ANTICOAGULANTS/ANTIPLATELETS

Question 1

warfarin antidote

Answer 1

Phytonadione (Vitamin K)

Question 2

Heparin antidote

Answer 2

FFP (50% correction)
protamine sulfate (1mg/100U of UFH in body)

Question 3

*Warfarin DDI (inhibitors of 2C9)

Answer 3

amniodarone
metronidazole
bactrim
abx that effect gut flora (Vit K)

Question 4

Who should not get anticoagulants?

Answer 4

active bleeding
GI or variceal bleed
aortic dissection ("sharp tearing sensation, radiates to back")

Question 5

Monitoring for warfarin and goal

Answer 5

INR 2-3 (some pts 2.5-3.5)

Question 6

Monitoring for UFH

Answer 6

aPTT (goal 1.5-2 x normal)

Question 7

How long does it take most patients to achieve basic INR goal of 2-3 on warfarin?

Answer 7

5-7 days

Question 8

Preferred route: Warfarin

Answer 8

SQ or PO
No IV (risk of anaphylaxis)

Question 9

Warfarin - SE

Answer 9

warfarin induced skin necrosis

bleeding

Question 10

Warfarin - food interactions

Answer 10

green, leafy veggies

Question 11

Preferred anticoagulant pregnancy?

Answer 11

heparin

Question 12

Which anticoagulant monitor PLT?

Answer 12

UFH and LMWH

Question 13

indication for ASA in peds

Answer 13

kawasaki syndrome

Question 14

ASA - SE

Answer 14

bleeding
ulcer
asthma exacerbation (if samter's triad - asthma + nasal polyps + allergies)
Reye's syndrome (kids with viral)
toxicity - Acid base disturbances

Question 15

Reye’s syndrome signs

Answer 15

Starts 3-5 days after ASA + virus
persistent vomiting
sleepiness
disorientation
seizures
LOC

Question 16

*Warfarin DDI - s isomer vs r isomer

Answer 16

s isomer -> CYP2C9

r isomer -> CYP3A4

Question 17

*LMWH dosing in mg or mg/kg

Answer 17

lovenox

Question 18

Can you give Warfarin for active clot?

Answer 18

No, must give UFH or LMWH first

Question 19

UFH indication

Answer 19

DVT prophylaxis

Question 20

UFH goal

Answer 20

PTT 1.5-2 x normal

Question 21

What if PTT does not increase on UFH?

Answer 21

consider anti-thrombin deficiency and UFH will not work

Question 22

Heparin (LMWH or UFH) - reversal

Answer 22

FFP (50% correction)
Protamine sulfate (1 mg neutralizes 100U UFH)

Question 23

Lovenox - CrCl consideration

Answer 23

if CrCl <30mL/min, give qd instead of bid

Question 24

HIT - treatment

Answer 24

Stop UFH or LMWH and give one of the following until Plt >100:
Fondaparinux (not FDA approved but common)
Direct Thrombin Inhibitor (DTI)

Question 25

Risk factors - HIT

Answer 25

>5x greater risk:
UFH > LMWH
>4 days of exposure
within last 30 days 
treatment > prophylaxis
postop > ortho/vascular (3-5 x greater)
female > male (1-3x greater)