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VTE Flashcards

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1
Q

Unfractionated Heparin Abbreviation

A

UFH

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2
Q

Unfractionated Heparin Dosing

A

Weight based: 80 units/kg IV bolus, 18 units/kg/hr infusion

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3
Q

Unfractionated Heparin Side Effects

A 
Major bleeding
Osteoporosis (if long term)
Hypersensitivity
HIT
HAT
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4
Q

Unfractionated Heparin Monitoring

A

aPTT: Baseline, 6 hours after dose or dose change (x24h), daily after 1st day
Platelet: QOD until day 14

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5
Q

Enoxaparin Brand

A

Lovenox

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6
Q

Enoxaparin Dosing

A

Prophylaxis: 30mg SQ q12h OR 40mg SQ daily
Treatment (actual body weight): 1mg/kg SQ q12h OR 1.5mg/kg SQ daily
If CrCl is less than 30ml/min:
Prophylaxis: 30mg SQ daily
Treatment: 1mg/kg SQ daily

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7
Q

Enoxaparin Side Effects

A

Black box warning: Do NOT use with neural anesthesia/spinal puncture
Bleeding
Thrombocytopenia (less than UFH)
Delayed HS skin reactions

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8
Q

Enoxaparin Monitoring

A

If CrCl less than 30mL/min (severe kidney failure), children, obesity, long courses, pregnancy, monitor anti-Xa level 4-6h post.

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9
Q

Dalteparin Brand

A

Fragmin

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10
Q

Dalteparin Dosing

A

Prophylaxis: 2500-5000 IU SQ daily
Treatment: 200 IU/kg SQ daily (MAX 18000 IU)

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11
Q

Dalteparin Side Effects

A

Black box warning: Do NOT use with neural anesthesia/spinal puncture
Bleeding
Thrombocytopenia (less than UFH)
Delayed HS skin reactions

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12
Q

Dalteparin Monitoring

A

If CrCl less than 30mL/min (severe kidney failure), children, obesity, long courses, pregnancy, monitor anti-Xa level 4-6h post.

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13
Q

Tinzaparin Brand

A

Innohep

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14
Q

Tinzaparin Dosing

A

Treatment: 175 anti-Xa IU/kg SQ daily

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15
Q

Tinzaparin Side Effects

A

Black box warning: Do NOT use with neural anesthesia/spinal puncture
Bleeding
Thrombocytopenia (less than UFH)
Delayed HS skin reactions

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16
Q

Tinzaparin Monitoring

A

If CrCl less than 30mL/min (severe kidney failure), children, obesity, long courses, pregnancy, monitor anti-Xa level 4-6h post.

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17
Q

Fondaparinux Brand

A

Arixtra

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18
Q

Fondaparinux Dosing

A 
Prophylaxis: 2.5mg SQ daily (not for less than 50 kg or CrCl less than 30ml/min)
Treatment:
Less than 50: 5mg SQ daily
50-100kg: 7.5mg SQ daily
Greater than 100kg: 10mg SQ daily
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19
Q

Fondaparinux Side Effects

A

Bleeding

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20
Q

Fondaparinux Monitoring

A

Can monitor anti-Xa levels, but no routine monitoring

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21
Q

Rivaroxaban Brand

A

Xarelto

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22
Q

Rivaroxaban Dosing

A

DVT prophylaxis: 10mg PO daily 12-35 days
DVT/PE treatment: 15mg PO BID x3 weeks, then 20mg daily
NV Atrial fibrillation:
20mg PO daily

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23
Q

Rivaroxaban Side Effects

A

Bleeding

Black box warning: spinal/epidural hematoma and premature D/C increases risk thrombotic event

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24
Q

Rivaroxaban Monitoring

A

Caution with CYP3A4/P-gp

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25
Edoxaban Brand
Savaysa
26
Edoxaban Dosing
DVT/PE treatment (after 5-10 days parenteral therapy): 60mg PO daily if CrCl is greater than 50 mL/min 30mg PO daily if CrCl 15-50 mL/min, body weight less than or equal to 60kg NV atrial fibrillation: 60mg PO QD if CrCl 50-95 mL/min 30mg PO QD if CrCl 15-50 mL/min
27
Edoxaban Side Effects
Bleeding Black box warning: spinal/epidural hematomas, premature discontinuation increases risk thrombotic event Less efficacy in NVAF patient CrCl is greater than 95 mL/min
28
Edoxaban Monitoring
Caution with CYP3A4/P-gp
29
Apixaban Brand
Eliquis
30
Apixaban Dosing
``` Pregnancy Class B! DVT prophylaxis: 2.5mg PO BID DVT/PE treatment: 10mg PO BID x7 days, then 5mg BID x6 months (2.5 after) NV atrial fibrillation: 5mg PO BID OR 2.5mg PO BID if 2 of: 1) age ≥ 80 years 2) weight ≤ 60kg 3) SCr ≥ 1.5mg/dL OR dialysis + age ≥ 80 years OR weight ≤ 60kg ```
31
Apixaban Side Effects
Bleeding | Black box warning: spinal/epidural hematomas, premature discontinuation increases risk thrombotic event
32
Apixaban Monitoring
Caution with CYP3A4/P-gp
33
Lepirudin Brand
N/A
34
Lepirudin Dosing
HIT: 0.15 mg/kg/h
35
Lepirudin Side Effects
Bleeding
36
Lepirudin Monitoring
Goal aPTT 1.5-2.5 | Reduce dose if CrCl less than 60 ml/min
37
Bivalirudin Brand
Angiomax
38
Bivalirudin Dosing
HIT or UFH alternative during PCI: 0.7 mg/kg bolus + 1.75 mg/kg/h infusion
39
Bivalirudin Side Effects
Bleeding
40
Bivalirudin Monitoring
None
41
Argatroban Brand
N/A
42
Argatroban Dosing
HIT: 2 mcg/kg/min OR 0.5 mcg/kg/min if hepatic insufficiency
43
Argatroban Side Effects
Bleeding
44
Argatroban Monitoring
Elevates INR falsely; overlap with warfarin until INR ≥4
45
Dabigatran Brand
Pradaxa
46
Dabigatran Dosing
DVT/PE treatment after 5-10 days parenteral anticoag: 150mg PO BID for CrCl ≥30 mL/min NV atrial fibrillation: 150mg PO BID if CrCl greater than 30 mL/min 75mg PO BID if 15-30 mL/min
47
Dabigatran Side Effects
Dyspepsia | Bleeding
48
Dabigatran Monitoring
Recommend alternate greater than 75yo | Keep in manufacturer's bottle
49
tPA, Alteplase Brand
Activase
50
tPA, Alteplase Dosing
10mg IV bolus + 90mg infusion over 2 hours | Most commonly for PE
51
tPA, Alteplase Side Effects
Bleeding
52
tPA, Alteplase Monitoring
None
53
Reteplase Brand
Retevase
54
Reteplase Dosing
10 units IV over 2 minutes + second dose in 30 mins | For ACS only
55
Reteplase Side Effects
Bleeding
56
Reteplase Monitoring
None
57
Tenecteplase Brand
Tnkase
58
Tenecteplase Dosing
30mg + 5mg/10kg over 60kg up to 50mg as IV bolus | For ACS only
59
Tenecteplase Side Effects
Bleeding
60
Tenecteplase Monitoring
None
61
Urokinase Brand
Abbokinase
62
Urokinase Dosing
VTE treatment: 4400 units/kg bolus over 10 minutes + 4400 units/kg/hour for 12 hours
63
Urokinase Side Effects
Bleeding
64
Urokinase Monitoring
None
65
Warfarin Brand
Coumadin, Jantoven
66
Warfarin Dosing
Starting dose: 5 mg PO QD | Available as 1, 2, 2.5, 3, 4, 5, 6, 7.5, and 10mg tablets
67
Warfarin Side Effects
Bleeding | Pregnancy Class X
68
Warfarin Monitoring
CYP2C9, 3A4, 2C19, 1A2 interactions Goal INR 2.0 – 3.0 *mechanical mitral/caged ball/high risk artificial valve goal INR 2.5 - 3.5

Therapeutics (7 decks)

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