus Flagyl or
Levofloxacin plus Flagyl or
Carbapenem

42
Q

Fever in the first 48 hours from operation for surgical site infection

A

only treat if wound is draining, local signs of inflammation, and cultures are revealing

then open and decried, start PCN and clindamycin