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NAPLEX 2024 > 34. Anticoagulation > Flashcards

34. Anticoagulation Flashcards

1
Q

T/F: Anticoagulants break down clots

A

False - they prevent blood clots from forming and keeping existing clots from getting bigger but do not break down clots

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2
Q

What can cause blood clots for form?

A

Blood vessel injury, blood stasis (stopping/slowing of blood flow) and prothrombotic conditions

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3
Q

What part of the coagulation cascade do UFH/LMWH (enoxaparin, dalteparin) work on?

A

Xa and thrombin IIa via antithrombin

UFH: equal anti-Xa and anti-thrombin IIa activity
LMWH: most anti-Xa activity than IIa

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4
Q

What part of the coagulation cascade does warfarin work on?

A

Inhibits factors II, VII, IX, and X

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5
Q

What part of the coagulation cascade do rivaroxaban, apixaban, edoxaban work on?

A

Xa (direct inhibitor)

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6
Q

What part of the coagulation cascade does argatroban (IV), bivalirudin (IV), dabigatran (PO) work on?

A

Thrombin IIa

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7
Q

What part of the coagulation cascade does fondaparinux work on?

A

Xa (indirect inhibitor) via antithrombin

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8
Q

DOACs are generally preferred for stroke prevention in Afib but if _______, use warfarin

A

mod-severe mitral stenosis or mechanical heart valve

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9
Q

DOACs are generally preferred for VTE treatment but if _____, use warfarin

A

antiphospholipid syndrome or mechanical heart valve

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10
Q

Compare DOACs vs warfarin in terms of DDIs, bleeding risk, and duration of action

A

DOACs have less DDIs, less or comparable bleeding risk, and shorter duration of action compared to warfarin

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11
Q

_____ do not cross-react with heparin-induced thrombocytopenia (HIT) antibodies

A

IV direct thrombin inhibitors (argatroban, bivalirudin)

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12
Q

T/F: all anticoagulants can cause significant bleeding and are classified as “high-alert” meds by ISMP

A

True

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13
Q

An acute drop in ___ (e.g. ≥ 2g/dL) could signify that bleeding is occurring (visible or not)

A

Hgb

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14
Q

UFH MOA

A

binds to antithrombin and accelerates its ability to inactivate thrombin (factor IIa) and factor Xa and prevents conversion of fibrinogen to fibrin

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15
Q

UFH dosing for VTE ppx

A

5000 units SC Q8-12H

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16
Q

UFH dosing for VTE treatment

A

80 units/kg IV bolus; 18 units/kg/hr infusion

Note: use TBW for dosing

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17
Q

UFH dosing for ACS/STEMI

A

60 units/kg IV bolus; 12 units/kg/hr infusion

Note: use TBW for dosing

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18
Q

Side effects of UFH

A

bleeding, thrombocytopenia, HIT, hyperkalemia, osteoporosis (long-term use), alopecia

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19
Q

Monitoring for UFH

A

aPPTT or anti-Xa level - check 6 hrs after initiation and q6h after therapeutic
aPPT therapeutic range is 1.5-2.5x control (depends on institution)
Platelets, Hgb, Hct at baseline and daily (decrease in platelets >50% from baseline suggests possible HIT)

Note: aPTT and anti-Xa monitoring not required for SC (VTE ppx)

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20
Q

Antidote of UFH

A

Protamine

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21
Q

Why is UFH continuous IV infusions common for treating VTE and ACS?

A

Short half-life (1.5hrs)

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22
Q

Why should UFH not be given IM?

A

hematoma risk

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23
Q

Heaprin lock-flushes (HepFlush) are only used to ___. Fatal errors, especially in neonates have occured when incorrect heparin strength (higher conc) was chosen.
Heparin injection 10,000 units/mL vs flushes 10 or 100 units/mL.

A

keep IV lines open

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24
Q

LMWH MOA

A

bind to antithrombin and accelerate ability to inactivate factor Xa and IIa
Anti-factor Xa activity&raquo_space;» anti-factor IIa activity

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25
Q

Enoxaparin (Lovenox) dosing for VTE ppx

A

30 mg SC Q12H or 40mg SC daily

CrCl < 30: 30 mg SC daily

Note: use TBW for dosing

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26
Q

Enoxaparin (Lovenox) dosing for VTE treatment and UA/NSTEMI

A

1mg/kg SC Q12H or 1.5 mg/kgSC daily (only for inpatient VTE treatment)

CrCl < 30: 1mg/kg SC daily

Note: use TBW for dosing

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27
Q

Enoxaparin (Lovenox) dosing for STEMI treatment in pts <75 yo

A

30 mg IV bolus + 1mg/kg SC dose followed by 1 mg/kg SC Q12H (max 100mg for first 2 SC doses only)

CrCl < 30: 30mg IV bolus + 1mg/kg SC dose, followed by 1mg/kg SC daily

Note: use TBW for dosing

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28
Q

Enoxaparin (Lovenox) dosing for STEMI treatment in pts ≥75 yo

A

No bolus, 0.75mg/kg SC Q12H - max 75mg for first 2 SC doses only

CrCl < 30: 1mg/kg/ SC daily, no bolus

Note: use TBW for dosing

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29
Q

Boxed warnings for enoxaparin (Lovenox)

A

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

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30
Q

Contraindications for enoxaparin (Lovenox)

A

Hx of HIT, active major bleed, hypersensitivity to pork

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31
Q

Side effects for enoxaparin (Lovenox)

A

bleeding, anemia, injection site reactions (e.g. pain, bruising, hematomas), decreased platelets (thrombocytopenia, including HIT)

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32
Q

Monitoring for enoxaparin (Lovenox)

A

Platelets, Hgb, Hct, SCr
More predictable anticoag response than UFH
Does not require anti-Xa level monitoring in most cases but recommended in pregnancy
May be useful to monitor in renal insufficiency, obestiy, low body weight, peds, elderly
Optain peak anti-Xa levels 4 hrs post SC dose

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33
Q

Antidote for enoxaparin (Lovenox)

A

Protamine

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34
Q

T/F: before self-administering Lovenox, you should expel the air bubble from syringe to reduce pain from injecting

A

False - do not expel air bubble for syringe prior to injection (can cause loss of drug)

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35
Q

T/F: Lovenox should be refrigerated

A

False - room temp

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36
Q

What kind of reaction is HIT?

A

Immune-mediated IgG drug reaction
The immune system forms antibodies against heparin bound to platelet factor 4 (PF4) &raquo_space; antibodies join and creates complex > complex binds to the Fc receptors on platelets&raquo_space; platelet activation

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37
Q

HIT is a ____ state and if left untreated, can cause many complications including heparin-induced thrombocytopenia and thrombosis (HITT). Can lead to amputations, post-thrombotic syndrome and/or death

A

prothrombotic

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38
Q

Probability of HIT can be assessed by calculating 4 Ts score which is based on ____

A

Thrombocytopenia: unexplained >50% drop in platelet count from baseline
Timing of platelet count drop: typical onset of HIT is 5-10 days after start of heparin or within hrs if pt has been exposed to heparin within past 3 months
Thrombosis
Other causes: ruling out other probable causes of HIT increases likelihood of diagnosis

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39
Q

If HIT is suspected or confirmed, what should you do?

A

Stop all forms of heparin and LMWH (including heparin flushes and heparin-coated catheters)
If pt is on warfarin and d/x with HIT, warfarin should be d/c and vit K should be administered

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40
Q

For immediate tx of HIT, rapid-acting non-heparin anticoag (e.g. ___) are to be used

A

Argatroban

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41
Q

After HIT is suspected/confirm, do not start warfarin therapy until the platelets have recovered to ≥ _____. Warfarin should be initiated at lower doses (5mg max) and overlap with non-heparin anticoag for minimum of ______ and until INR is within target range for at least _____

A

150,000 cells/mm3
5 days
24 hrs

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42
Q

If HIT is suspected/confirmed and urgent cardiac surgery or PCI is required, ___ is preferred anticoag

A

Bivalirudin

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43
Q

Apixaban (Eliquis) dose for nonvalvular AFib (stroke ppx)

A

5mg PO BID
If pt has at least 2 of the folloiwng: age ≥80 yo, weight ≤60kg, or SCr ≥1.5, then give 2.5mg BID

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44
Q

Apixaban (Eliquis) dose for DVT/PE treatment

A

Initial 10mg PO BID x 7 days then 5mg PO BID

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45
Q

Rivaroxaban (Xarelto) doses ≥ ___ hsould be taken with food

A

15mg

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46
Q

Rivaroxaban (Xarelto) dose for nonvalvular Afib (stroke ppx)

A

CrCl > 50: 20mg PO daily with evening meal
CrCl 15-50 :15mg PO daily with evening meal
CrCl < 15: avoid use

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47
Q

Rivaroxaban (Xarelto) dose for DVT/PE Treatment

A

Initial: 15mg PO BID x21 days, then 20 mg PO daily with food
CrCl <30: avoid use

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48
Q

Pt is on rivaroxaban (Xarelto) 15mg BID but missed their dose. What do you recommend?

A

Take immediately to ensure intake of 30mg/day (two 15mg tabs may be taken at once) then resume regular schedule on the following day

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49
Q

Pt is on rivaroxaban (Xarelto) 10, 15, or 20mg daily but missed their dose. What do you recommend?

A

take immediately on the same day, otherwise skip

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50
Q

Which oral direct factor Xa inhibitor should not be used for nonvalvular afib (stroke ppx) if CrCl > 95?

A

Edoxaban (Savaysa)

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51
Q

Edoxaban (Savaysa) dose for DVT/PE treatment

A

60mg daily - start after 5-10 days of parenteral anticoagulation

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52
Q

Boxed warnings for oral direct factor Xa inhibitors (apixaban, rivaroxaban, edoxaban)

A

Pts receiving neuraxial anesthesia (epidural, spinal) or undergoing spinal puncture are at risk of hematomas and subsequent paralysis
Premature d/c increases risk of thrombotic events

Edoxaban only: reduced efficacy in nonvalvular afib pts with CrCl > 95 (do not use)

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53
Q

Contraindications for oral direct factor Xa inhibitors (apixaban, rivaroxaban, edoxaban)

A

active pathological bleeding

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54
Q

Monitoring for oral direct factor Xa inhibitors (apixaban, rivaroxaban, edoxaban)

A

Hgb, Hct, SCr, LFTs
No monitoring of efficacy required

55
Q

Antidote for apixaban (Eliquis) and rivaroxaban (Xarelto)

A

andexanet alfa (Andexxa)

56
Q

Contraindications of fondaparinux (Arixtra)

A

Severe renal impairment CrCl <30

Others: active major bleed, bacterial endocarditis, thrombocytopenia with positive test for anti-platelet antibodies in presence of fondaprinux

57
Q

Apixaban is a substrate of CYP3A4 and P-gp. Avoid use with strong dual inducers of CYP3A4 and P-gp such as ___

A

carbamazepine, phenytoin, rifampin, St. John’s wort

58
Q

Apixaban is a substrate of CYP3A4 and P-gp. Avoid use with strong dual inducers of CYP3A4 and P-gp such as ___ or combined P-gp and strong CYP3A4 inhibtors such as ____

A

carbamazepine, phenytoin, rifampin, St. John’s wort

ketoconazole, itraconazole, lopinavir/ritonavir, tironavir, conivaptan

59
Q

If switching from warfarin to rivaroxaban, stop warfarin and switch when INR is ____

A

INR < 3

60
Q

If switching from warfarin to edoxaban, stop warfarin and switch when INR is ____

A

INR ≤ 2.5

61
Q

If switching from warfarin to apixaban, stop warfarin and switch when INR is ____

A

<2

62
Q

If switching from warfarin to dabigatran, stop warfarin and switch when INR is ____

A

<2

63
Q

If switching from oral Xa inhibitors (apixaban, rivaroxaban, edoxaban) to warfarin, what should you do?

A

Stop Xa inhibitor. start parenteral anticoag and warfarin at next scheduled dose
Edoxaban only: refer to package labeling for conversion recs

64
Q

If switching from dabigatran to warfarin, what should you do?

A

start warfarin 1-3 days before stopping dabigatran (determined by renal function, refer to dabigatran labeling)

65
Q

Dabigatran (Pradaxa) dose for DVT/PE treatment and reduction in risk of recurrent DVT/PE

A

150mg BID, start after 5-10 days of parenteral anticoagulation

66
Q

Antidote for dabigatran (Pradaxa)

A

Idarucizumab (Praxbind)

67
Q

Which PO anticoag must be dispensed in original container and discard 4 months after opening?

A

Dabigatran (Pradaxa)

68
Q

T/F: dabigatran can be crushed and administered by NG tube if necessary

A

False - swallow capsules whole (do not break, chew, crush, or open) // do not administer by NG tube

69
Q

Dabigatran (Pradaxa) side effects

A

dyspepsia, gastritis-like symptoms, bleeding (including GI bleeding)

70
Q

Contraindications of dabigatrain (Pradaxa)

A

Active pathological bleeding, tx of pts with mechanical prosthetic heart valves

71
Q

What is the antidote for IV direct thrombin inhibitors (argatroban, bivalirudin (Angiomax))

A

No antidote

72
Q

What anticoag have boxed warning for pts receiving neuraxial anesthesia (epidural, spinal) or undergoing spinal puncture d/t risk of hematomas and subsequent paralysis?

A

PO direct factor Xa inhibitors (apixaban, rivaroxaban, edoxaban)
enoxaparin
Fondaparinux
Dabigatran (Pradaxa)

73
Q

Warfarin MOA

A

competitively inhibits the C1 subunit of the multi-unit vit K epoxide reductase (VKORC1) enzyme complex&raquo_space; reduces regeneration of vit K epoxide and causes depletion of active clotting factors II, VII, IX, and X and anticoagulants protein C and S

74
Q

Warfarin (Jantoven, Coumadin) dosing

A

Health outpatients ≤ 10mg daily for first 2 days, then adjust dose per INR

Lower doses (≤ 5mg) for elderly, malnourished, taking drugs which can increased warfarin levels, liver disease, Hf, or high risk of bleeding

75
Q

Warfarin (Jantoven, Coumadin) is contraindicated in pregnancy except with ____

A

mechanic heart valves at high risk for thromboembolism

76
Q

Warfarin (Jantoven, Coumadin) and presence of CYP2C9 ____ alleles and/or polymorphism of ____ gene may increase bleeding risk

A

*2 or *3
VKORC1 gene

77
Q

Side effects of warfarin (Jantoven, Coumadin)

A

bleeding/bruising (mild to severe), skin necrosis, purple toe syndrome

78
Q

Goal INR is 2-3 (target 2.5) for most indications. INR 2.5-3.5 (target 3) is for high-risk indications such as ____

A

mechanical mitral valve
2 mechanical heart valves or mechanical aortic valve with 1 additional risk factor (e.g. previous DVT, Afib, hyper-coagulable state)

79
Q

S-warfarin is primarily metabolized via CYP ___ and R-warfarin is primarily metabolized via CYP___.

A

S-warfarin: CYP2C9
R-warfarin: CYP3A4

80
Q

Which enantiomer is 3-5x more potent than the other enantiomer?

A

S-warfarin > R-warfarin
Hence why DDIs with CYP2C9 has greater impact on anticoag effect

81
Q

Antidote of warfarin (Jantoven, Coumadin)

A

vit K

82
Q

CYP2C9 inducers that can decrease INR include ___

A

carbamazepine, phenobarbital, phenytoin, rifampin (large drop in INR) and St. John’s wort

83
Q

CYP2C9 inhibitors that increase INR include ____

A

amiodarone, azole antifungals (e.g. fluconazole, keotoconaozle, voriconazole), capcitabine, cimetidine, fluvastatin, fluvoxamine, metronidazole, tamoxifen, igecycline, TMP/SMX and zafirlukast

84
Q

When starting amiodarone, dose of warfarin should be decreased by ___

A

30-50%

85
Q

T/F: Use of NSAIDs, antiplatelet agents, other anticoags, SSRI/SNRIs can increase INR (therefore bleeding risk)

A

False - they increase bleeding risk but may not increase INR

86
Q

When using warfarin, drugs that increase clotting risk such as ___ should be d/c if possible

A

Estrogen and SERMs

87
Q

What dietary supplements can increase bleeding risk when used with warfarin?

A

Chamomile, chondroitin, dong quai, high doses of fish oils, 5 Gs (garlic, ginger, ginkgo, ginseng, glucosamine), vit E, and willow bark

88
Q

What foods have high vit K and cause decrease in INR?

A

spinach (cooked), broccoli, brussel sprouts, collard greens, kale, turnip greens, green onion, swiss chard, endive, parsley

Others: asparagus, cabbage, canola oil, cauliflower, coleslaw, lettuce (red leaf or butterhead), watercress, some teas

89
Q

Warfarin tablet colors

A

Please Let Greg Brown Bring Peaches To Your Wedding

Pink - 1mg
Lavender - 2mg
Green - 2.5mg
Brown/Tan - 3mg
Blue - 4mg
Peach - 5mg
Teal - 6mg
Yellow - 7.5mg
White - 10mg

90
Q

Pt has acute DVT/PE and doctor wants to start warfarin. What do you recommend?

A

Start warfarin on the same day as parenteral anticoag (e.g. enoxaparin or UFH) and continue both anticoags for minimum of 5 days and until INR is ≥2 for at least 24h (2 consecutive days)

91
Q

For pts with consistently stable INRs on warfarin, INR testing can be up to every ____ instead of monthly

A

every 12 weeks

92
Q

For IV UFH reversal, what is the dose of protamine

A

1mg protamine will reverse ~100 units of heparin
Since UFH has very short half-life, reverse amt of heparin given in the last 2-2.5 hrs
Max dose: 50mg

93
Q

What is the max dose of protamine

A

50mg

94
Q

For LMWH reversal, what is the dose of protamine

A

Enoxaparin given within last 8 hrs: 1mg protamine per 1 mg of enoxaparin
Enoxaparin given >8 hrs ago: 0.5mg protamine per 1 mg of enoxaparin

95
Q

Vit K or phytonadione (Mephyton) formulations

A

PO or IV

SC not recommended d/t variable absorption
IM not recommended d/t risk of hematoma

96
Q

Side effects of Vit K or phytonadione (Mephyton) for warfarin reversal

A

anaphylaxis, flushing, rash, dizziness

97
Q

Boxed warnings of Vit K or phytonadione (Mephyton) for warfarin reversal

A

severe reactions resembling hypersensitivity reactions (e.g. anaphylaxis) - rare

98
Q

Four factor prothrombin complex concentrate (Human) (KCentra) should be administered with ___

A

vit K

99
Q

Four factor prothrombin complex concentrate (Human) (KCentra) works on ___

A

factors II, VII, IX, X, protein C and S

100
Q

What are off label options for warfarin reversal?

A

Three factor prothrombin complex concentrate (Human) (Profilnine)
Factor VIIa recombinant (NovoSeven RT, Sevenfact)

101
Q

What formulation of vit K is preferred for reversal in pts without significant or major bleeding?

A

Oral vit K (generally doses of 2.5-5mg)

IV vit K should only be used if pt is experiencing serious bleeding
Infuse slowly d/t risk of anaphylaxis

102
Q

Pt on warfarin INR is above therapeutic range but < 4.5 without bleeding. What do you do?

A

Reduce or skip warfarin dose. Monitor INR

103
Q

Pt on warfarin INR is supratherapeutic 4.5-10 without bleeding. What do you do?

A

Hold 1-2 doses of warfarin. monitor INR
Routine use of vit K is not recommended if no evidence of bleeding

104
Q

Pt on warfarin INR >10 without bleeding. What do you do?

A

Hold warfarin
Give oral vit K 2.5-5mg even if not bleeding
Monitor INR, resume warfarin at lower dose when INR therapeutic

105
Q

Pt on warfarin experiencing major bleeding. What do you do?

A

Hold warfarin
Give IV vit K 5-10mg by slow injection and four-factor prothrombin complex concentrate (PCC)
PCC suggested over fresh frozen plasma (FFP) d/t risk of allergic reactions, infection transmission, longer prep time, slower onset, and higher volume

106
Q

Stop warfarin ____ before major surgery

A

~5 days

107
Q

Pt is on warfarin and has mechanical heart valve, Afib, or VTE at high risk of thromboembolism, ___ is recommended when stopping warfarin for surgery.

A

LMWH or UFH (bridge)

108
Q

D/C therapeutic-dose SC LMWH ___ before surgery

A

24 hrs

Note: UFH IV thearpy can be stopped 4-6 hr before surgery

109
Q

T/F: All pts d/c warfarin prior to surgery should be bridged with LMWH or UFH d/t clotting risk

A

False - not required for pts at low risk of thromboembolism

110
Q

Symptoms of DVT

A

pain in affected limb and unilateral lower extremity swelling

111
Q

DVTs can be diagnosed with ___

A

ultrasound (or MRI or venography in some cases)
D-dimer lab test can aid in diagnosis
PE suspected = pulmonary CT angiogram can dx

112
Q

Modifiable risk factors for venous thromboembolism

A

Acute medical illness
Immobility
Medications (e.g. SERMs, drugs containing estrogen, ESAs)
Obesity (BMI ≥30)
Pregnancy and postpartum period
Recent surgery or major trauma

113
Q

Non-modifiable risk factors for VTE

A

Increasing age
Cancer or chemotherapy
Previous VTE
Inherited or acquired thrombophilia (e.g. antithrombin deficiency, factor V Leiden, antiphospholipid syndrome, protein C or S deficiency)
Certain disease states (e.g. HF, nephrotic syndrome, respiratory failure)

114
Q

If pts have contraindication to anticoags (such as active bleed) or have high risk for bleeding, what are non-drug alternatives to prevent VTE?

A

Intermittent pneumatic compression (IPC) devices or graduated compression stockings

115
Q

What are some recommendations for long-distance travels at risk for VTE?

A

Frequent ambulation
calf muscle exercises
sitting in aisle seat
using graduated compression stockings with 15-30 mmHg pressure at the ankle during travel

Note: aspirin or anticoag should NOT be used just for traveling

116
Q

Any VTE that is caused by surgery or a reversible risk factor should be treated for ___

A

3 months

117
Q

VTE that is unprovoked (unknown cause) should be treated for ___

A

usually longer than 3 months as long as bleeding risk is low-moderate

118
Q

T/F: Estrogen-containing meds and selective estrogen receptor modulators (SERMs) are contraindicated in pts with hx of or current VTE and should be d/c

A

True

119
Q

For pts without cancer, ___ anticoag are preferred for the first 3 months of treatment for DVT

A

dabigatran and oral factor Xa inhibitors&raquo_space; warfarin

120
Q

For pts with cancer, ___ anticoag are preferred

A

oral factor Xa inhibitors are preferred over other oral anticaogs and LMWH

121
Q

If Afib > 48 hrs or unknown duration: anticoag for at least ___ prior to and after cardioversion (when normal sinus rhythm is restored)
If using warfarin, target INR of ___

A

3 weeks
4 weeks
INR goal 2-3

122
Q

If Afib ≤ 48 hrs and undergoing elective cardioversion: start full therapeutic anticoagulation at presentation, perform cardioversion, and continue full anticoag for at least ____ while pt is in normal sinus rhythm

A

4 weeks

123
Q

What types of patients have highest risk for clotting/strokes?

A

Pts with Afib and mechanical heart valves - treat with warfarin only
Factor Xa inhibitors and DTIs are not approved for this population

124
Q

If CHA2DS2-VASC score is 0 (males) or 1 (females), what do you recommend for afib stroke ppx therapy

A

Risk of stroke is low
No anticoag recommended

125
Q

If CHA2DS2-VASC score is ≥ 1(males) or ≥ 2 (females), what do you recommend for afib stroke ppx therapy

A

Risk of stroke is moderate
Oral anticoag may be considered

126
Q

If CHA2DS2-VASC score is ≥ 2 (males) or ≥ 3 (females), what do you recommend for
afib stroke ppx therapy

A

Risk of stroke is high
Oral anticoag recommended (DOAC (apixaban, rivaroxaban, edoxaban, dabigatran) > warfarin)

127
Q

What is CHA2DS2-VASC score based on?

A

C - CHF
H - HTN
A2 - Age ≥75 yo (worth 2 points)
D - DM
S2 - prior Stroke/TIA (worth 2 points)
V - vascular disease (prior MI, PAD, aortic plaque)
A - age 65-74 yo
Sc - sex category, female

Every category worth 1 point except Age ≥75yo and prior stroke/TIA (worth 2 points)

128
Q

What is HAS-BLED score based on?

A

H - HTN (SBP > 160)
A - abnormal liver or kidney function (worth 1-2 points)
S - prior stroke
B - bleeding tendnecy or predisposition
L - labile INR (if on warfarin)
E - elderly (age > 65)
D - drugs (aspirin, NSAIDs), excess use of alcohol (worth 1-2 points)

Every category worth 1 point except abnormal live or kidney function and drugs (aspirin, NSAIDs) or excess use of alcohol (worth 1-2 points)

129
Q

For ppx and tx of VTE in pregnant women, ___ is preferred

A

LMWH

130
Q

Since warfarin is teratogenic, women who require chronic warfarin therapy for mechanical heart valves or inherited thrombophilias are generally converted to ___ during pregnancy. They may be switched back to warfarin after ___ week of pregnancy and then back to LMWH closer to delivery

A

LMWH
13th (after 1st trimester)

131
Q

When LMWH is used in pregnancy, ____ monitoring is recommended

A

anti Xa

132
Q

Where can enoxaparin SC be administered?

A

Right or left side of your abdomen, at least 2 inches from belly button

133
Q

T/F: after administering enoxaparin you should rub the site of injection to ensure proper absorption

A

false - can lead to bruising, do not rub

NAPLEX 2024 (74 decks)

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