Anticoag

Question 1

What can increase bleed risk when given with anticoagulants?

Answer 1

NSAIDs, SSRIs, fish oil, garlic, ginger, ginkgo, ginseng, glucosamine, willow, grapefruit

Question 2

Heparin route of admin

Answer 2

IV or SubQ (NOT IM = hematoma)

Question 3

Heparin SE

Answer 3

increased AST, thrombocytopenia/HIT, bleeding

Question 4

Heparin antidote

Answer 4

Protamine

Question 5

Enoxaparin dosing

Answer 5

generally 1 mg/kg
QD for prevention
BID for treatment
renal dosing: 30 mg qd

Question 6

Enoxaparin antidote and monitoring

Answer 6

Protamine. Maybe monitor antiXa but not always req.

Question 7

Warfarin full effect in how many days?

Answer 7

6 days

Question 8

VItamin K effect on Warfarin

Answer 8

Vit K DECREASES Warfarin

decreases INR

Question 9

When to avoid Warfarin?

Answer 9

HIT patients, with Amiodarone or NSAIDs, CYP2C9 genetic variation or CYP3A4 interactions

Question 10

Warfarin antidote?

Answer 10

Vitamin K

Question 11

Warfarin INR goals

Answer 11

2-3 for normal range

2.5-3.5 for mitral valve pts

Question 12

Increased Bleed Risk with Warfarin

Answer 12

Amiodarone, Zafirlukast, Azoles, Bactrim, Macrolides(zpak), tetracycline, FQs, PCNs, etravirine

Question 13

Drugs that decrease INR

Answer 13

Carbamazepine, Phenytoin, Phenobarb, Rifampin, Aprepitant, St Johns, Primidone, vit K

Question 14

Black Box for Dabigatran or Bivlirudin

Answer 14

Epidural = hematoma = paralysis

Question 15

Pradaxa generic

Answer 15

Dabigatran

Question 16

What anticoagulant can HIT patients take?

Answer 16

IV Argatroban

and Fondaparinux

Question 17

Pradaxa antidote

Answer 17

Praxbind

Question 18

Argatroban antidote

Answer 18

NONE

Question 19

Dabigatran notes

Answer 19

BID for tx, QD for prevention. Pglycoprotein so avoid w/ carbamaz, rifamp, dexamethasone, St Johns

Question 20

Xarelto generic

Answer 20

Rivaroxaban

Question 21

Eliquis generic

Answer 21

Apixaban

Question 22

Savaysa generic

Answer 22

Edoxaban

Question 23

Arixtra generic

Answer 23

Fondaparinux

Question 24

Fondaparinux antidote and monitoring?

Answer 24

No antidote

Monitor platelets and antiXa

Question 25

Anticoag safe in pregnancy?

Answer 25

Fondaparinux

Question 26

What is HIT?

Answer 26

Unexplained 50% drop in platelets. Treat w/ vit K, D/C all heparins, start Argatroban. Wait for Warfarin until platelets come back up. (use together x 5 days)

Question 27

Antiplatelet therapies

Answer 27

(PO only) Plavix, Effient, Brillinta

Question 28

Plavix generic

Answer 28

Clopidogrel

Question 29

Effient generic

Answer 29

Prasugrel

Question 30

Brillinta generic

Answer 30

Ticagrelor (ok to crush, use in NG tube)

Question 31

CYP2C19 Med

Answer 31

Clopidogrel - requires this enzyme for activation

Question 32

Fatal SE of Clopidogrel

Answer 32

TTP = thrombotic thrombocytopenic purpura

Question 33

When to D/C anticoags vs antiplatelets before procedure

Answer 33

24 hrs for anticoag (Xarelto)

5 days for Plavix

Question 34

Downsides to Effient

Answer 34

More bleeding that Plavix. Can’t use in > 75 yo
no antidote (same for plavix)
Contra for TIA/past stroke

Question 35

IV Platelet Aggregation Inhibitors

Answer 35

Abciximab (Reopro) *irreversible
Eptifibatide (Integrilin)
Tirofiban (Aggrastat)

Question 36

Fibrinolytic Notes

Answer 36

STEMI only. IV only
*must get within 30 mins of heart attack/hospital arrival
Alteplase, Reteplase, Tenecteplase