Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics Humber > Anti Coag Special Populations > Flashcards

Anti Coag Special Populations Flashcards

1
Q

CKD Dose Adjust of Renally Elim PARENTERAL Anti coags : Dalteparin

-If CrCL < 30 mL/min What do u adjust the dose to?

A

avoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Enoxaparin :

-If CrCL 20-30 mL/min?
-If CrCL < 20 mL/min or on dialysis?
-Hospitalized pt’s can use (Enox)?

A

1 mg/kg SQ daily

UFH is preferred !

-Hospitalized pt’s can use 0.7 mg/kg SQ daily + trough anti-Xa levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Bivalirudin :

-If CrCL 30-60 mL/min
-If CrCL 10-29 mL/min or CVVHD?
-If IHD?

These are ____ doses, adjust rate per ??

A

0.08 mg/kg/hr

0.05 mg/kg/hr

0.04 mg/kg/hr

starting, protocol and aPTT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Fondaparinux :
CrCl<30 mL/min
-What can u use to help guide therapy in CKD stage 3?
-What about ckd stage 4 or 5 ?

A

AVOID IN VTE

use antiXa levels

AVOID in CKD stages 4 and 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Whats ur goal anti-Xa trough when using Enoxaparin in renally adjusted pt’s?

A

< 0.4 IU/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CKD Dose adjustments of DOACS When Treating VTE : DABIGATRAN

For CrCL < 30 mL/min?
For CrCL < 50 mL/min with concomitant use of PGP inhibitors,(Ketoconazole, quinidine, verapamil, erythro, cyclosporine, amio, dronedarone) ?

A

DONT USE

avoid coadmin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A. RIVAROXABAN when TREATING VTE :

CrCL < 15 mL/min?

B. APIXABAN ADJUSTMENT?

A

DONT USE

NO RENAL DOSE ADJ. 10 mg po bid for 7 days then 5 mg PO BID afterwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

C. EDOXABAN

For CrCL 15-50 mL/min or weight <= 60 kg or who use certain PGP inhibitors?

For CrCL < 15 mL/min?

A

30 mg PO DAILY

dont use for tx of VTE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some high risk patient groups that may require LMWH monitoring with Anti-Xa levels? (4)

A

Obesity
renal impairment with CrCL < 30
Elderly + Children
Cancer pt’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

OBESITY BMI > 40 kg/m^2 : For each state the prophylaxis dosing and the therapeutic dosing adjustments

  1. UFH
  2. LMWH
  3. Fondaparinux
  4. DTI’s
  5. Warfarin
A
  1. Consider higher doses like 7500 units SQ TID or 10k units sq BID if weight > 120 kg
    -Can follow anti Xa levels

No adjust needed

  1. 0.5 mg/kg SQ daily or 30% incr from standard dose + anti Xa monitoring

for VTE : 0.75 mg/kg SQ BID (use actual body weight) + anti Xa monitoring

  1. no recs
    -fixed dose of 10 mg SQ daily for weight > 100 kg for VTE. Can use anti Xa to monitor
  2. n/a

use actual body weight. titrate to effect based on aPTT

  1. n/a

may require higher initial dose at start but titrate towards INR endpoint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Obesity and DOACs :

Which drugs are appropriate options regardless of high BMI and weight for tx of VTE?

Suggest not to use the following for VTE tx in obese pt’s?

A

apixaban or rivaroxaban

Dabigatran, edoxaban, Betrixaban

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Indications for using Anti-thrombotics In pregnancy? (Pre existing Disease)

A

-Acute VTE
* Chronic VTE
* Atrial fibrillation
* Valvular and structural
heart disease
* Ischemic stroke
* Acute coronary syndromes
* Peripheral artery occlusive
disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Indications for using Anti-thrombotics In pregnancy? (Pre existing risk factors)

A

Hypercoagulable conditions such as AT deficiency or antiphospholipid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

AntiCoag Recc in Pregnancy :

Which 2 agents can u use, and which 2 should u avoid?

A

LMWH : preferred. doesnt cross placenta, not transferred through breast milk

UFH : yes as alternative to LMWH. Preferred in pt’s with severe renal issues, doesnt cross placenta. Long term use –> Osteoporosis

Vitamin K antags (Avoid during preg if u can because it’s a teratogen and MAY Cross placenta)

DOACs (avoid during preg). Potential risk for fetal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

LMWH in Pregnancy :
-What kind of monitoring to consider?
-In preg women with severe renal dysfunction?
-What kind of preparations to use?

For epidural catheter placement to minimize risk of spinal hematoma :
-How long do u have to wait between last therapeutic LMWH injection?
-How long must u wait between last PROPHYLACTIC LMWH injection?

When should pregnant women consider switching to UFH?

A

-Anti Xa
-UFH

-Preservative free (pre filled syringes)

  • > = 24 hrs
  • > = 12 hrs

36-37 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Development of cancer is associated with?

Tumor cells produce their own ??

What can also activate blood clotting?

A

Activation of blood coagulation

procoagulant factors

Anti-tumor drugs (chemotherapy)

17
Q

Cancer Associated Thrombosis :

  1. Which drug class can u use for initial tx (10 days) and maintenance tx with CrCL > 30?
  2. What about DOACS in cancer pt’s not at high risk of GI or GU bleeding ?
  3. If LMWHs or DOACS are CI, what can u use?
  4. How long must u use LMWHs or DOACS to treat cancer associated thrombosis?
A
  1. LMWHs
  2. Apixaban or Rivaroxaban for initial tx (10 days) OR EDOXABAN (after 5 days of parenteral AC) and also can use these agents as maintenance tx
  3. UFH
  4. minimum of 6 months
18
Q

PRIMARY PROPHYLAXIS of Asx Carriers of Inherited Thrombophilias :

A. This is not necessary unless there’s additional risk factors present such as?

B. If someone’s on hormonal therapy and may have inherited thrombophilia, what should be considered?
-What about recc’s regarding anticoag prophylaxis?

C. Pregnancy associated with Inherited thrombophilia –> recurrent fetal loss

In the antepartum period, if theyre AT3 deficient, what should u use as prophylaxis?

In postpartum period and AT3, protein c + s deficiency, whats prophylaxis?

A

A. using hormonal therapy and if they’re pregnant

B. Consider alternative method of contraception or avoid

  • No reccs

C.
-UFH or LMWH prophylaxis.
-Prophylaxis with SQ UFH or LMWH or warfarin (target INR 2-3) for 6 weeks

19
Q

For pt’s with Inherited Thrombophilia, minimum period of tx is at least how many months?

Which pt’s should u consider long term anticoag for?

For patients with 2 or more spontaneous episodes of VTE how long is therapy?

A

at least 3-6 months

-pt’s with protein C,S, deficiency with family history .
-For AT3 deficiency or antiphospholipid antibodies

indefinite therapy

20
Q

Antiphospholipid Syndrome
-What kind of disorder?
-Associated with both?
-Clinical presentation includes? (4)

A

-Autoimmune disorder of hypercoagulability
-Arterial and venous thrombosis

-Thrombosis, recurrent miscarriage, thrombocytopenia, prolonged baseline aPTT

21
Q

Lupus Anticoagulant and Interference w/monitoring parameters :

1) Pt’s with lupus anticoag have elevated ___ and prolongation of ____
-typically not associated with?

HEPARIN : what’s not a reliable predictor of therapeutic efficacy and what should u use in its place?

WARFARIN : Utilize chromogenic assay for factor X and use in which pt’s?

A
  1. baseline aPTTs , PT (falsely elevated INR)
    -INCR risk of bleeding

aPTT, anti-Xa levels

pt’s with abnormal baseline INR

22
Q

Timing of ANtiCOAG Interruption:

  1. Vitamin K antag (warfarin)
    -When should you discontinue?
    -Proceed with surgery when INR is?
  2. DOACS
    -High bleed risk procedure vs low bleed risk
    -for individuals taking dabigatran with CrCL 30-50?
  3. UFH
    -Discontinue when?
    -Preferred in which setting?
  4. LMWH
    -discontinue when?
    -avoid in ?
    -For BID dosing?
    -For once daily dosing?
A
  1. discontinue 5 days prior to elective surgery +/- bridging with LMWH or heparin
    <1.5
  2. discontinue doac two days before surgery day. Resume on second day after surgery .

-discontinue one day before surgery. continue day after surgery

  • omit an additional dose before procedure
  1. Discontinue 4 hrs prior to procedure. Preferred in hospital due to quick onset and offset and reversability.
  2. Discontinue 24 hrs prior to procedure

-renal dysfunction
- omit evening dose prior to procedure
-give 1/2 dose on morning before day of surgery

23
Q

Bridging Anticoag
-What does this involve?
-Which pt’s fit into the criteria to bridge?

A

Administration of short acting anticoag such as LMWH, during interruption of longer acting agent such as warfarin

Pt’s on vit k antag, procedure has low/mod/high risk of bleeding AND they have high thromboembolic risk

24
Q

VTE prophylaxis Chart in hospitalized pt’s

A

See Chart

25
Q

Reasons to NOT USE pharma VTE prophylaxis : RIsk factors for bleeding ?

1.Active ____
2.Bleeding how soon prior to admission?
3.Platelet count of?
4.Age?
5.___failure with INR of ?
6.Severe __?

A

gastroduodenal ulcer

3 months prior to admit

< 50 x 10^9/L

> = 85

Hepatic failure, >1.5

Renal dysfunction

Therapeutics Humber (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions