00 Anticoagulation Flashcards
What are the indications for Unfractionated Heparin?
ACS, VTE Treatment, VTE Prophylaxis
What is Unfractionated Heparin dosing like for ACS?
Bolus: 60 units/kg IV. Drip: 12 units/kg/hr IV. Use actual body weight
What is Unfractionated Heparin dosing like for VTE Treatment?
Bolus: 80 units/kg IV. Drip: 18 units/kg/hr IV. Use actual body weight
What is Unfractionated Heparin dosing like for VTE Prophylaxis?
5000 units SQ BID-TID
What are the goal levels for Unfractionated Heparin?
Adjust per PPT goal (~1.5-2.5x baseline)
How are the effects of Unfractionated Heparin reversed?
Protamine (1mg ~100 units heparin; max 50mg, give over 10 minutes)
What is the generic name of Lovenox?
Enoxaparin (LMWH)
What are the indications for Lovenox?
DVT prophylaxis, DVT treatment, STEMI, Non-STEMI
What is a usual dose for Lovenox when being used for a DVT prophylaxis?
Usually 30mg SQ Q12h OR 40mg SQ daily
What is Lovenox dosing like for DVT Treatment?
1mg/kg SQ Q12h OR 1.5mg/kg SQ daily
When do you need to adjust the Lovenox dose?
For renal impairment. Once CrCl < 30 you need to go do the daily dosing (30mg SQ daily for prophylaxis or 1mg/kg SQ daily for treatment)
What are the contraindications to Lovenox use?
History of HIT. Active bleed. Allergy to pork
What is the generic name of Innohep?
Tinzaparin (LMWH)
When is Innohep (Tinzaparin) contraindicated?
Sulfite allergy
What is the generic name of Fragmin?
Dalteparin (LMWH)
What is the generic name of Arixtra?
Fondaparinux (Factor Xa Inhibitor)
What is Arixtra (Fondaparinux) approved for?
DVT prophylaxis. DVT/PE Treatment
What is the dosing of Arixtra (Fondaparinux) for DVT prophylaxis?
2.5mg SQ daily
What is the dosing of Arixtra (Fondaparinux) for DVT/PE prophylaxis?
< 50kg: 5mg SQ daily
50-100kg: 7.5mg SQ daily
> 100kg: 10mg SQ daily
When is Arixtra (Fondaparinux) contraindicated for DVT prophylaxis?
In patients < 50kg
What dose adjustment is required for Arixtra (Fondaparinux)?
If CrCl < 30: USE IS CONTRAINDICATED
What is the only non-PO Factor Xa Inhibitor?
Arixtra (Fondaparinux, given SQ)
What is the generic name of Xarelto?
Rivaroxaban (Factor Xa Inhibitor)
What is the generic name of Eliquis?
Apixaban (Factor Xa Inhibitor)
What is the BBW with Xarelto (Rivaroxaban)?
D/c of Rivaroxaban in patients with non-valvular A.fib can put patients at increased risk of thrombotic events, like stroke
What is the BBW with Eliquis (Apixaban)?
If Apixaban is being used to prevent stroke in A.fib patients, an increased risk of stroke may occur upon Apixaban d/c
What is the generic name of Pradaxa?
Dabigatran (Direct Thrombin Inhibitor)
What is an ADR you need to be cautious about with Pradaxa (Dabigatran)?
Gastritis and GI bleeding
Which DTI requires hepatic adjustment?
Argatroban
What is the generic name of Angiomax?
Bivalirudin (DTI)
Which factors does Warfarin inhibit?
SNOT: 7, 9, 10, 2
What are the normal goals with Warfarin dosing?
Most indications: 2-3.
Mechanical mitral valve replacement: 2.5-3.5
When is Warfarin contraindicated?
Pregnancy Category X
What pharmacologic considerations should be made with Warfarin?
VKORC1 and CYP2C9
What are the Warfarin colors/doses?
Please Let Greg Brown Bring Peaches To Your Wedding: Pink (1), Lavender (2), Green (2.5), Brown (3), Blue (4), Peach (5), Teal (6), Yellow (7.5), White (10). All in mg
When does vitamin K need to be administered?
Supra-therapeutic INR > 10 (2.5mg PO x1). Any signs of bleeding (5-10mg IV + PCC/Factor 7)
