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7442 Cardio Test 3 > VTE > Flashcards

VTE Flashcards

(85 cards)

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1
Q

enoxaparin (VTE prophylaxis general medical pts)

Dose?

A

dose: 40mg SQ QD

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2
Q

dalteparin (VTE prophylaxis general medical pts)

Dose?

A

5,000 units SQ QD

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3
Q

UFH (VTE prophylaxis general medical pts)

dose?

A

5,000 units SQ Q8h or Q12h

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4
Q

fondaparinux (VTE prophylaxis general medical pts)

dose?

A

2.5mg SQ QD

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5
Q

betrixaban (VTE prophylaxis general medical pts)

dose?

A

160mg PO x 1 dose, then 80mg PO QD for 35-42 days

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6
Q

What is preferred for VTE prophylaxis in orthopedic surgical pts?

A

LMWH

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7
Q

Apixaban (VTE prophylaxis in orthopedic surgical pts)

dose?

A

2.5mg PO BID

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8
Q

rivaroxaban (VTE prophylaxis in orthopedic surgical pts)

dose?

A

10mg PO QD

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9
Q

dabigatran (VTE prophylaxis in orthopedic surgical pts)

dose?

A

110mg PO on day of surgery, followed by 220 mg PO QD

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10
Q

Duration of provoked VTE Tx?

A

3 months

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11
Q

apixaban VTE Tx dosing regimen?

A

10mg PO BIX x 7 days, then 5mg PO BID, then option to reduce to 2.5mg PO BID after 1st 6 months

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12
Q

rivaroxaban VTE Tx dosing regimen?

A

15mg PO BID x 21 days, then 20mg PO QD, then option to reduce to 10mg PO QD after 1st 6 months

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13
Q

dabigatran VTE Tx dosing regimen?

A

first 5 days parenteral UFH, LMWH, fondaparinux (all SQ), then switch to 150mg PO BID dabigatran

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14
Q

Edoxaban VTE Tx dosing regimen?

A

first 5 days parenteral UFH, LMWH, fondaparinux (all SQ), then switch to 60mg PO daily Edoxaban

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15
Q

warfarin VTE Tx dosing regimen?

A

at least 1st 5 days UFH, LMWH, fondaparinux (all SQ), overlapped with warfarin PO QD AND INR >=2.0, then dose adjusted to INR 2.5

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16
Q

Parenteral anticoagulants:

What does UFH inhibit?

A

factor Xa dn thrombin (IIa) in a 1:1 ratio

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17
Q

Parenteral anticoagulants:

What does LMWH inhibit?

A

factor Xa and thrombin (IIa) in 3:1 ratio

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18
Q

Parenteral anticoagulants:

What does fondaparinux inhibit?

A

factor Xa (not thrombin)

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19
Q

UFH continuous IV infusion initial dosing?

A

80 units/kg bolus (max 10,000 Units) IV, followed by 18 units/kg/hr (max 2,000 units/hr)

adjust based on institution-specific heparin infusion nomogram

SQ not preferred

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20
Q

UFH SQ dosing?

A

333 units/kg bolus SQ, followed by 250 units/kg SQ Q12hr

not preferred

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21
Q

What aPTT results in no change to heparin dosing?

A

50-55

take next aPTT 6hrs after previous aPTT

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22
Q

UFH highlighted AE?

A

thrombocytopenia (HIT)

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23
Q

enoxaparin VTE Tx dose?

A

1mg/kg BID or 1.5 mg/kg SQ daily

syringes: 30, 40, 60, 80, 100, 120, 150 mg/mL available

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24
Q

dalteparin VTE Tx dose?

A

100 units/kg SQ BID or 200 units/kg SQ daily

refilled syringes: 2500, 5000, 7500, 10000, 12500, 15000, 18000 units/xmL

avoid with CrCl < 30 mL/min

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25
fondaparinux VTE dose?
<50kg: 5mg SQ daily 50-100kg: 7.5mg SQ daily >100kg: 10mg SQ daily
26
Reduce fondaparinux (VTE Tx) by how much with CrCl 30-50?
50% CrCl < 30 avoid using
27
heparin induced thrombocytopenia (HIT) is what PLT count?
< 100 x 10^9/L
28
heparin induced thrombocytopenia (HIT) is what PLT reduction?
> 50% reduction from baseline
29
What score represents low probability for HIT?
< 3
30
What score represents intermediate probability for HIT?
4-5
31
What score represents high probability for HIT?
> 6
32
Parenteral anticoagulation monitoring: check platelets when?
baseline and every 2-3 days between days 4-14 or until UFH/LMH d/c
33
What factor Xa inhibitor is not indicated for VTE Tx?
betrixaban
34
rivaroxaban VTE Tx dosing?
Initiation: 15mg PO BID x 21 days Maintenance: 20mg PO daily Extended: option to reduce to 10mg PO daily after 6 months QD dosing avoids parenteral anticoagulation
35
rivaroxaban atrial fibrillation dosing?
20mg PO daily CrCl 15-50: 15mg PO daily CrCl < 15: avoid QD dosing avoids parenteral anticoagulation
36
Take rivaroxaban with or without food?
with food to improve absorption
37
Apixaban VTE Tx dosing?
initiation: 10mg PO BID x 7 days maintenance: 5mg PO BID extended: option to reduce to 2.5mg PO BID after 6 months BID dosing avoids parenteral anticoagulation
38
Apixaban atrial fibrillation dosing?
5mg PO BID 2.5mg PO BID if any 2 of the following: >= 80yo, SCr > 1.5, weight <= 60kg BID dosing avoids parenteral anticoagulation
39
edoxaban VTE dosing?
Initiation: UFH, LMWH, or fondaparinux x 5-10 days | maintenance/extended: 6mg PO daily, or 30mg PO daily if <= 60kg
40
edoxaban atrial fibrillation dosing?
60mg PO QD
41
Which DOAC is minimally metabolized by CYP 3A4?
edoxaban (Savaysa)
42
dabigatran VTE Tx dosing?
initiation: UFH, LMWH, or fondaparinux x 5-10 days | maintenance/extended: 150mg PO BID
43
dabigatran atrial fibrillation dosing?
150mg PO BID
44
Which DOACs have interactions with dual strong P-gp and CYP3A4 inducers?
rivaroxaban, apixaban
45
Which DOACs have interaction with only P-gp inducers/inhibitors?
edoxaban, dabigatran
46
Which DOAC is favored in pts with Hx of GI bleed?
apixaban
47
Which DOAC causes dyspepsia?
dabigatran
48
DOAC contraindications?
- active bleeding | - prosthetic heart valves
49
DOAC limitations (use not recommended)?
- age < 18 yo | - pregnancy/lactation
50
DOAC requirements?
- stable renal fxn | - stable hepatic fxn
51
Pneumonic to remember increasing warfarin tab doses?
Please Let Greg Brown Bring Peaches To Your Wedding pink, lavender, green, brown, blue, peach, teal, yellow, white
52
Warfarin inhibits synthesis of what clotting factors?
II, VII, IX, X SNOT - seven, nine, two, ten also inhibits synthesis of endogenous anticoagulant proteins C and S
53
VTE Tx: Overlap warfarin with parenteral anticoagulant how long?
minimum of 5 days AND until INR > 2.0 for 24hrs
54
warfarin VTE Tx dosing?
initial: 5mg PO QD maintenance: 10mg PO daily x 2 days, then 5mg PO daily other: 2.5mg PO QD for high risk pts plus parenteral SQ: UFH, LMWH, fondaparinux
55
INR goal for VTE Tx with warfarin?
2.5 (2-3)
56
Warfarin: INR < 5 with no transient factor identified
increase weekly dose 10-20% consider 1.5-2x supplemental dose
57
warfarin: INR 1.5-1.7 with no transient factor identified
increase weekly dose 5-15% consider 1.5-2x supplemental dose
58
warfarin: INR 1.8-1.9 with no transient factor identified
if previous 2 INR within range, no explanation for out of range INR, and INR does not represent increased clotting risk consider NO change otherwise: increase weekly dose 5-105 consider 1.5-2x supplemental dose
59
warfarin: INR < 1.5 INR 1.5-1.7 INR 1.8-1.9 with transient factor identified
consider 1.5-2x supplemental dose, return to previous weekly dose
60
warfarin: INR 3.1-3.2 no transient factor identified
if previous 2 INR within range, no explanation for out of range INR, and INR does not represent increased clotting risk consider NO change otherwise: decrease weekly dose by 5-10%
61
warfarin: INR 3.3-3.4 no transient factor identified
decrease weekly dose 5-10%
62
warfarin: INR 3.5-3.9 no transient factor identified
decrease weekly dose 5-15%, consider holding 1 dose
63
warfarin: INR 3.1-3.2 INR 3.3-3.4 INR 3.5-3.9 transient factor identified
consider holding 1-2 doses, return to previous weekly dose
64
warfarin: INR >= 4.0 transient factor and/or no transient factor identified
hold until INR < 3.0 decrease weekly dose by 5-20% if pt high bleeding risk consider low-dose oral vitamin k check INR every 1-2 days until INR < 3, then q 1-2 weeks
65
warfarin: Check INR how often in inpatient setting?
q 1-3 days
66
warfarin: outpatient setting in pts who are stable x 3 months check INR how often?
q 8-12 weeks
67
What antibiotic decreases warfarin effect?
rifampin decreases INR
68
What analgesic increases warfarin effect?
tramadol increases INR
69
Do antifungals increase or decrease warfarin effect?
decrease fluconazole, ketoconazole, miconazole
70
d/c warfarin how many days before procedure?
5 bridge resume warfarin 12-24hrs after procedure
71
warfarin perioperative management: bridge if VTE within what time frame?
past 3 months severe hypercoagulable state
72
warfarin perioperative management: maybe bridge if VTE within what time frame?
past 3-12 months
73
warfarin perioperative management: do NOT bridge if VTE within what time frame?
> 12 months ago
74
breastfeeding pts are optimal ___ candidates DOAC or warfarin
warfarin
75
Which can be used in renal/hepatic impairment? DOAC or warfarin
warfarin
76
UFH dose (VTE prophylaxis) in obesity?
7500 units SQ Q8h no change to VTE TX doses; use actual body weight for Tx doses
77
VTE obesity weight/BMI?
> 100kg or BMI > 40
78
Avoid DOACs with what weight/BMI?
> 120kg or BMI > 40 or monitor with peak and trough
79
Severe renal impairment CrCl for VTE?
AKI, dialysis, or CrCl < 30ml/min
80
What agent is preferred for prophylaxis and acute Tx of VTE in pts with severe renal impairment?
UFH warfarin may also be used; dose adjusted based on INR
81
Avoid what two hirudin derivatives in pts with severe renal impairment?
dalteparin, fondaparinux
82
What pregnancy category is warfarin?
X safe in lactation
83
What agent is preferred for VTE Tx in cancer pts?
LMWH
84
VTE: What is category 1 mono therapy?
dalteparin
85
VTE: What is category 1 combo therapy?
LMWH + edoxaban

7442 Cardio Test 3 (6 decks)

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