Anticoag Flashcards
vitamin K given IV has a risk of the following adverse reaction:
Answer
A Acute dystrophy B Seizures C Peripheral neuropathy D Anaphylaxis E Neuroleptic malignant syndrome
D
Anaphylaxis
Incorrect
The administration of vitamin K intravenously is associated with the risk of anaphylaxis (dyspnea, cardiac arrest, hypotension, shock).
The physician plans to start ST on enoxaparin, but would like to order a laboratory test to monitor efficacy of enoxaparin therapy. Which of the following could be recommended?
Answer
A aPTT Q6H B INR daily C Peak anti-Xa, 4 hours after the dose D Trough anti-Xa, before the next dose E There is no laboratory test to monitor efficacy of this therapy
C
Peak anti-Xa, 4 hours after the dose
Incorrect
Routine monitoring of enoxaparin with anti-Xa levels is not necessary, but can be done in certain patients. Anti-Xa levels should be drawn 4 hrs after the SQ dose (peak).
Low molecular weight heparins have a boxed warning concerning this risk:
Answer
A Stevens Johnson syndrome B Spinal or epidural hematoma formation C Pancreatitis D Severe bleeding E Acute renal failure
B
Spinal or epidural hematoma formation
Incorrect
LMWHs, the Xa inhibitors and dabigatran all carry this boxed warning. The risk is highest if the patient receives neuraxial anesthesia or has a spinal puncture concurrently. These hematomas may result in long-term or permanent paralysis.
A patient is being started on Pradaxa. Choose the correct statement regarding Pradaxa:
Answer
A
Once a bottle of Pradaxa is opened, the capsules must be used within 15 days.
B
Once a bottle of Pradaxa is opened, the capsules must be used within 60 days.
C
Once a bottle of Pradaxa is opened, the capsules must be used within 90 days.
D
Once a bottle of Pradaxa is opened, the capsules must be used within 120 days.
E
If Pradaxa capsules are transferred to an amber container, they are good up to 2 months.
D
Once a bottle of Pradaxa is opened, the capsules must be used within 120 days.
A pharmacist working in an inpatient medical ward of the local hospital is responsible for monitoring anticoagulation therapy. She routinely obtains laboratory parameters and adjusts the doses of low molecular weight heparins (LMWHs), as needed. In which of the following clinical situations is it appropriate to monitor the level of anticoagulation with LMWH therapy? (Select ALL that apply.)
Answer
A Patients with a myocardial infarction B Significant renal impairment C Pregnant patient with PE D Pregnant patient with mechanical heart valves E Extremes of body weight Incorrect These clinical scenarios are appropriate for monitoring LMWH therapy.
B Significant renal impairment C Pregnant patient with PE D Pregnant patient with mechanical heart valves E Extremes of body weight Incorrect These clinical scenarios are appropriate for monitoring LMWH therapy.
What effect would be predicted if a patient on warfarin with a stable INR is started on amiodarone?
Answer
A
The INR would decrease and the patient may experience bleeding.
B
The INR would increase and the patient may clot.
C
The INR would increase and the patient may experience bleeding.
D
The INR would decrease and the patient may clot.
E
The INR would not change.
C
The INR would increase and the patient may experience bleeding.
Incorrect
Amiodarone inhibits the metabolism of warfarin; therefore, increasing the INR and potentially causing the patient to bleed. When a patient stabilized on warfarin will require amiodarone, clinicians generally reduce the warfarin dose by 30-50% to account for this.
CJ is a 44 year-old female with hyperlipidemia and hypertension. She is referred to a pharmacist-managed anticoagulation clinic with a newly diagnosed, first unprovoked episode of lower left leg DVT. She is a teacher and drinks 1 glass of wine per day. Lab/vitals: Weight: 325 lbs, Height: 6’1”, Scr 0.6 mg/dL (1 month ago), Baseline INR 1.1. What INR goal and duration of warfarin therapy should be recommended to treat CJ’s DVT?
Answer
A INR goal of 1.5-2.5 for 6 months B INR goal of 2-3 for 1 year C INR goal of 2-3 for at least 3 months D INR goal of 2-3 indefinitely E INR goal of 2.5-3.5 for 3-6 months
C
INR goal of 2-3 for at least 3 months
Incorrect
Guidelines recommend that the first, unprovoked VTE be treated for at least 3 months with an INR goal of 2-3.
A 42 year-old female with a heart condition presents to the hospital with a DVT. The medical resident wishes to give her a low molecular weight heparin (LMWH), but the supervising physician insists on using unfractionated heparin. What are advantages to the use of LMWHs over unfractionated heparin? (Select ALL that apply.)
Answer
A
LMWHs are more efficacious than heparin in treating DVTs.
B
LMWHs are more cost effective than heparin.
C
LMWHs are easier to reverse in patients that experience significant bleeding.
D
LMWHs do not require monitoring in most patients.
E
LMWHs have a more consistent anticoagulation response.
Incorrect
When dosed correctly, UFH and LMWH are generally thought to be equally effective for most indications. Unlike heparin, LMWHs do not require routine monitoring. Anti-factor Xa levels can be monitored in select patients, but this is not necessary in most patients. LMWHs are more cost effective than heparin, because they do not require monitoring (in most cases), offer a more predictable response and patients can be discharged earlier.
B
LMWHs are more cost effective than heparin.
D
LMWHs do not require monitoring in most patients.
E
LMWHs have a more consistent anticoagulation response.
Incorrect
When dosed correctly, UFH and LMWH are generally thought to be equally effective for most indications. Unlike heparin, LMWHs do not require routine monitoring. Anti-factor Xa levels can be monitored in select patients, but this is not necessary in most patients. LMWHs are more cost effective than heparin, because they do not require monitoring (in most cases), offer a more predictable response and patients can be discharged earlier.
Which of the following procedures can help reduce medication errors associated with heparin? (Select ALL that apply.)
Answer
A
Do not use the color of the syringe or packaging to verify the dose.
B
Provide inservices that review heparin safety.
C
If possible, outsource the preparation of heparin flushes.
D
Make sure unit nurses prepare the heparin doses.
E
Implement protocols to initiate and manage therapy.
A
Do not use the color of the syringe or packaging to verify the dose.
B
Provide inservices that review heparin safety.
C
If possible, outsource the preparation of heparin flushes.
E
Implement protocols to initiate and manage therapy.
Incorrect
All anticoagulants are high-alert medications and errors have resulted in patient death. Heparin comes in many different strengths. To help avoid errors, heparin should not be stocked in unfamiliar concentrations. The color of the bag or syringe should not be used to verify the dose. Having the pharmacy prepare the flush syringes (rather than busy unit nurses) can help reduce errors. Buying prepared heparin syringes (outsourcing) is preferable to compounding them on-site. Refer to the Medication Safety chapter for additional discussion of high-alert medications.
Which of the following agents is/are safe to use in a patient at risk for HIT? (Select ALL that apply.)
Answer
A Argatroban B Bivalirudin C Dalteparin D Enoxaparin E Heparin
A
Argatroban
B
Bivalirudin
Incorrect
Argatroban and bivalirudin (Angiomax) are FDA approved for use in patients at risk for HIT. Angiomax is mainly used for PCI.
AG is beginning warfarin therapy. She asks the pharmacist which foods are high in vitamin K. Which of the following foods are high in vitamin K? (Select ALL that apply.)
Answer
A Cauliflower B Canola and soybean oils C Broccoli and spinach D Fish and fish oils E Green and black tea
A Cauliflower B Canola and soybean oils C Broccoli and spinach
E
Green and black tea
Incorrect
It is important to counsel the patient to eat consistent amounts of vitamin K daily and avoid large, sudden changes in intake of foods rich in vitamin K. These food should not be eliminated from the diet, but consistency is very important.
