Parenteral Anticoagulants

Question 1

what class of anticoagulants contain a specific pentasaccharide sequence at the end?

Answer 1

UFH

Question 2

how does UFH work

Answer 2

pentrasaccharide portion of the compound bind to AT (antithrombin)

Question 3

what factors doe UFH work on?

Answer 3

XIIa 
XIa
IX
Xa
and thrombin

Question 4

what is the VD of UFH?

Answer 4

0.07L/KG

Question 5

what parenteral agent is renally cleared at high doses?

Answer 5

UFH

Question 6

what is the 1/2 life of UFH?

Answer 6

30-150mins

Question 7

what are the two LMWH injections that are availabe in the US?

Answer 7

Enoxaparin

Dalteparin

Question 8

how does the LMWH work?

Answer 8

indirectly inhibit clotting factors Xa and IIa by binding to AT (antithrombin)

Question 9

what factors does LMWH inhibit

Answer 9

Xa

thrombin

Question 10

what is the bioavalility of enoxaparin and dalteparin

Answer 10

enoxaparin: 92-100%
dalteparin: 87%

Question 11

what is the time to peak of enoxaparin

Answer 11

3-5 hours

Question 12

what is the time to peak for dalteparin?

Answer 12

4 hours

Question 13

how is enoxaparin and dalteparin eliminated?

Answer 13

renally

Question 14

what is the 1/2 life of enoxaparin?

Answer 14

4.5-7 hours

Question 15

what is the 1/2 life of dalteparin?

Answer 15

3-5 hours

Question 16

what factor does fondaparinux inhibit?

Answer 16

factor Xa

Question 17

what is the bioavalibity of fondaparinux?

Answer 17

100%

Question 18

what is the Vd of fondaparinux

Answer 18

7-11 L

Question 19

what is the 1/2 life of fondaparinux

Answer 19

17-21 hours

Question 20

what is the initial dosing for UFH for treatment of VTE

Answer 20

bolus 80units/kg (Max 5000units)

then 18units/kg infusion

Question 21

what is the dose of UFH for STEMI/NSTEMI

Answer 21

bolus 60units/kg. (Max 4000units)

then 12 units/kg infusion (max 1000 units)

Question 22

what is the dose of UFH for AFIB?

Answer 22

bolus 60units/kg. (Max 5000units)

then 12 units/kg infusion (max 1000 units)

Question 23

what is the dose of UFH for pts with CABG

Answer 23

80-360units/kg

Question 24

what is the dose of UFH for pts with cardiac AF ablation?

Answer 24

50-150units/kg

Question 25

what are the labs that you would want to monitor inpts that are using UFH

Answer 25

APTT | anti Xa

Question 26

what are the anti Xa levels for UFH PPX: treatment:

Answer 26

PPX: 0.1-03 TX: 0.3-0.7

Question 27

when do you draw aPTT and anti Xa levels for UFH (timing) BOLUS: Infusion:

Answer 27

post bolus: 6-8 hours | infusion: 4-6 hours

Question 28

what is the PPX dosing for VTE for enoxaparin?

Answer 28

30mg BID or 40mg daily

Question 29

what is the TX dosing for VTE for enoxaparin?

Answer 29

1mg/kg BID or 1.5mg/kg daily

Question 30

what is the STEMI dose for enoxaparin?

Answer 30

< 75 30mg IV bolus then 1mg/kg (BID) | > 75 NO BOLUS 0.7mg/kg (BID)

Question 31

what is the dose of dalteparin for VTE PPX

Answer 31

5000 units daily

Question 32

what is the dose of dalteparin for VTE Treatment?

Answer 32

100units/kg BID | 200units/kg Daily for 1 month then 150units/kg daily

Question 33

what is the dose of fondaparinus for VTE PPX?

Answer 33

2.5mg Daily

Question 34

what is the TX dose of fondaparinux for VTE tX?

Answer 34

<50kg: 5mg daily 50-100kg: 7.5mg daily >100kg: 10mg daily

Question 35

what is the dose of fondaparinux for ACS?

Answer 35

2.5mg Daily

Question 36

For pts with CrCl less than 30ml/min what is the PPX and TX dose of enoxaparin?

Answer 36

PPX: 30mg daily TX: 1mg/kg daily

Question 37

Can fondaparinux be use in pts with CrCl less than 30ml/min?

Answer 37

NO - contraindicated

Question 38

what are the anticoagulants of choice in pt undergoing HD?

Answer 38

Heparin | warfarin

Question 39

``` For patients that are overweight what is the recommended dose of for VTE TX Enoxaparin Fondaparinux UFH Dalteparin? ```

Answer 39

Enoxaparin: 1mg/kg BID Fondaparinux: 10mg daily UFH: 80units/kg bolus then 18units/kg

Question 40

For pts with Morbid obesity what are the recommended doses for VTE PPX Enoxaparin Fondaparinux UFH Dalteparin?

Answer 40

Enoxaparin: 40mg BID Fondaparinux: 2.5mg daily UFH: 7500 units TID Dalteparin: 7500 units daily

Question 41

what parentral agent is contraindicated for pts that weight less than 50kg?

Answer 41

Fondaparinux

Question 42

In what cases are parentreral Direct thrombin inhitbtors used?

Answer 42

1. HIT 2. ACS/PCI 3. Antithrombin deficency 4. heparin allergy 5. no response to heparin

Question 43

what are the 2 parenteral Direct thrombin inhibitors

Answer 43

argatroban (Acova) | Bilvalirudin (Angiomax)

Question 44

what is the brand name for bilvalirudin

Answer 44

angiomax

Question 45

what is the dose of argatroban for HIT?

Answer 45

2mcg/kg/min. | adjust to aPTT of 1.5-3x baseline aPTT

Question 46

what are the labs that need to be monitored for agatroban and bilvalirudin?

Answer 46

aPTT | ACT (activated clotting time)

Question 47

which Direct thrombin inhibitor is more likely to cause false elevated INRs?

Answer 47

Argatroban

Question 48

what is the dose of argatroban for MI?

Answer 48

100mcg/kg IV bolus then 1-3mcg/kg/min

Question 49

what is the DTI of choice in pts under going cardiac bypass and cardiac catherterization?

Answer 49

Bivalirudin

Question 50

what DTI can be eliminated via hemodialysis?

Answer 50

Bivalirudin

Question 51

T or Fase the rise of INR during parenteral DTI infusion is false elevation and does not reflect any anticoagulation effect

Answer 51

TRUE

Question 52

How does hypothermia effect bivalirudin elimination?

Answer 52

reduces it

Question 53

what are the common ADE with argatroban?

Answer 53

``` chest pain/hypotension Diarrhea vomiting headache back ache dypnea ```

Question 54

what is the common ADE with heparin?

Answer 54

thrombocytopenia | increase liver amiotransferase level

Question 55

what is the common ADE for enoxparin (LOVENOX)?

Answer 55

``` Diarrhea/nausea anemia hemorrhage thrombocytopenia increase LFTs Fever ```

Question 56

what are the Common ADE for Dalteparin(FRAGMIN)

Answer 56

Hematoma bleeding from nose irration at local site of injection

Question 57

what are the common ADE for fondaparinux (ATRIXA)

Answer 57

injection site rash | fever

Question 58

what is the dose of bivaliruding (angiomax) for HIT?

Answer 58

0.15mg/kg/hour IV | adjust aPTT to 1.5-2.5 x baseline