Need To Know Dosing Exam Ill

Question 1

What is the class of Metoprolol tartrate (Lopressor)?

Answer 1

Beta-1 selective blocker

Question 2

What is the mechanism of action (MOA) of Metoprolol tartrate?

Answer 2

Decreases HR by blocking beta-1 receptors → reduces AV nodal conduction

Question 3

What is the IV dose of Metoprolol tartrate for acute AFib?

Answer 3

2.5–5 mg IV every 6–12 hours

Question 4

What is the oral dose of Metoprolol tartrate for chronic use?

Answer 4

25–100 mg BID

Question 5

What are the clinical pearls for Metoprolol tartrate?

Answer 5

Use in HFrEF; avoid abrupt discontinuation; bradycardia risk

Question 6

What is the class of Diltiazem (Cardizem)?

Answer 6

Non-DHP calcium channel blocker (benzothiazepine)

Question 7

What is the MOA of Diltiazem?

Answer 7

Blocks L-type calcium channels → slows AV node conduction

Question 8

What is the IV dose of Diltiazem for acute AFib?

Answer 8

0.25 mg/kg IV bolus, then continuous infusion 5–15 mg/hour

Question 9

What is the oral dose of Diltiazem for chronic use?

Answer 9

ER: 120–360 mg daily

Question 10

What are the clinical pearls for Diltiazem?

Answer 10

Avoid in HFrEF; causes bradycardia and hypotension

Question 11

What is the class of Amiodarone (Pacerone)?

Answer 11

Class III antiarrhythmic (also has class I, II, IV activity)

Question 12

What is the MOA of Amiodarone?

Answer 12

Blocks K⁺ channels → prolongs action potential and refractory period

Question 13

What is the IV loading dose of Amiodarone?

Answer 13

150 mg IV over 10 minutes, then 1 mg/min x6 hrs, then 0.5 mg/min x18 hrs

Question 14

What is the maintenance oral dose of Amiodarone?

Answer 14

100–400 mg daily depending on goal (e.g. 200 mg daily long-term)

Question 15

What are the clinical pearls for Amiodarone?

Answer 15

Long half-life (~58 days), interacts with warfarin and digoxin, monitor for thyroid, liver, pulmonary toxicity

Question 16

What is the class of Apixaban (Eliquis)?

Answer 16

DOAC (Factor Xa inhibitor)

Question 17

What is the MOA of Apixaban?

Answer 17

Selectively inhibits factor Xa → reduces thrombin formation

Question 18

What is the dose of Apixaban for AFib?

Answer 18

5 mg PO BID; reduce to 2.5 mg BID if ≥ 2+ of the following: Age ≥80, Weight ≤60 kg, Serum creatinine ≥1.5 mg/dL

Question 19

What are the clinical pearls for Apixaban?

Answer 19

Preferred in ESRD, lower bleeding risk in gastrointestinal, no routine monitoring

Question 20

What is the class of Rivaroxaban (Xarelto)?

Answer 20

DOAC (Factor Xa inhibitor)

Question 21

What is the MOA of Rivaroxaban?

Answer 21

Same as Apixaban

Question 22

What is the dose of Rivaroxaban for AFib?

Answer 22

20 mg PO daily with evening meal; 15 mg daily if CrCl 15–50 mL/min

Question 23

What are the clinical pearls for Rivaroxaban?

Answer 23

Take with food for absorption if dose >15mg; elimination 15% renal

Question 24

What is the class of Heparin (UFH)?

Answer 24

Indirect thrombin inhibitor

Question 25

What is the MOA of Heparin?

Answer 25

Binds antithrombin III → inactivates thrombin and factor Xa

Question 26

What is the IV dose of Heparin for VTE treatment?

Answer 26

80 units/kg IV bolus, then 18 units/kg/hour infusion

Question 27

What is the monitoring goal for Heparin?

Answer 27

aPTT goal ~60–90 seconds or anti-Xa 0.3–0.7 IU/mL

Question 28

What are the clinical pearls for Heparin?

Answer 28

Short half-life, reversible with protamine, HIT risk (Heparin Induced Thrombus)

Question 29

What is the class of Enoxaparin (Lovenox)?

Answer 29

LMWH

Question 30

What is the MOA of Enoxaparin?

Answer 30

Preferentially inhibits Factor Xa via antithrombin

Question 31

What is the treatment dose of Enoxaparin?

Answer 31

1 mg/kg SC q12h OR 1.5 mg/kg SC daily; Renal (CrCl <30): 1 mg/kg SC daily

Question 32

What are the clinical pearls for Enoxaparin?

Answer 32

Avoid in ESRD; anti-Xa monitoring in obese/under weight 50< or >150 pregnant/renal impaired patients Avoid HIT allergies

Question 33

What is the class of Aspirin?

Answer 33

Antiplatelet (COX-1 inhibitor)

Question 34

What is the MOA of Aspirin?

Answer 34

Irreversibly inhibits COX-1 → ↓ thromboxane A2 → ↓ platelet aggregation

Question 35

What is the loading dose of Aspirin for stroke?

Answer 35

325 mg PO once

Question 36

What is the maintenance dose of Aspirin for stroke?

Answer 36

81 mg PO daily

Question 37

What are the timing recommendations for Aspirin after stroke?

Answer 37

Give 24 hrs after thrombolytics; Within 24–48 hrs if no thrombolytics

Question 38

What are the clinical pearls for Aspirin?

Answer 38

GI bleeding risk; avoid NSAIDs; start dual antiplatelet therapy (DAPT) if minor stroke

Question 39

What is the class of Clopidogrel (Plavix)?

Answer 39

Antiplatelet (P2Y12 inhibitor)

Question 40

What is the MOA of Clopidogrel?

Answer 40

Irreversibly blocks P2Y12 receptor → inhibits ADP-mediated platelet activation

Question 41

What is the loading dose of Clopidogrel?

Answer 41

300–600 mg PO once

Question 42

What is the maintenance dose of Clopidogrel?

Answer 42

75 mg PO daily

Question 43

What are the clinical pearls for Clopidogrel?

Answer 43

Used in DAPT after stroke or ACS, CYP2C19 interactions (omeprazole), avoid in combo with Prasugrel

Question 44

What is the class of Alteplase (tPA)?

Answer 44

Thrombolytic

Question 45

What is the MOA of Alteplase?

Answer 45

Converts plasminogen to plasmin → dissolves clots

Question 46

What is the dose of Alteplase for ischemic stroke?

Answer 46

0.9 mg/kg IV (max 90 mg); 10% as bolus over 1 min, rest over 60 min

Question 47

What are the clinical pearls for Alteplase?

Answer 47

Only within 4.5 hours of stroke onset, requires BP <185/110 before starting

Question 48

What is the class of Tenecteplase (TNK)?

Answer 48

Thrombolytic

Question 49

What is the MOA of Tenecteplase?

Answer 49

Same as Alteplase but longer half-life and higher fibrin specificity

Question 50

What is the dose of Tenecteplase?

Answer 50

0.25 mg/kg IV push (max 25 mg)

Question 51

What are the clinical pearls for Tenecteplase?

Answer 51

Not FDA-approved for stroke yet but gaining use; single bolus option