VTE Drugs

Question 1

Dose for Lovenox abdominal surgery prophylaxis

Answer 1

40 mg SC q24 hours

Question 2

Dose for Lovenox acute medical illness prophylaxis

Answer 2

40 mg SC q24 hours

Question 3

Dose for Lovenox hip replacement prophylaxis

Answer 3

30 mg q12h or 40 mg once daily

Question 4

Dose for Lovenox knee replacement prophylaxis

Answer 4

30 mg q12h

Question 5

Dose for Lovenox hip fracture surgery prophylaxis

Answer 5

30 mg q12h or 40 mg once daily

Question 6

Dose for Dalteparin hip replacement prophylaxis

Answer 6

2500 IU 2 hours prior to surgery, 2500 IU the evening of surgery, then 5000 IU daily thereafter

Question 7

Dose for Dalteparin knee replacement prophylaxis

Answer 7

5000 IU once daily

Question 8

Dose for Dalteparin hip fracture surgery prophylaxis

Answer 8

2500 IU 2 hours prior to surgery, 2500 IU the evening of surgery, then 5000 IU once daily thereafter

Question 9

Renal dosing for Lovenox

Answer 9

If CrCL is less than 30 mL/min, use 30 mg SC once daily

Question 10

Renal dosing for Dalteparin

Answer 10

None

Question 11

Renal dosing for Tenzaparin

Answer 11

None

Question 12

MOA of LMWH

Answer 12

Factor Xa and thrombin inhibitors

Question 13

MOA of Fondaparinux

Answer 13

Factor Xa inhibitor (injection)

Question 14

Dose for Fondaparinux hip replacement surgery prophylaxis

Answer 14

2.5 mg once daily starting 6-8 hours after surgery

Question 15

Dose for Fondaparinux knee replacement prophylaxis

Answer 15

2.5 mg once daily starting 6-8 hours after surgery

Question 16

Dose for Fondaparinux hip fracture surgery

Answer 16

2.5 mg once daily starting 6-8 hours after surgery

Question 17

Renal dosing for Fondaparinux prophylaxis

Answer 17

If CrCL is less than 50, there isn’t renal dosing given

If less than 30, do not use!

Question 18

Weight based dosing for Fondaparinux prophylaxis

Answer 18

Patients who weigh less than 50 kg should not use fondaparinux for VTE prophylaxis (treatment still OK)

Question 19

What is the duration of therapy for prophylaxis with surgeries?

Answer 19

At least 10 days and up to 35 days

Question 20

MOA of Unfractionated heparin?

Answer 20

Forms complex with antithrombin to block factors II and Xa

Question 21

Dose for UFH prophylaxis

Answer 21

5000 units SC every 8 hours
or
5000 units SC every 12 hours

Question 22

Dose for Rivaroxaban for knee surgery prophylaxis

Answer 22

10 mg once daily x 12 days

Question 23

Dose for Rivaroxaban for hip surgery prophylaxis

Answer 23

10 mg once daily x 35 days

Question 24

Dose for Rivaroxaban after VTE

Answer 24

20 mg once daily with food

Question 25

Dose for Apixaban knee replacement prophylaxis

Answer 25

2.5 mg twice daily x 12 days

Question 26

Dose for Apixaban hip replacement prophylaxis

Answer 26

2.5 mg twice daily x 35 days

Question 27

Dose for Edoxaban knee replacement prophylaxis

Answer 27

NONE - not approved for prophylaxis

Question 28

Dose for Edoxaban hip replacement prophylaxis

Answer 28

NONE - not approved for prophylaxis

Question 29

Dose for Dabigatran knee replacement prophylaxis

Answer 29

NONE - not approved for prophylaxis

Question 30

Dose for Dabigatran hip replacement prophylaxis

Answer 30

NONE - not approved for prophylaxis

Question 31

Dose for Lovenox for DVT/PE treatment

Answer 31

1 mg/kg SC q12 hours or 1.5 mg/kg SC q24 hours

Question 32

How long should a patient be on LMWH and Warfarin during VTE treatment?

Answer 32

LMWH for 5 days *AND* until INR is between 2-3 (for 24 hours)

Question 33

In cancer patients being treated for DVT/PE, what should be used instead of warfarin?

Answer 33

LMWH

Question 34

Dose for Dalteparin for DVT/PE treatment

Answer 34

200 IU/kg once daily

Question 35

Dose for Fondaparinux for VTE treatment

Answer 35

5 mg SC once daily when weight is less than 50 kg 7.5 mg SC once daily when weight is between 50 and 100 kg 10 mg SC once daily when weight is over 100 kg

Question 36

When would you use UFH for VTE treatment?

Answer 36

When you have a patient with renal insufficiency Dosing: Loading 80-100 units/kg, max 10,000 units Infusion rate 17-20 mg/kg/hr with max 2300 units/hr

Question 37

Dose for Apixaban for VTE treatment

Answer 37

10 mg twice daily for 7 days, then 5 mg twice daily

Question 38

Dose for Dabigatran for VTE treatment

Answer 38

150 mg twice daily after 5-10 days parenteral

Question 39

Dose for Edoxaban for VTE treatment

Answer 39

60 mg once daily after 5-10 days parenteral If less than 60 kg, use 30 mg once daily

Question 40

Which drug do you renally dose for patients with CrCL greater than 95 mL/min?

Answer 40

Edoxaban - do not use

Question 41

Renal dosing for Edoxaban

Answer 41

30 mg once daily

Question 42

Dose for Rivaroxaban for VTE treatment

Answer 42

15 mg twice daily with food for 21 days, then 20 mg once daily

Question 43

Renal dosing for Apixaban

Answer 43

2.5 mg twice daily (AF only)

Question 44

Renal dosing for Dabigatran

Answer 44

75 mg twice daily (AF only)

Question 45

Renal dosing for Rivaroxaban

Answer 45

15 mg once daily (AF only)

Question 46

Renal dosing for Warfarin

Answer 46

Not required