00 Anticoagulation Flashcards
How is Unfractionated Heparin dosed for Acute Coronary Syndrome (ACS)?
Bolus: 60 units/kg IV
Drip: 12 units/kg/hr IV
How is Unfractionated Heparin dosed for VTE Treatment?
Bolus: 80 units/kg IV
Drip: 18 units/kg/hr IV
How is Unfractionated Heparin dosed for VTE Prophylaxis?
5000 units SQ BID-TID
What type of goal do you want to dose Unfractionated Heparin to?
~1.5-2.5x baseline
What type of body weight do you use for Unfractionated Heparin dosing?
Actual body weight
What is the generic name of Lovenox?
Enoxaparin (LMWH)
What are the normal prophylaxis doses seen with Lovenox?
30mg SQ Q12h
40mg SQ Daily
How is Lovenox dosed for DVT Treatment?
1mg/kg SQ Q12h or
1.5mg/kg SQ Daily
When should Lovenox be dose adjusted?
When CrCl < 30. At that point, use the Q12h doses as the new daily doses for both prophylaxis and treatment
What is a unique contraindication for all LMWH?
Allergy to pork
What is the generic name of Fragmin?
Dalteparin (LMWH)
What is the generic name of Innohep?
Tinzaparin (LMWH; avoid in sulfa allergy)
What is the generic name of Arixtra?
Fondaparinux (Indirect Factor Xa Inhibitor)
What is the only Factor Xa Inhibitor that comes IV?
Arixtra (Fondaparinux)
How is Fondaparinux dosed for DVT Prophylaxis?
2.5mg SQ Daily (contraindicated when < 50kg)
How is Fondaparinux dosed for DVT/PE Treatment?
< 50kg: 5mg SQ Daily
50-100kg: 7.5mg SQ Daily
> 100kg: 10mg SQ Daily
When is Fondaparinux use contraindicated?
If CrCl < 30
How are all Factor Xa Inhibitors eliminated?
Renal
What is the generic name of Xarelto?
Rivaroxaban (Factor Xa Inhibitor) - PO
What is the generic name of Eliquis?
Apixaban (Factor Xa Inhibitor) - PO
Of the three Factor Xa Inhibitors, which one is NOT FDA-indicated for TREATMENT of DVT/PE?
Eliquis (Apixaban)
What is the generic name of Pradaxa?
Dabigatran (DTI)
What is Argatroban?
DTI
What is the generic name of Angiomax?
Bivalirudin (DTI)
What is the only PO DTI?
Pradaxa (Dabigatran)
All DTI’s renally cleared except?
Argatroban (Hepatic)
What is an ADR associated with Pradaxa (Dabigatran)?
Gastritis and GI bleeding
What do you need to remember when dispensing Pradaxa (Dabigatran)?
If dispensed as a BOTTLE (vs. blister pack), MUST keep in original container. Discard after 4 months
Which factors does Coumadin (Warfarin) inhibit?
SNOT: Seven, Nine, Ten, and Two
What are the normal goals used with Warfarin?
INR for most indications: 2-3
Mechanical mitral valve replacement: 2.5-3.5
What pregnancy category is Warfarin?
Category X
What are the pharmacoGENOMIC considerations for Warfarin?
VKORC1 and CYP 2C9
What are the different doses for the Warfarin pills?
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)
If a patient develops hit with a heparin product, what should be done?
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
What type of patients should Dabigatran, Rivaroxaban, and Apixaban not be used in?
Patients with prosthetic heart valves
What is the BBW with Lovenox (Enoxaparin)?
Patients receiving neuraxial anesthesia (epidural, spinal) or undergoing spinal puncture are at risk of hematomas and subsequent paralysis
What is the MOA of Unfractionated Heparin (UFH)?
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
What is the MOA of LMWHs?
Work similar to heparin except that the inhibition is much greater for Factor Xa than Factor IIa
Why should you be cautious with Factor Xa inhibitors and DTIs?
Neither have an antidote
What must you remember to tell patients using Enoxaparin?
Do not expel the air bubble in the syringe prior to injection (unless your doctor has advised you to do so)
