questions 1 Flashcards
1
Q
what should the dose of Aspirin be if also on an antiplatlet?
A
75-100mg (81mg dose)
2
Q
what is the dose of protamine for the resversal of Heparin
A
1mg of protamine for every 100 units of heparin (up to 50mg) give slow IV over 10 mins
3
Q
what is the dose of protamine for the reversal of Dalteparin
A
1mg IV for every 100 anti-Xa units of Dalteparin
4
Q
what is the dose of protamine for the reversal of enoxparin?
A
1mg IV for every 1mg of enoxaparin in the previous 8 hours (if more than 8 hours but less than 12 hours since last dose may only need to give 1/2 (0.5mg/1mg of enoxaparin)
5
Q
what drug is used for patients with heparin induced thrombocytopenia (HIT)
A
Bivalirudin (angio max)
6
Q
what is the dose of Bivalirudin for HIT?
A
0.15mg/kg/hour continuous IV infusion
7
Q
what is the dose of Bivalirudin for PCI (percutaneous Coronary intervention thrombosis) Prophylaxis
A
0.75mg/kg bolus then 1.75mg/kg/hr IV infusion
8
Q
what is the dose of heparin for thromboembolic disorder (prophylaxis) the 1st trimester of pregnancy?
A
5000-7500 units subQ every 12 hours
9
Q
what is the dose of heparin for thromboembolic disorder (prophylaxis) in the 2nd trimester of pregnancy
A
7500-10000 units SQ every 12 hours
10
Q
what is the dose of heparin for thromboembolic disorder (prophylaxis) in the 3rd trimester of pregnancy
A
10000 units SQ every 12 hours
11
Q
can warfarin and heparin be use while breast feeding?
A
yes!
12
Q
what is the equation to calculate INR?
A
[PT of the patient/ PT of the normal range mean] ^ISI
13
Q
Calculate CHADSVASc sore.
A
Congestive heart failure - 1 Hypertension - 1 Age > 75 - 2 Diabetes - 1 Stroke (TIA) -2 Vascular disease - 1 Age 65-74 -1 Sex - FEMALE - 1 (0 if you are a male)
14
Q
what is the therapy recommendations for pts with a CHADS VASC score of 0
A
dont give then anything
15
Q
what is the therapy recommendation for pts with CHASDVASc score of 1
A
OAC (DOAC > warfarin) or Aspirin 81mg or no therapy
16
Q
what is the therapy recommendation for pts with CHADSVACs score of 2
A
Oral anticoagulation recommended (DOAC preferred over warfarin)
17
Q
which board governs regulation of labs?
A
The Centers for Medicare & Medicaid Services (CMS)
regulates all laboratory testing (except research) performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA)
18
Q
Is CLIA state or federal?
A
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 are United States federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research.
19
Q
Which regulation established the laboratory standard in the US?
A
The OSHA Laboratory Standard (Occupational Exposure to Hazardous Chemicals in Laboratories, 29 CFR § 1910.1450) is the primary regulation, but laboratory personnel and EHS staff should understand its relationship to the hazard communication standard.
20
Q
What types of labs have to register with CLIA?
A
all labs examining “materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings.”
21
Q
What are the 3 levels of CLIA testing?
A
Waived tests
moderate complexity tests
high complexity tests.
22
Q
What is a CLIA-waived laboratory test?
A
Point of Care Testing, are low complexity tests (including Hemoglobin and Hematocrit) that may be performed by other personnel with proper training.
23
Q
what Vit k dependent protein has the longest 1/2 life
A
PROTHROMBIN (Factor II). - 60 hours
24
Q
what Vit K dependent protein has the shortest 1/2 life
A
Factor VII and protein C (3-6 hours)
25
which genetic thrombophilia work up can be affected by warfairn
Protein C and S deficiency
| APS (lupus anticoagulant), antithrombin
26
how to congestive HF exacerbations effect warfarin/INR
increase response to warfarin Increases INR
BECAUSE: increase in hepatic congestion and decreased warfarin catabolism.
27
how normal blood clots when a blood vessel is injured
1. platelets are drawn to site of injury and from a loose c plug
2. Factor V enzyme reactions on the surface of the platelets generate fibrin, fibrin holds the platelets together (CLOT)
3. when there is enough fibrin APC ( protien c) inactivates factor V stopping the clot from growing
28
what is factor V Leiden
is when pts have a mutation in their factor V gene , that is resistent to APC.
therefore APC has a harder time stopping the clot from growing. (APC resistance)
29
how much does your risk of VTE go up with heterozygous vs homozygous Factor V leiden
homo: goes up by 25-50 fold
hetero: 5-7 fold
30
how does cimetidine effect warfarin
inhibits hepatic microsomal activity, decreaseing the metabolic clearance of warfarin (INCR INR)
31
what are major medications that inhibit metabolism of warfarin (increase INR/bleeding risk)
Amiodarone Garlic
Cimetidine Ginger
Aspirin Ginseng
Dapsone Gingko biloba
Erythromycin Green tea
Metronidazole
Indomethacin
Cotrimoxazole
Fluconazole
Amiodarone
Bactrim
Flagyl
32
What are the major medications that induce metabolism of warfarin (decrease INR)
rifampin
barbiturates
carbamzeprine
phenytoin
33
which enantiomer of warfarin is the most potent
S -is 5x more potent than R producing the anticoagulation affect
34
which enantiomers of warfarin is protein bound, which is bound mainly to albumin
S- albumin
| R- protein
35
what is the major enzyme that metabolizes warfarin
CYP2C9: those who have mutations in this
| CYP2C9*2 and CYP2C9*3 require sig less warfarin dose
36
which enantiomers of warfarin is effect the most by CYP2C9
S
37
which enantiomer of warfarin does amiodarone affect
S
38
what do you recommend to a patient with bleeding gums
press firmly on the part of the gum that is bleeding for 30 mins
Dont: drink hot beverages, use straw, spit, rinse, smoke for 24 hours
avoid hard foods 1-2 days, if bleeding does not stop in 1-2 days contact your dentist or doctor
39
what do you recommend to a patient with nose bleeding
squeeze your nostrils together with your fingers below the bone. Hold it for 5 mins straight, if that doesnt work try a decongestant nose spray
- put 2 squirts in the bleeding nostril
- squeeze your nostrils together for 15 mins
- do it again if you're still bleeding
- go to the ER if it doesnt stop after 3 tries
40
what is the alternative therapy for pts with heparin allergy
(lepirudin), bivalirudin, and argatroban
41
What type of HIT is NON-immune
HIT Type 1
42
what is the treatment for type 1 HIT?
Do not discontinue heparin
(slight fall in platelt count within 1st 2 days after heparin plts >100,000, returns to normal with continued heparin admin)
43
which type of HIT is immune
TYPE 2
44
Do we need to discontinue Heparin for HIT 2?
YES
45
what is the most commonly acquired thrombophillia?
Antiphospholipid antibody syndrome
46
what are some ways a patient can acquire a thrombophilia
- pregnancy
- HIV
- SLE (systemic lupus erythematosus)
47
what is the only DOAC that is approved for PPX of VTE in acute medically Ill pts at risk for thrombosis and what is the dose
Rivaroxaban 10mg daily while inpt.
after discharge continued fro 31-39 days
48
what is the the only DOAC that is approved for the risk reduction of MACE (CV death, MI, and chronic CAD/PVD) and what is the dose
Rivaroxaban 2.5mg BID
+ Aspirin 81mg daily
49
what are the two DOAC that require lead in with parentral agents for 5-10 days prior to start for the TX of VTE
Dabigatran and Edoxaban
50
what would you do if warfarin pt has INR >10 and no active bleeding.
Hold warfarin and give 2.5mg mg Orally to decrease risk of hemorrhargic complications.
51
what are the factors that warfarin works on? which also are the vit K dependent factors
VII, IX, X, II and protein C and S `
52
if pt has active bleeding on warfarin what are the reversal agents that you can give?
1. Vit K IV (5-10mg)
| 2. K-centra (4FPPC)
53
why is PCC preferred over FFP
PPC doesnt need to be cross matched
- no fluid overload
- no bld borne pathogens,
- allergic reactions
- also has decrease ICH compared to FFP
54
what is the difference between 4F PCC and 3FPCC
4FPCC: has factors II, VII, IX, X and protein C &S
4FPCC: also has heparin so dont use in pt with HIT
3FPCC : ONLY has II, IX, X = so not as effective
55
what is the dose of 4FPCC (Kcentra) with the following INR readings
INR 2-3.9
INR 4-6
INR >6
INR 2-3.9 = >25 IU/Kg
INR 4-6 = > 35 IU/Kg
INR >6= > 50 IU/Kg
56
what is the reversal agent of fondaparinux
which one and what dose (if there is one)
there is one specific for it but you can use Recombinant factors VII
10-40mcg/kg/IV
57
what is the dose of IV Vit K
5-10mg/ml (1mg/min in at least 50ml infused over 30-60mins to decrease risk of reactions)
dont use SQ d/t irratic abs
IM= hematoma
58
what is the pregnancy category for
protamine?
Vit K?
protamine and Vit K = C
59
what is the onset of action of protamin
5mins
60
what are the risks (ADE with protamine)?
angiodemia
pulmonary edema
thrombocytopenia
61
what are the factors in Fresh frozen plasma ? FFP
II, VII, IX, X
62
what is the onset of action of FFP
1-4 hours
63
how is k-centra supplied
500-1000 unit vials
64
what is the difference between
Kcentra PCC4
Belulin PCC3
Profiline PCC3
Kcentra PCC4:II, VII, IX, X and protein C&S
room temp or fridge
Belulin PCC3: II, VII very little , IX, X (needs to be thawed cause it has to be refrigerated
Profiline PCC3: II, VII Very little, IX, X
room temp or fridge
65
what is the onset of action for
Oral VITK
IV VITK
Oral VITK : 12-24 hours
IV VITK : 4-12 hours
it can take up to 12-48 hours before we see effects
66
what are the 2 antidotes for fibrinogic/thrombolyutic (tpa, tenekplase) agents
aminocaproic acid
transexamic acid
Clotting promoter
It can treat conditions that cause excessive bleeding. It can also control bleeding during or after surgery.
67
what is the dose of transexamic acid?
1g IV 10mins then
| 1g over 8 hours
68
what is the dose of amiocaproic acid?
IV
PO
4-5g IV over 1 hours then
1g IV over 8 hours
PO: 5g 1st hour then 1g every hour for 8 hours
69
how do you switch from UFH to LMWH or fondaparinux
stop UFH 1-2 hours after 1st dose of LMWH or fonda
70
how do you swtich from UFH to DOAC
START DOAC a tthe same time that UFH is discontinued
71
how do you go from LMWH to UFH
start UFH within 6 hours of the next schedule time for LMHW dose
72
how do you go from DABI to parentral agent ?
if CrCL > 30ml/min: Stop DABI and start parentral agent at next schedule time for Dabi dose
CrCl <30ml/min: stop DABI and wait 24 hours before starting parentral agent
73
For pts that have to be on DAPT (due to High CAD risk like MI < 6wks ago, baremetal or drug eluding stent < 6wks) and must have surgery now can't wait until DAPT is no longer indicated what should you do for low bleeding risk procedures?
take DAPT until 1 day prior to procedure
74
For pts that have to be on DAPT (due to High CAD risk like MI < 6wks ago, baremetal or drug eluding stent < 6wks) and must have surgery now can't wait until DAPT is no longer indicated what should you do for HIGH bleeding risk procedures?
- stop ASA 7 day prior
- stop plavix (APP) 5 days prior
- bridge with GP IIb/IIIa
Tirofliban: stop 3-6 hours prior to procedure
epitifibade: stop 4-12 hours piror to procedure
75
For pt with acute coronary syndrome (STEMI) what is the duration of therapy that is recommended with anticoagulant?
therapy with any anticoag for 48 hours or until PCI
MAX 8 days
76
what are the 2 main anticoagulants for the tx of NSTE_ ACS and STEMI?
UFH and LMWH
77
what is the dose of LMHW for NSTE-ACS
1mg/kg BID until PCI
78
what is the dose of LMHW for STEMI?
<75 30mg IV bolus then 15 later 1mg/kg BID
>75 NO BOLUS then 0.7mg/kg BID
79
what other parentral agents can be used for NSTE-ACS or STEMI?
Fondaparinux
Bivalrudin
these are mainly as adjunctive therapy or if the pt also has HIT
80
what is the Bivalrudin dose for
NSTE-ACS?
STEMI?
0.1mg/kg. then 0.25mg/kg/hr
STEMI: 0.75mg/kg bolus then 1.75mg/kg/hr
81
what is the most common valvualar issues from most to least ?
Mitral regurgitation (backward flow) > Aortic regurg >Aortic stenosis (increase resistance to flow) > mitral stenosis
82
what are the risk factors for VTE in pts with prosthetic heart valves?
1. atroventricular position
2. prior VTE
3. Multiple prosthetic valves
4. AFIB
5. mitral stenosis
6. Ejection Fractions < 35%
83
what are the HIGH VTE risk valves
1. prosthetic mitral valves (mechanical)
2. cage and ball valve
3. aortic tiliting disc valve
if pt has had thrombotic even in the past 6 months
84
Moderate VTE risk for valves
bileaflet aortic valve with 1 of the following
| AFIB, storke, TIA, HTN, CHF, DM, Age >75
85
Low VTE risks for valves
any bileaflet aortic valve
86
what is recommended for all bioprosthetic heart valve pts
Mitral:
Aortic:
Mitral: VKA for 3 months then low dose ASA
Aortic: ASA
Same thing for repair and replacement
87
Mitral clip is a catheter directed procedure to attach a clip to help mitral valve close more completely. Mainly for pts with severe HF (III,IV) that cant undergo heart surgery: what is the recommended anticoag therapy
ASA 325 for 6- 12 months
or
plavix 1 month
88
There are 2 types of LVAD (Axial flow and centrifugal) what is the preop recommendation for LVAD
post op?
stop warfarin and any anticoagulant 5 days prior and bridge with UFH
POST OP start HEPARIN day 1 and ASA if possible. Dont start warfarin until all the tubes are out.
89
LVAD cans alert what coag factors and how
decrease: F XI and XII
90
what disease can LVADs cause
it causes hemolysis because of the turbulant flow = Von Willebrand disease = plt dysfunction
91
can you use DAPT for pts that are undergoing cardioversion/ablation?
NO wait until DAPT is no longer required
92
how long after cardioversion/ablation should pt remain on anticog therapy
at least 3 months
93
if you have to stop anticoag therapy for cardioversion/ablation what can you bridge with?
Aspirin
94
How long is VKA recommended before and after a cardioversion?
3 wks before
| 4 wks after
95
watchman procedure is sucessful if it has less that what % leak
after 45 days of VKA what anticoag regimen is recommended?
sucessful if less than 5% leak
after 45 days - start plavix and aspirin 325 for 6mths
after 6mths still no leak Aspirin 325 ONLY
96
what are the 10 risk factors for VTE
1. Advance age
2. prolonged immobility
3. pregnancy/postpartum
4. obesity
5. cancer
6. frail/chronic illness
7. thrombophillia
8. prior VTE
9. hormone therapy
10. medical illness (IBS, nephroci syn, vasculitius)
97
for acute PE you can possibily use thromblyics either systemic or catheter directed. what are the two thrombolytics that can be used?
1. Alteplase
| 2. tenecteplase
98
what is the dose of alteplase?
10mg IV bolus then 90mg IV over 2 hours
50-100mg Bolus for Cardiac arrest
99
what is the dose of tenecteplase?
```
<60kg - 30mg
60-70 - 35mg
70-80 - 40mg
80-90 - 45mg
>90 = 50mg.
```
ALL IV BOLUSS
100
what are the abosulte CI for thrombolytics (7)
1. active bleeding
2. previous ICH
3. structrual intracranial disease
4. ischemic stroke < 3 mths
5. brian/spinal surgery < 3mths
6. head trauma < 3 mths
7. bleeding conditions
101
IVC filters are recommended for all pts that have CI for anticoag therapy what are some reasons why they would have CI?
massive PE tx with thrombolysis
Chronic PE Tx with thrmboendartrectomy
recurrent VTE despite adequate anticoag and inablity to increase anticoag
102
what is the most common thromophilic state?
Factor V lieden
103
What factors do Factor V Liden prevent inactivation of?
V and VIII therefore the these two factors stick around longer and increase thrombosis
104
what is the difference between TYPE 1 and TYPE II Protein C deficiency?
TYPE1: general decrease in the amt of protein C (decrease synthesis)
TYPE II: the amount protein C is unchanged but there are less functioning ones (dysfxn)
105
what does the level of protein C activity assay have to be in order to show deficiency?
<55%
106
Protein S deficiency is found as both bound and free and normally found 60% bound and 40% free which two factors does it prevent the inactivation of?
V and VIII (just like protein C deficency)
107
what is the difference between Protein S deficiency TYPE I, II, III
TYPE I - both free and bound are decreased
TYPE II- the total number of protein is unchanged but they dont work (dysfunction) - rare
TYPE III - total number is the same but Disproportionally bound (more BOUND than Free)
108
what can decrease protein S? (6)
1. Pregnancy
2. liver disease
3. estrogen therapy
4. Warfarin therapy
5. DIC
6. Nephrotic syndrome
109
what does Protthrombin 20210 gene mutation do?
dominate gene mutation on factor II therefore it increases the levels of prothrombin by 30% = more clots
110
Antithrombin deficiency is when you are deficient in antithrombin (natural anticoagulant) that decreases/inactivates what factors?
```
II
IX
X
XI
XII
```
111
what is the difference in type I and type II antithrombin?
Type I: decrease activity
| Type II: abnormal function (mainly mutation at the thrombin binding site)
112
what are the 8 types of acquired antithrombin deficiency?
1. Sepsis
2. pregnancy
3. liver disease /fatty liver
4. DIC
5. acute thrombosis
6. Chemotherapy
7. nephrotic syndrome
8. Heparin therapy
113
how do you diagnosis APS (antiphospholipid antibody syndrome)?
pregnancy morbidity or vascular thrombosis
+
a positive test of one the following
1. lupus anticoagulant
2. Beta 2 glycoprotein antibodies
3. cardiolipin antibodies
you then have to confirm 12 wks later
114
Systemic lupus erythematousus can cause which thrombophilia?
APS (antiphospholipid syndrome)
115
how does dysfibrinogenemia work?
mutation on the fibrinogen = doesnt work well (decrease fibrin formation)
116
which thrombophilia can effect Pt/INR therefore try and use chromogenic X activity assay?
1. Dysfibrinogenemia (PT is prolonged)
| 2 APS
117
how long do you have to discontinue anticoagulant before testing for thrombphilia?
2 wks
118
preganancy can increase which factors
II, VII, VIII, X
119
what are the acquired thrombophillia in pregnancy?
protien S deficency
| antithrombin deficiency
120
which thrombophllia causes both venous and arterial clots?
Lupus anticoagulant
| Antiphosphlipid anticoagulant
121
what are the two thrombphillias that are identified using genetic testing?
factor V liden and
| prothrombin gene G20210 A mutation
122
which anticoagulants can affect Lupus anticoagulant testing?
and how it is +/-
ALL OF THEM (heparin, LMWH, warfarin, DTI, DOAC)
MAKE IT A False positive +
123
which anticoagulants affect Beta glycoprotein 1 antibody testing and anticardiolpin antibodies?
NONE of them
124
which anticoagulants affect testing for factor V Lieden?
NONE (genetic testing)
125
which anticoagulants affects testing for prothrombin gene muatation
NONE (genetic testing)
126
which anticoagulants affects testing for activated protein C resistance?
NONE
127
which anticoagulant affects protein S and Total antigen testing?
warfarin
128
Factor Xa inhibitors (riva, apixa, edox) can falsely increase which thrombphillia assay?
protein C antigen
129
Direct thrombin inhibitors can falsely increase which thromphillia assay?
```
antihrombin activity (NOT antigeN)
Protein C and S activity ( NOT ANTIGEN)
```
130
warfarin can decrease which thrombophillia assay?
Anthrombin activity
| and any protein C and S activity or antigen assay
131
LMWH can decrease which thrombophillia assay?
Antithrombin activity and antigen
132
LMWH can increase which thrombophillia assay
protein C and S activity
133
Heparin can decrease which thrombophillia assay?
antithrombin activity and antigen
134
heparin can increase which thrombphillia assay
protein S activity
135
what is HIT type 1?
non-immune reaction due to plt aggregation which can cause modest decrease in plts
rarely doe they go below 100
136
what is HIT TYPE II
plt activating immune complex = IgG binds to heparin =PF4 complex which take about 5 days from initial heparin exposure to do
1. bind to monocytes/endothellia cells = tissue factor production = thrombosis
2. release of microparticles = thrombosis
3. lease to plt aggregation and consumption = thrombocytopenia
137
what are the arterial and venous complications for HIT
arterial: MI, Stroke, limb ischemia
venous: PE, DVT, venous limb gangrene (esp when HIT happened in the presence of warfarin, thats why you have to reverse warfarin)]
more venous than arterial
138
what are the cutaneous manifestations of HIT
skin necrosis at heparin injection site
warfarin induced necrosis
bilateral adrenal hemorrhage
139
what is the only FDA approve tx for HIT?
argatroban at 2mcg/kg/min
140
To monitor argatorban what does the aPTT and ACT need to read for HIT?
aPTT: 1.5-3x baseline
ACT: 60-90 seconds
141
If pt has a prior hx of HIT and needs to be bridge what parentral agent is recommended.
HIT ab present
HIT ab NOT present
ab present: argatroban/bilvalrudin
non present: fondaparinux
142
what is the dosing of Bilvalrudin for PI with or without HIT (FDA approved for PIC and cardiac surgery)
BOLUS 0.75mg/kg
1.75mg/kg/hour
if CrcL <30ml/min: bolus is the same: 1mg/kg/hr
hemodialysis: bolus is the same: 0.5mg/kg/hr
143
what is the preferred anticoagulant for acute VTE in pregnancy? and what is the dose
LMWH at 1mg/kg BID
144
what is the dose of UFH in pregnancy? for acute VTE
1: 333 units/kg bolus then 250mg units/kg BID
2. 80units/kg bolus then 18 units/kg/hr IV
(after 5 days of IV can convert to BID/TID SC dosing)
must have anti-Xa level between 0.3-0.7u/ml
145
when do you stop LMWH prior to delivery of baby?
24 hours prior to planned delivery and epidural
146
when do you stop SC UFH prior to delivery of baby?
24 hours prior to planned delivery and epidural
147
when do you stop IV UFH prior to delivery of baby?
4-6 hours prior to planned delivery and look at CBC before epidural
148
when should you resume LMWH after delivery of baby?
Vaginal 4-6 hours post deliver
cesarean: 6-12 hours post delivery
( must be at least 24 hours from epidural or 4 hours from catheter removal)
149
when should you resume UFH post partdum?
Vaginal 4-6 hours post deliver
cesarean: 6-12 hours post delivery
must be at least 1 hour from epidural or catheter removal
150
which anticoagulants are pregnancy cat B
Argatroban
fonaparinux
LMWH
151
what is the diagonistic test for pregnant women?
duplex ultrasound: Accurate non-invasive
D-Dimer is useless : these levels are naturally elevated in pregnant women
152
what is the antiplatelet of choice if elderly pt has to be on triple therapy ?
Plavix
153
which immunomodulary drugs can increase risk of thrombosis?
Thalidomide
Lenalidomide
for multiple myeloma when used with dexamethasone can increase risk of thrombosis
154
thrombocytopenia in cancer pts is mainly cause by what? (4 causes)
1. chemotherapy
2. bone marrow cancer
3. infection
4. liver disease
155
what plt count do you need to decrease LMHW therapy?
when PLT is less than 50,000
156
what is the most common cause of non-bacterial thrombic endocarditis? what is the tx and duration
adenocarcinoma is the most common cause
UFH (can consider LMWH but NEVER WARFARIN)= continued indefinitely due to reoccurrence
157
what is the most frequently used anticoagulant in children with DVT-PE?
LMWH
158
When should you draw Anti-Xa levels to monitor LMWh therapy?
4 hours after the 3rd and 4th dose.
159
what is the Treatment dose of LMWH for VTE in premature neonates?
2mg/kg BID
160
what is the Treatment dose of LMWH for VTE in full term neonates? (<1 month of age)
1.7mg/kg BID
161
what is the Treatment dose of LMWH for VTE in infants 1-3 months?
1.5mg/kg BID
162
what is the Treatment dose of LMWH for VTE in infants >3 months?
1mg/kg BID
163
what is the PPX dose for children less than < 2 months?
0.75mg/kg BID
164
what is the PPX dose of children greater than >2 months ?
0.5mg/kg BID
165
what is the dose of warfarin for children who will be started as inpt?
0.2mg/kg daily (7.5mg MAX dose daily)
166
what is the only DOAC that must be taken orally and should not be adminstered through an enternal feeding tube?
Dabigatran
167
which DOAC see a 20% decrease in concentration when given with antacids>
Dabigatran
168
what are the 1/2 life of these factors (put them in order from most to least)
II
VII
IX
X
Protein C
Protein S
Most to least
```
II- 72 hours
protein S: 60 hours
X: 27-48 hours
IX: 21-30 hours
protein C 9 hours
VII: 4-6 hours
```
169
what factors does Heparin inhibit?
```
XII
XI
X
IX
II
```
V and VIII
170
how often do you need to measure apTT for heparin for VTE treatment and what is the goal
every 6 hours
1.5-2.5x control
171
what is the dose of Dalteparin for the tx of VTE?
<56 : 10,000 units daily
| >56 kg: 18,000 units daily
172
PPX of dalteparin dose?
5000 units daily
