Thrombus Antiplatelt Med Cross

Question 1

What are two types of thrombi

Answer 1

White and red

White, platelet rich, in arteries

Red, fibrin and RBC rich, forms in the veins

Question 2

3 categories of anti thrombotic

Answer 2

Antiplatelet
Anticoagulant
Fibrinolytic

Question 3

What antithrombotic prevents clot formation

Answer 3

Anticoagulant

Question 4

Which antithrombotic breaks up existing clot

Answer 4

Fibrinolytic

Question 5

Which antithrombotic interfere with platelet activation

Answer 5

Antiplatelet

Question 6

Txa2 can be harmful how?

Answer 6

It is responsible for platelet activation and aggregation and causes vasoconstriction in the body

Too much can create plug and form cardiovascular disease

Question 7

What is ADPs role

Answer 7

Platelet activation

Question 8

What is 5-HT role in the body

Answer 8

Platelet aggregation and vasoconstriction

Question 9

What is IIb and IIIa inhibitors role in body

Answer 9

Platelet aggregation

Question 10

3 coagulation pathways

Answer 10

1. Intrinsic, damage cells
   2- extrinsic , damaged blood vessels
   3- common pathway

Question 11

Warfarin monitors ____

Answer 11

INR

Question 12

PTT monitors

Answer 12

Heparin

Question 13

Prior to administering anticoagulant what to ensure

Answer 13

Make sure no prior contraindicated meds
Check baseline cbc and with platelet count
Check serum creatinine
Check liver function

Question 14

Warfarin is a ______ antagonist

Answer 14

Vitamin K

Question 15

Your pt eats a lot of spinach what might u counsel them on if they are on warfarin

Answer 15

Eating lots of spinach may counteract, reduce effectiveness of warfarin

Question 16

What is the uses of warfarin

Answer 16

DVT, AND PE TREATMENT
PREVENT STROKE IN A PT WITH A FIB OR A HEART VALVE

Question 17

Monitoring INR for warfarin what should inr be

Answer 17

Should be about 2-3 is goal

Question 18

INR GOAL for pt who has a mechanical mitral valve or any mechanical valve with risk factors such as heart failure, or MI, embolism?

Answer 18

2.5-3.5

Question 19

Warfarin dosing start low at what dose?

Answer 19

5 mg po daily

Question 20

Warfarin dosing if over 75, and hepatic insufficiency ?

Answer 20

2.5 mg

Question 21

What are some issues with warfarin

Answer 21

Slow onset and offset, diet interaction
Need to monitor routinely
Interact with spinach
Inr checked every 3 day

Question 22

Known drug interaction with warfarin

Answer 22

Amoxicillin
Cephalosporin
Metronidazole
Doxycycline
NSAIDS

Question 23

What drugs increase INR when given with warfarin

Answer 23

Amiodarone
Ciprofloxacin
Metronidazole
Fluconazole
Bactrim

Question 24

A pt you prescribed warfarin has had an increase in his INR, and in looking at his medication list u note he currently takes rifampin, Benadryl and is also on amiodarone for his heart, which med do u suspect is causing his increased INR WHICH COULD LEAD TO INCREASE bleeding

Answer 24

Amiodarone
Increases inr increases the effect of warfarin

Question 25

INCREASE INR MEANS WHAT

Answer 25

Blood taking longer to clot, risk for bleed

Question 26

A pt u recently prescribed warfarin at 5 mg and u note a decrease in the patients INR what do u suspect could be causing this decrease, the meds he takes are currently sertraline, phenytoin, and Rosuvastatin,

Answer 26

Phenytoin

Question 27

Which meds decrease INR

Answer 27

Rifampin Carbamezepine Phenytoin Phenobarbital St. John’s wart

Question 28

If INR IS decreased the patient is at increased risk for ?

Answer 28

Stroke, or clot means warfarin is metabolized too quick can be due to medication interactions

Question 29

If in monitoring pt u note there INR IS BETWEEN 4.5-10 what would u do?

Answer 29

Hold 1-2 doses of warfarin and monitor INR, resume at a lower dose No vitamin k is recommended

Question 30

If INR is over 10 what would u do?

Answer 30

Hold warfarin and give vitamin k 2.5-5 mg po (oral) even if not bleeding Can mix with orange juice to improve taste

Question 31

Clinical pearl for reversing warfarin with vitamin k

Answer 31

Do not give subcutaneous or intramuscular vitamin k injection, it is associated with erratic absorption, do not use Oral route is preferred When warfarin is stopped, Takes 5 days to return to baseline, with vitamin k takes only 1 Iv vitamin k should be diluted with 50 ml normal saline and administered for 10-30 mins

Question 32

When warfarin is stopped takes about __ days to return to baseline but with vitamin k it takes only __ day

Answer 32

5 1

Question 33

Which route is preferred with vitamin k

Answer 33

Oral route

Question 34

Iv vitamin k 10mg should be diluted with ____ ml normal saline over 10-30 mins

Answer 34

50 Avoid hypersensitivity rxn

Question 35

When is Dabagatran used

Answer 35

Orally used for preventing stroke and embolism in pt with a fib VTE, TX PREVENTING VTE AFTER HAVING VTE

Question 36

Dabagatran monitoring

Answer 36

Renal and hepatic monitoring

Question 37

Dabagatran do not use if creatine clearence is less than ___ in a fib or less than ___ in VTE

Answer 37

15 30

Question 38

Xarelto avoid use with

Answer 38

Inhibitors such as ketoconazole and Ritonavir, make xarelto too effective can lead to toxicity And avoid with inducers, phenytoin, rifampin, St. John wart m carbamezepine, inducer will make xarelto less effective

Question 39

Xarelto monitoringneenal function dose is reduced is cr cl _____ (a fib) and should not be used if car clearence less than ___ VTE

Answer 39

15-50 30

Question 40

Xarelto used

Answer 40

Prevent stroke in or with a fib Treat VTE Prevent VTE after hip or knee replacement Also now used for PAD

Question 42

Rivaroxaban (xarelto good for VTE

Answer 42

Prophylaxis

Question 43

Anticoagulation involves 3 phases

Answer 43

Initiation phase, parenteral or high dose Treatment phase, 3 months Extended phase

Question 44

Is doac preferred over warfarin

Answer 44

Yes, less side effect drug monitoring, inr monitoring Depends on pts insurance

Question 45

Apixaban, eliquous acute invitation phase what dose to start (FOR VTE TX)

Answer 45

10 mg PO BID, first 7 days

Question 46

Rivaroxaban (xarelto) initiation early acute phase treatment start with ____( for VTE TREATMENT)

Answer 46

15 mg PO BID, first 21 days

Question 47

Acute VTE can do unfractionated heparin infusion [inpatient] , or enoxaparin and continue 5 days and then what options

Answer 47

can do warfarin simultaneously or Initiate Dabagatran or edoxaban after 5th day

Question 48

Unfractionated Heparin monitoring

Answer 48

Baseline aptt And check aptt in 6 hours (goal is 60-80 second)

Question 49

Eliqous uses

Answer 49

Used to prevent stroke, treat active VTE, and prevent VTE

Question 50

Eliquous dose reduction if age if ___80 or weight is <__

Answer 50

> greater than 60 kg

Question 51

What drug to avoid eliquous

Answer 51

Avoid inhibitors such as ketoconazole and Ritonavir Avoid inducers like St. John’s wart, rifampin

Question 52

What meds are started without initial parenteral

Answer 52

Xarelto and eliquous

Question 53

Unfractionated heparin administered as _____ injection for VTE prophylaxis

Answer 53

Subcutaneous

Question 54

Adverse effects of Unfractionated heparin

Answer 54

Bleeding Heparin induced thrombocytopenia Osteoporosis

Question 55

If pt is being prescribed warfarin and eats a lot of salads and leafy greens what would u counsel them about

Answer 55

Make sure if eating leafy greens, patient has a consistent diet if they eat salads Monday to Friday make sure they continue to eat them Monday to Friday

Question 56

Antiplatelet therapy for PAD

Answer 56

Aspirin 81-325 mg po, or do clopidogril (plavix-75 mg) if can’t take aspirin Cilostazol, 100 mg to improve walking distance and for an add on therapy