ANTICOAGULANTS/ANTIPLATELETS Flashcards
warfarin antidote
Phytonadione (Vitamin K)
Heparin antidote
FFP (50% correction) protamine sulfate (1mg/100U of UFH in body)
*Warfarin DDI (inhibitors of 2C9)
amniodarone
metronidazole
bactrim
abx that effect gut flora (Vit K)
Who should not get anticoagulants?
active bleeding
GI or variceal bleed
aortic dissection ("sharp tearing sensation, radiates to back")Monitoring for warfarin and goal
INR 2-3 (some pts 2.5-3.5)
Monitoring for UFH
aPTT (goal 1.5-2 x normal)
How long does it take most patients to achieve basic INR goal of 2-3 on warfarin?
5-7 days
Preferred route: Warfarin
SQ or PO No IV (risk of anaphylaxis)
Warfarin - SE
warfarin induced skin necrosis
bleeding
Warfarin - food interactions
green, leafy veggies
Preferred anticoagulant pregnancy?
heparin
Which anticoagulant monitor PLT?
UFH and LMWH
indication for ASA in peds
kawasaki syndrome
ASA - SE
bleeding ulcer asthma exacerbation (if samter's triad - asthma + nasal polyps + allergies) Reye's syndrome (kids with viral) toxicity - Acid base disturbances
Reye’s syndrome signs
Starts 3-5 days after ASA + virus persistent vomiting sleepiness disorientation seizures LOC
*Warfarin DDI - s isomer vs r isomer
s isomer -> CYP2C9
r isomer -> CYP3A4
*LMWH dosing in mg or mg/kg
lovenox
Can you give Warfarin for active clot?
No, must give UFH or LMWH first
UFH indication
DVT prophylaxis
UFH goal
PTT 1.5-2 x normal
What if PTT does not increase on UFH?
consider anti-thrombin deficiency and UFH will not work
Heparin (LMWH or UFH) - reversal
FFP (50% correction) Protamine sulfate (1 mg neutralizes 100U UFH)
Lovenox - CrCl consideration
if CrCl <30mL/min, give qd instead of bid
HIT - treatment
Stop UFH or LMWH and give one of the following until Plt >100:
Fondaparinux (not FDA approved but common)
Direct Thrombin Inhibitor (DTI)
