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Pharmacy Practice 5 > Anticoags > Flashcards

Anticoags Flashcards

1
Q

identify each scoring category of a CHADS-VASc score

A

CHF: 1
HTP: 1
75 or over: 2
Diabetes: 1
Stroke/transient ischaemic attack/thromboembolism: 2
vascular disease (prior MI, peripheral artery disease or aortic plaque): 1
age 65-74: 1
if female: 1

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2
Q

what is HAS-BLED used for?

A

risk of treating with an anticoagulant
HTP (non-controlled)
Abnormal renal function
abnormal liver function
stroke
bleeding tendency
labile INRs
elderly (over 65)
drugs
alcohol:

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3
Q

what is a reversal agent of warfarin?

A

give vitamin K

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4
Q

what is a reversal agent for Savaysa, Eliquis, and Xarelto?

A

Endexa

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5
Q

what is a reversal agent for Pradaxa?

A

praxbind

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6
Q

what is “bridging” and how does it relate do warfarin treatment?

A

bridging is when you put a pt on another drug until the first drug reaches full effect. Warfarin takes time to reach full effect, so another anticoag can be given until it does

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7
Q

what is Pradaxa’s dosage for nonvalvular a fib? what about venous thromboembolism (VTE)? VTE prophylaxis?

A

150mg bid
parental anticoag for 5-10 days, then 150mg bid
110mg for 1st day, then 220mg qd

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8
Q

what is Eliquis’s dosage for nonvalvular a fib? what about venous thromboembolism (VTE)? VTE prophylaxis?

A

5mg bid
10mg bid for 1 wk, then 5mg bid
2.5mg bid

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9
Q

what is Xarelto’s dosage for nonvalvular a fib? what about venous thromboembolism (VTE)? VTE prophylaxis?

A

20mg qd with evening, fatty meal
15mg bid with food for 3 wks, then 20mg qd with food
10mg qd with largest meal of the day

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10
Q

what is Savaysa’s dosage for nonvalvular a fib? what about venous thromboembolism (VTE)? VTE prophylaxis?

A

60mg qd
parental coag for 5-10 days, then 60mg qd
not used

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11
Q

when should we not use Savaysa and why?

A

in pts with a CrCl less than 95 because of increased risk of ischemic stroke

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12
Q

Which anticoags require renal dose adjustment?

A

pradaxa and xarelto

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13
Q

when does dose of eliquis require reduction?

A

patients 80 or older, body weight 60kg or less, or serum creatinine 1.5 or more

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14
Q

what is pradaxa’s generic name?

A

dabigatran

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15
Q

what is eliquis’s generic name?

A

apixaban

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16
Q

what is Xarelto’s generic name?

A

rivaroxaban

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17
Q

what is Savaysa’s generic name?

A

edoxaban

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18
Q

what are the FAB Four drug-drug interactions with Warfarin?

A

Flagyl, amiodarone, bactrim, and fluconazole

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19
Q

what is warfarin’s therapeutic range?

A

usually 2-3

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20
Q

what is INR?
what is normal INR?

A

it is a calculation based on prothrombin time which measures how long it takes for a clot to form
INR=1

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21
Q

for a patient with A-fib starting on Warfarin, what is the duration of treatment? what is goal INR range?

A

lifetime
2-3

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22
Q

for a patient with a bioprosthetic valve replacement starting on Warfarin, what is the duration of treatment? what is goal INR range?

A

3 months
2-3

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23
Q

for a patient with a mechanical valve replacement starting on Warfarin, what is the duration of treatment? what is goal INR range?

A

lifetime
2.5-3.5

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24
Q

T/F valve replacement drug treatment includes Warfarin, DOACs, and/or aspirin

A

False, only Warfarin

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25
Q

for a patient with VTE (DVT or PE) starting on Warfarin, what is the duration of treatment? what is goal INR range?

A

usually 3 months
2-3

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26
Q

for warfarin dosing, what does it mean when INR is too low and what do we do?

A

it means blood is clotting too fast and the risk of clotting is too high, so warfarin dose needs to be increased

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27
Q

for warfarin dosing, what does it mean when INR is too high and what do we do?

A

it means blood is clotting too slow and the risk of bleeding is too high, so warfarin dose needs to be decreased

28
Q

If a pt is on warfarin, what is the adjustment/period to recheck INR for the following INR values:
<1.5
1.5-1.9
2-3
3.1-3.9
4-4.9
5 or higher

A

<1.5: inc weekly dose 10-20%, consider extra dose, check back in 4-8 days
1.5-1.9: increase weekly dose by 5-10%, check back in 7-14 days
2-3: no change required, check number of consecutive in-range INRs for 1 week for up to 6-8 weeks
3.1-3.9: decrease weekly dose by 5-10%, check back in 7-14 days
4-4.9: hold 0-2 doses, decrease weekly dose by 10-20%, check back in 4-8 days
5 or higher: assess risk of bleed

29
Q

if a patients INR on warfarin is 1.8-1.9, what is the recommendation? what about 3.1-3.2?

A

for both situations: consider no change and repeat INR in 7-14 days

30
Q

Vitamin K can be used to manage warfarin-associated bleeding or bleeding risk. what do we do in regards to vitamin K administration in the following situations:
Serious or life-threatening bleeding
INR > 10 without bleeding
INR 4.5-10 without bleeding
INR < 4.5 without bleeding

A

Serious or life-threatening bleeding: 10mg IV vit K
INR > 10 without bleeding: 2.5-5mg oral vit K
INR 4.5-10 without bleeding: optional: 1-2.5mg vit K
INR < 4.5 without bleeding: no vit K indicated

31
Q

if INR over 5 with warfarin, when should the pts INR be rechecked?

A

within 3 days

32
Q

when should INR be rechecked after administering vit K?

A

the next day

33
Q

if pt is using warfarin and a parenteral anticoag, when should INR be checked and for how long?

A

daily starting the 3rd day until INR is 2 or more

34
Q

for the first 3 months of warfarin therapy, routine INR monitoring should not be longer than?

A

6 weeks

35
Q

for pts stable on warfarin for at least 3 months, we can check INR at intervals of?

A

6-8 wks

36
Q

what is Virchow’s triad describing risk factors for VTE?

A

reduced blood flow, blood vessel injury, and increased coaguability

37
Q

what are the effects of a pulmonary embolism?

A

chest pain, SOB, tachypnea (rapid breathing), tachycardia, hemoptysis (coughing up blood), and cyanosis (lack of oxygenation)

38
Q

how do we diagnose a pulmonary embolism?

A

-positive D-dimer test (degradation product formed when cross-linked fibrin is broken down by plasmin
- CTPA
-compression ultrasound
-ventilation-perfusion scans

39
Q

what is the PERC criteria?

A

pulmonary embolism rule-out criteria: 8 variables used, if none are positive its likely pt doesn’t have a PE

40
Q

what is the Wells Criteria?

A

used to assess the likelihood of PE or DVT,

41
Q

what are the pharmacologic treatments of VTE?

A

heparin/low molecular weight heparin
fondaparinux
warfarin
DOACs

42
Q

*** know how to calculate a heart rate using the box method!

A
43
Q

what does INR stand for?

A

international normalized ratio

44
Q

what does PT stand for?

A

prothrombin time

45
Q

what does PTT stand for?

A

partial thromboplastin time

46
Q

what does SVT stand for?

A

supraventricular tachycardia

47
Q

what does CABG stand for?

A

coronary artery bypass graft

48
Q

what does PCI stand for?

A

percutaneous coronary intervention

49
Q

what does PAD stand for?

A

peripheral artery disease

50
Q

what does PVD stand for?

A

peripheral vascular disease

51
Q

what does VTE stand for?

A

venous thromboembolism

52
Q

define cardiac output

A

mount of blood pumped out by the ventricles within a given time

53
Q

define stroke volume

A

volume of blood ejected with each heartbeat

54
Q

define preload

A

volume of blood in that stretches ventricles at the end of diastole and just before systole

55
Q

define afterload

A

amount of vascular resistance to ventricular contraction

56
Q

define atherosclerosis

A

Hardening of the arteries caused by a buildup of plaque

57
Q

define erythrocytes

A

RBCs

58
Q

define Erythrocytopenia

A

Low red blood cell count

59
Q

define Erythrocytosis

A

High red blood cell count

60
Q

define Thrombocytes

A

platelets

61
Q

define Thrombocytopenia

A

Low platelet count

62
Q

define Thrombocytosis

A

High platelet count

63
Q

define Leukocytes

A

White blood cells

64
Q

define Leukocytosis

A

High white blood cell count

65
Q

define Leukocytopenia

A

Low white blood cells

66
Q

define Hematology

A

The study of blood & blood disorder

67
Q

define embolus

A

A moving blood clot

Pharmacy Practice 5 (8 decks)

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