A1C Lecture part 2

Question 1

What is an INR?
____________is a protein produced by the liver and is one of the
factors in the blood that promotes clotting

Answer 1

Prothrombin

Question 2

A prothrombin test measures the time it takes for the blood to clot

Answer 2

clot

Question 3

The Prothrombin time test results can be reported as an
international standardized ratio called an __________________ (INR)

Answer 3

International Normalized
Ratio

Question 4

A patient’s INR is used to monitor the safety and efficacy of anticoagulation
therapy
Anticoagulation therapy: Warfarin (Coumadin)

Question 5

ISI=_______________

Answer 5

International sensitivity index

Question 6

INR Goals
Patients that are not taking anticoagulation therapy have an INR around __________

Answer 6

0.8-1.1

Question 7

A high INR correlated to an increased risk of _________

Answer 7

bleeding

Question 8

A low INR correlated to an increased risk of _________

Answer 8

clotting

Question 9

Therapeutic goals depend on disease state being treated

INR _________
Atrial fibrillation
DVT/PE treatment
Bioprosthetic mitral valve for first 3 months
Mechanical aortic valve

Answer 9

INR 2-3

Question 10

INR _________
Mechanical mitral valve

Answer 10

2.5 – 3.5

Question 11

Warfarin and INR Considerations

Drug interactions
Inducers and inhibitors of CYP2C9, CYP1A2, CYP3A4
Food interactions
Foods with high amounts of vitamin K will decrease INR
Kale, liver, broccoli, brussel sprouts, lettuce, asparagus, cauliflower, spinach

Other considerations
Age
Medical conditions
Alcohol consumption

Question 12

What happens to the INR?

St. John’s wort is an inducer of CYP3A4

I just started a diet and all I eat is salad

Bactrim and Flagyl are inhibitors of CYP2C9

Cigarettes are an inducer of CYP1A2, I am quitting

Yesterday was my 21st birthday

Question 13

CoaguChek
Each system contains:
CoaguChek INRange meter
CoaguChek XS Softclix lancing device
CoaguChek Softclix lancets (bag of 10)
User’s manual and Quick reference guide
USB cable and 4 AAA batteries

Uses more than or equal to ______microliters of fresh capillary blood to measure INR

Measuring range INR: __________

Meter more than $500

24 test strips is $140

Answer 13

more than or equal to 8 microliters

0.8-8.0

Question 14

How to use CoaguChek XS in 4 simple steps

Step 1: Put a test strip in the CoaguChek INRange

Step 2: Prick your finger with the CoaguChek Softclix XS lancing device

Step 3: Place a drop of blood on the strip.

Step 4. After about one minute, read the result on the CoaguCheck INRange display.

Question 15

CoaguChek Counseling

Match the LOT number of the meter of the meter to the LOT number on the test strip bottle

Test strips must be kept in original container and must be used within 10 minutes when removed

You have 180 seconds after inserting strip into the meter to apply your blood to the strip

You must apply blood to test strip within 15 seconds of lancing fingertip to avoid clotting

Place meter flat surface-movement can result in error message

Report INR test results to provider either online or via phone

From the time the meter first displays low battery message, you can complete 3 more tests

Question 16

Who would benefit from CoaguChek?
Patients who want to have more control over their INR
Patients who want the freedom to test wherever it is convenient
Patients who prefer a finger prick opposed to a venous blood draw
Patients who want peace of mind and confidence of knowing their INR
Patients who will be on long-term anticoagulation

Question 17

Coronary Heart Disease (CHD) ** leading cause of death in the US! **
MI
Angina pectoris
HF
Coronary death

Question 18

Cerebrovascular Disease
Stroke ** leading cause of disability in the US! **
Transient Ischemic Attack (TIA)
Peripheral Arterial Disease
Thoracic or abdominal aortic aneurysm