VTE Prophylaxis Flashcards Preview

662 > VTE Prophylaxis > Flashcards

Flashcards in VTE Prophylaxis Deck (57)
Loading flashcards...
1

Prophylaxis goal?

Identify patient risk Determine risk level Select the correct regimen pharm and non pharm

2

Non pharm treatment Therapy for VTE

Graduated compression stockings (GCS) - good for low or moderate risk Can wear leg too big - IPC- intermittent pneumatic compression increase circulation

3

Pharmacologic Prophylaxis

Duration is unclear but once patient can ambulate or other RFs are gone then dc therapy - Knee replacement, treatment for 12 days after - Hip replacement 35 days after

4

Standard dosing for LMWH ?

Regardless of weight

5

Risk Level

6

  • What are the goals for VTE treatment?

  • Prevent short term complications within 6 months 
      • Prevent extension of clot
      • Prevent embolism clot
      • Prevent death
    • Prevent long term complications past  6 months 
      • Post thrombotic syndrome 
      • Pulmonary HTN 
      • Recurrent VTE

7

UFH is from?

Does what to clots?

From procine stomach or bovine lung

Does not dissove clot but prevents growth 

Binds to AT

neutralizes Thrombin factors Xa IX, Xia, XIIa

8

UFH is administered?

Non specific binding site so?

IV and Sub Q

Sub Q onset is 1-2 hours

Poor bioavailability 

9

It is critical to achieve ___ of  UFH within the first?

What type of dosing is there?

therapeutic dose within 24 hours 

Weight base

Standard dose

VTE chart

10

UFH requires close monitoring and is done by the lab test?

Activated partial thromboplastin time (aPTT) 

11

Normal therapeutic range for aPTT?

___ to ___ the control aPTT value

28-42 seconds

1.5 to 2.5 

12

Baseline aPTT is done?

 6 hours after starting UFH infusion and 6 hours have dose change

Takes 6 hours to reach steady state 

13

Adverse effects of UFH/

  • Bleeding
  • Thrombocytopenia 
    • HIT in 5%
  • Long term use can casue Alopecia, Hyperkalemia, Osteoporosis

14

HIT

  • Is an immune system clotting disorder
    • Formation of abnormal antibodies cause platelet activation 
  • Monitor platelets every 2-3 days during UFH therapy 
  • If platelets fall below 50% from baseline or below 120000 think HIT

 

15

UFH antidote?

Protamine

16

UFH is ok to using in ___ patients

if patient is ____

Contraindication?

Pregnant 

Can breastfeed

Contraindication is Hx of HIT

17

LMWH

Binds to Xa not much to do with thrombin 

18

Advantages of LMWH?

  • The anticoagulant response is more predictable less binding to plasma and cellular proteins
    • Reduced need for monitoring 
  • Improved SUB Q bioavailability 
  • Longer half life
  • Lower chance of HIT
  • Lower chance of osteoporosis

 

19

LMWH products

Parin, Parin, Parain

 

Dalteparin

Enoxaparin

Tinzaparain

20

LMWH has much greater effect on ___ 

but a draw back is that there is no?

Xa activity

has no antidote 

21

Priot to therapy of LMWH you should?

Dosing is strictly ____ based

Given ___ in ___ 

Baseline PT/INR, aPTT, CBC w/ platelet, serum creatinine

 

Weight based

QD or BID

Given Sub Q in the abdomen 

22

AE of LMWH?

Contraindications?

  • Bleeding
  • Bruising
  • HIT lower risk though
  • Contraindicated if Hx of HIT or suspected HIT

23

Protamine can be used as an antidote for LMWH but it only neutralizes it by?

60%

24

LMWH is a great choice over UFH in patients that are?

pregnant 

25

If it is an uncomplicated DVT most patients can treat from?

But the regimen must be?

This reduces?

From home

Strict regimen

Cost saving

26

Factor Xa inhibitors?

  • Fandaparinux SUB Q
  • Rivaroxaban
  • Apixaban
  • Edoxaban 

27

Fondaparinux is indicated for?

  • Prophylaxis of DVT in patients undergoing surgery
  • Treatment of DVT or PE when administered with warfarin

 

 

28

Fondaparunix has a ___ onset

___ elminated no ___ metabolism 

Long ___

 

rapid onset

renally eliminated no liver metabolism

long half life

29

AE of Fondaparinux?

If major bleeding?

Life threatening bleeding

  • Bleeding, monitor CBC at baseline
  • If major bleeding then
    • Fresh frozen plasma
    • Factor concentrates
  • Life threatening bleed
    • Factor VIIa super expensive

30

Rivaroxaban and Apixaban

Substrates of?

CYP3A4 and p-glycoprotein

Drugs that inhibit this increase levels significantly (Ketoconazole, ritonavir, clarithromycin)

Drugs that induce these may decrease levels (Carbamazepine, phenytoin, amiodarone, macrolides, diltiazem, rifampin, St johns)