Stevenson Flashcards
What is atrial fibrillation?
this is a condition where a patient’s atria isn’t contracting properly.
can get tachycardia induced cardiomyopathy (weakened heart)
Why is it that a fib increases the risk of blood clot formation?
heart rate is too fast–swirling of blood in atria
not contracted out sufficiently
Where do blood clots form in the heart?
usu the left appendage of the left atria
What are the 2 types of stroke? Frequency of each?
Hemorrhagic: 20% of strokes. more fatal.
Embolic: 80% of strokes
Warfarin in high doses is?
Rat Poison
When people have mechanical valves & have a fib…there is only one anticoagulant that can be used. Which one?
Warfarin
What is the leading cause of cardioembolic stroke?
non-valvular atrial fibrillation
T/F Risk of intracranial bleeding with anticoagulation therapy increases with age in nonvalvular AF.
True.
What is Lovanox?
liquid low molecular weight heparin
subcu admin
factor Xa inhibitor
What are NOAC? Give 3 examples.
novel oral anticoagulants
Pradaxa
Xarelto
Eliquis
What are some contraindications to taking Pradaxa?
major GI bleeds
renal failure b/c excreted renally
What is the mechanism of pradaxa?
direct thrombin inhibitor
What are the mechanisms of Xarelto & ELiquis?
Factor 10a inhibitors
What INR is therapeutic for a fib patients?
2-3
What could be bad about an a fib patient on an anticoagulant eating a bunch of leafy greens in the summer?
Vit K!!
could change INR to closer to 1 & more coagulable.
Could form a clot & throw it.
What is the rating system for patients with atrial fibrillation to see if they need an anticoagulant?
CHADSS2 Congestive Heart Failure HTN Age >75 yo Diabetes TIA (2 pts) Stroke (2 pts) More than 1-->put them on an anticoagulant.
HOw is Eliquis excreted?
renal
stool
liver
**can be given to patients with renal failure b/c of the 3 different excretion methods.
HOw long does it take for warfarin to become therapeutic?
4-6 days
don’t just send a DVT pt w/ warfarin
What % of PE patients die?
25%
HOw long does it take for the novel drugs to become therapeutic?
60-90 minutes
- *don’t use after a serious surgery or right before a serious surgery b/c bleeding could happen
- *don’t use right after a bunch of polyp removal after a colonoscopy
PATCHHH is used for codes. WHat does it stand for?
PE acidosis tension pneumothorax cardiac tamponade hypovolemia hypoxemia hyperkalemia
What are some symptoms of PE?
hypoxic-sudden SOB
circulatory collapse-hypotensive
arrhythmia
Pt presents to the ER w/ a PE. He has prostate cancer that has been treated for 1 mo with chemo & radiation. He has acute SOB & he dropped at home. Intubated. Found arrhythmia. What do you treat him with?
heparin IV.
Not subcu!
Or Lovanox w/ 12 hours dosing.
Why don’t you want to use warfarin or novel agents to treat the previous patient?
warfarin: takes 4-5 days to work
novel: could cause him to bleed out if he needs a central line or something.
