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Board Study Topics > 00 Anticoagulation > Flashcards

00 Anticoagulation Flashcards

1
Q

How is Unfractionated Heparin dosed for Acute Coronary Syndrome (ACS)?

A

Bolus: 60 units/kg IV
Drip: 12 units/kg/hr IV

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2
Q

How is Unfractionated Heparin dosed for VTE Treatment?

A

Bolus: 80 units/kg IV
Drip: 18 units/kg/hr IV

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3
Q

How is Unfractionated Heparin dosed for VTE Prophylaxis?

A

5000 units SQ BID-TID

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4
Q

What type of goal do you want to dose Unfractionated Heparin to?

A

~1.5-2.5x baseline

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5
Q

What type of body weight do you use for Unfractionated Heparin dosing?

A

Actual body weight

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6
Q

What is the generic name of Lovenox?

A

Enoxaparin (LMWH)

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7
Q

What are the normal prophylaxis doses seen with Lovenox?

A

30mg SQ Q12h

40mg SQ Daily

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8
Q

How is Lovenox dosed for DVT Treatment?

A

1mg/kg SQ Q12h or

1.5mg/kg SQ Daily

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9
Q

When should Lovenox be dose adjusted?

A

When CrCl < 30. At that point, use the Q12h doses as the new daily doses for both prophylaxis and treatment

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10
Q

What is a unique contraindication for all LMWH?

A

Allergy to pork

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11
Q

What is the generic name of Fragmin?

A

Dalteparin (LMWH)

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12
Q

What is the generic name of Innohep?

A

Tinzaparin (LMWH; avoid in sulfa allergy)

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13
Q

What is the generic name of Arixtra?

A

Fondaparinux (Indirect Factor Xa Inhibitor)

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14
Q

What is the only Factor Xa Inhibitor that comes IV?

A

Arixtra (Fondaparinux)

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15
Q

How is Fondaparinux dosed for DVT Prophylaxis?

A

2.5mg SQ Daily (contraindicated when < 50kg)

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16
Q

How is Fondaparinux dosed for DVT/PE Treatment?

A

< 50kg: 5mg SQ Daily
50-100kg: 7.5mg SQ Daily
> 100kg: 10mg SQ Daily

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17
Q

When is Fondaparinux use contraindicated?

A

If CrCl < 30

18
Q

How are all Factor Xa Inhibitors eliminated?

A

Renal

19
Q

What is the generic name of Xarelto?

A

Rivaroxaban (Factor Xa Inhibitor) - PO

20
Q

What is the generic name of Eliquis?

A

Apixaban (Factor Xa Inhibitor) - PO

21
Q

Of the three Factor Xa Inhibitors, which one is NOT FDA-indicated for TREATMENT of DVT/PE?

A

Eliquis (Apixaban)

22
Q

What is the generic name of Pradaxa?

A

Dabigatran (DTI)

23
Q

What is Argatroban?

A

DTI

24
Q

What is the generic name of Angiomax?

A

Bivalirudin (DTI)

25
Q

What is the only PO DTI?

A

Pradaxa (Dabigatran)

26
Q

All DTI’s renally cleared except?

A

Argatroban (Hepatic)

27
Q

What is an ADR associated with Pradaxa (Dabigatran)?

A

Gastritis and GI bleeding

28
Q

What do you need to remember when dispensing Pradaxa (Dabigatran)?

A

If dispensed as a BOTTLE (vs. blister pack), MUST keep in original container. Discard after 4 months

29
Q

Which factors does Coumadin (Warfarin) inhibit?

A

SNOT: Seven, Nine, Ten, and Two

30
Q

What are the normal goals used with Warfarin?

A

INR for most indications: 2-3

Mechanical mitral valve replacement: 2.5-3.5

31
Q

What pregnancy category is Warfarin?

A

Category X

32
Q

What are the pharmacoGENOMIC considerations for Warfarin?

A

VKORC1 and CYP 2C9

33
Q

What are the different doses for the Warfarin pills?

A

Please Let Greg Brown Bring Peaches To Your Wedding: Pink (1mg), Lavender (2mg), Green (2.5mg), Brown (3mg), Blue (4mg), Peach (5mg), Teal (6mg), Yellow (7.5mg), White (10mg)

34
Q

If a patient develops hit with a heparin product, what should be done?

A

D/c all heparin products, reverse Coumadin (if currently on), Start another IV anticoagulant (ARGATROBAN!!!). Do not start Coumadin again until PLT > 150 and overlap for 5 days with Argatroban

35
Q

What type of patients should Dabigatran, Rivaroxaban, and Apixaban not be used in?

A

Patients with prosthetic heart valves

36
Q

What is the BBW with Lovenox (Enoxaparin)?

A

Patients receiving neuraxial anesthesia (epidural, spinal) or undergoing spinal puncture are at risk of hematomas and subsequent paralysis

37
Q

What is the MOA of Unfractionated Heparin (UFH)?

A

Binds to anti-thrombin (AT) and inactivates thrombin (Factor IIa) and Factor Xa (as well as factors IXa, XIa, XIIa, and plasmin) and prevents the conversion of fibrinogen to fibrin

38
Q

What is the MOA of LMWHs?

A

Work similar to heparin except that the inhibition is much greater for Factor Xa than Factor IIa

39
Q

Why should you be cautious with Factor Xa inhibitors and DTIs?

A

Neither have an antidote

40
Q

What must you remember to tell patients using Enoxaparin?

A

Do not expel the air bubble in the syringe prior to injection (unless your doctor has advised you to do so)

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