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Therapeutics 2 - Fall 2017 > Weber - AntiCoag > Flashcards

Weber - AntiCoag Flashcards

1
Q

which NOACs are used for post-op prophylaxis

A

DRA

dabigatran; Rivaroxaban; apixaban

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2
Q

which NOACs are used for Non-Valvular A.Fib

A

DRAE

dabigatran; rivaroxaban; apixaban; edoxaban

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3
Q

which NOACs are used for Secondary prevention of DVT/PE

A

RA

Rivaroxaban; Apixaban

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4
Q

which NOACs are used for VTE prophylaxis

A

Betrixaban

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5
Q

which NOAC for post-op prophylaxis is used for ONLY hip replacement

A

Dabigatran

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6
Q

which NOAC for post-op prophylaxis is used for hip AND knee replacement

A

Rivaroxaban; Apixaban

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7
Q

which NOACs for DVT/PE treatment are for MAINTENANCE only

A

Edoxaban and Dabigitran (aka need parenteral anticoag for 5 - 10 days)

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8
Q

which NOACs are for DVT/PE treatment for maintenance and acute?

A

Rivaroxaban; Apixaban

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9
Q

is it an inhibitor or an activator (of the coag system?)

Von Willebrand Factor

A

activator

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10
Q

is it an inhibitor or an activator (of the coag system?)

Tissue Factor

A

activator

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11
Q

is it an inhibitor or an activator (of the coag system?)

Factor VIIa

A

activator

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12
Q

is it an inhibitor or an activator (of the coag system?)

Heparin

A

inhibitor

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13
Q

is it an inhibitor or an activator (of the coag system?)

Thrombomodulin

A

inhbiitor

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14
Q

is it an inhibitor or an activator (of the coag system?)

Factor Xa

A

activator

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15
Q

is it an inhibitor or an activator (of the coag system?)

Thrombin

A

activator

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16
Q

is it an inhibitor or an activator (of the coag system?)

Tissue Plasminogen Activator

A

activator

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17
Q

is it an inhibitor or an activator (of the coag system?)

Antithrombin

A

inhibitor

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18
Q

is it an inhibitor or an activator (of the coag system?)

Protein C

A

inhibitor

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19
Q

is it an inhibitor or an activator (of the coag system?)

Protein S

A

inhibitor

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20
Q

is it an inhibitor or an activator (of the coag system?)

plasminogen activator inhibitor 1

A

inhibitor

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21
Q

which NOACs are used for DVT/PE treatment

A

DRAE

dabigatran; rivaroxaban; apixaban; edoxaban

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22
Q

what 3 things make up Virchows triad

A

Hypercoaguable state
Circulatory stasis
Endothelial injury

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23
Q

UFH:

is it specific or non specific binding

A

non specific

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24
Q

UFH: what is its MOA?
It interacts with ______ which catalyzes formation of thrombin/antithrombin complexes
it also binds to _______ and ______

A

ATIII; heparin; platelets

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25
Q

Dosing for UFH:

A

80 units/kg (BOLUS)

18 units/kg/hr (INFUSION)

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26
Q

Labeled Uses for UFH

A
  • prophylaxis and tx of thromboembolic disorders

- Anticoag for extracorpeal (outside of body) and dialysis procedures

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27
Q

UFH: Pregnancy Category ______

A

B

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28
Q

aPTT stands for?

A

activated partial thromboplastin test

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29
Q

what is the therapeutic range for aPTT

A

1.5 - 2 times the normal

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30
Q

Monitoring for UFH:

A

@ baseline
Check @ 6 hrs (after first dose/each dose change)
Check DAILY for 1st day unless out of range)

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31
Q

ADEs of UFH

A
  • bleeding
  • HIT
  • Osteoporsis
  • hypersensitivity
32
Q

HAT or HIT?

aka HIT Type 1

A

HAT

33
Q

HAT or HIT?

Non-immune mediated

A

HAT

34
Q

HAT or HIT?

Immune mediated

A

HIT

35
Q

HAT or HIT?

Platelets > 100,000

A

HAT (that is known as mild decrease)

36
Q

HAT or HIT?

Platelets decrease by more than 50%

A

HIT

37
Q

HAT or HIT?

Platelets < 100,00

A

HIT

38
Q

HAT or HIT?

occurs b/w 7 - 14 days

A

HIT

39
Q

HAT or HIT?

occurs b/w 48 - 72 hours

A

HAT

40
Q

HAT or HIT?

Need to discontinue Heparin

A

HIT

41
Q

HAT or HIT?

Do NOT need to discontinue Heparin

A

HAT

42
Q

how to manage HIT?

A
  • stop all heparin products
  • give alternate anticoags
  • Do NOT give platelet infusions
  • Do NOT give warfarin unless platelet is >150,000
  • Evaluate for thrombosis
43
Q

ADEs of Protamine

A
  • Hypotension
  • Bradycardia
  • Anaphylaxis
44
Q

Protamine Dosing

A

MAX 50 mg over 10 minutes

Protamine Dose per 100 units of UFH:

  • immediate: 1 - 1.5
  • 30 mins - 120 mins: 0.5 - 0.75
  • > 120 mins: 0.25 - 0.375
45
Q

LWMH: inhibits ____ more than _____

A

Xa; thrombin (II)

46
Q

Monitoring for Enoxaparin

A

CBC w/ platelet
fecal occult blood
SCr
Anti-Xa levels

47
Q

Max weight for enoxaparin

A

144 kg

48
Q

Blackbox warning for LWMH:

A

neural anesthesia or spinal puncture can lead to increased risk of spinal hematoma leading to paralysis

49
Q

what drug(s) are injectable indirect factor Xa inhibitor

A

Fondaparinux

50
Q

what is fondaparinux’s MOA

A

attaches to AT(III) and prevents factor Xa from working

51
Q

Fondaparinux Specifications:
Do not use if _________ or ______
(Can or Cannot) be used in HIT
Pregnancy Category ______

A

do not use if renal dysfunction (CrCl < 30 mL/min)
OR
do not use for prophylaxis with low body weight (<50 kg)
CAN be used in HIT
Category B

52
Q

what drugs are direct IV thrombin inhibitors

A

Lepirudin
Bivalrudin
Argatroban

53
Q

Switching DOAC from Warfarin:

Can be done when INR is what for each drug?

A

D: < 2
R: < 3
A: < 2
E: < 2.5

54
Q

NOAC Contraindications

A
  • recent GI bleeding
  • Malignancy
  • Varices (slit in esophagus)
  • Arteriovenous malformations
  • Recent brain/spine/eye surgery
  • Concurrent use of other anticoags
55
Q

Steps for bleeding management:

A 
1 - d/c med
2 - apply manual compression
3 - maintain BP
4 - surgical or radiological intervention
5 - blood products +/- PCC
56
Q

Monitoring for Idarucizumab

A

baseline aPTT –> repeat in 2 hours –> q12h until normal

57
Q

Other Considerations that could be utilized for bleeding management:

A
  • activated charcoal < 2 hours of bleeding
  • Hemodialysis - for dabigatran ONLY
  • Tranexamic Acid
58
Q

Genetic Variances and Warfarin:

CYP2C9 - what are the alleles that are affected

A

1,2,*3

59
Q

Genetic Variances and Warfarin:
CYP2C9 -
what variety occurs in 1/3 white patients

A

2/3

60
Q

Genetic Variances and Warfarin:
CYP2C9 -
which Genetic variance needs about a 80% warfarin dose lowering

A

3/3

61
Q

Genetic Variances and Warfarin:
CYP2C9 -
which Genetic variance needs about a 35% warfarin dose lowering

A

2/3 or 1/3

62
Q

Genetic Variances and Warfarin:
CYP2C9 -
which Genetic variance needs about a 20% warfarin dose lowering

A

1/2

63
Q

Genetic Variances and Warfarin:
VKORC1
what are the genetic variances for VKORC1

A

1639:A/G

64
Q

which race is likely to have 1639AA

A

asian

65
Q

which race is likely to have 1639GG

A

african americans

66
Q

a 1639GG mutation leads to (decreased or increase warfarin resistance) and leads to patients needing a (lower or higher) warfarin

A

INcreased resistance; Higher warfarin dose

67
Q

a 1639AA mutation leads to (decreased or increase warfarin sensitivity) and leads to patients needing a (lower or higher) warfarin

A

increased sensitivity; lower warfarin dose

68
Q

what are the requirements to be genetic tested for warfarin allele mutations?

A

1) pt is warfarin naive
AND
2) genetic test results are available before the 6th dose
AND
3) pt is at high risk of bleeding if INR is elevated
(if ALL 3 - can do genetic warfarin testing)

69
Q

How to calculate INR

A

(patients PT/mean normal PT)^ISI

ISI = international sensitivity index

70
Q

Recommended INR Goals

A

For Mechanical Heart Valve (mitrial) - 2.5 - 3.5

For Everything else (2 - 3)

71
Q

How to bridge UFH/LMWH/Xa to warfarin (what are the requirements)

A

OVERLAP for at LEAST 5 days AND wait until INR is in therapeutic range

72
Q

Most patients will start at ____ mg per day

but what patients may need less than the regular starting dose

A

start at 5 mg;
Exceptions:
> 60 years old; debilitated; Malnourished; CHF; liver disease; Concomitant Medications; High bleeding risk; Genetic Factors

73
Q

Dose Alteration for Warfarin: (Goal: 2 - 3)

if INR < 2

A

increase by 5 - 15%

74
Q

Dose Alteration for Warfarin: (Goal: 2 - 3)

if INR 3.1 - 3.5

A

decrease 5 - 15%

75
Q

Dose Alteration for Warfarin: (Goal: 2 - 3)

if INR 3.5 - 4.0

A

hold 0 - 1 doses

then decrease by 10 - 15%

76
Q

Dose Alteration for Warfarin: (Goal: 2 - 3)

if INR > 4.0

A

hold 0 - 2 doses

decrease by 10 - 15%

Therapeutics 2 - Fall 2017 (22 decks)

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