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My own Naplex > Anticoagulation > Flashcards

Anticoagulation Flashcards

1
Q

Which factors does warfarin inhibit

A

2, 7, 9, 10

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2
Q

Which are the direct xa inhibitors?

A

DOACS

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3
Q

What does fondaparinux inhibit?

A

Antithrombin which indirectly inhibits xa

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4
Q

What does UFH inhibit

A

antithrombin which then inactivates thrombin (factor 2a) and 10a

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5
Q

what does LMWH inhibit

A

smaller so more xa than antithrombin but both

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6
Q

What are the direct thrombin inhibitors?

A

argatroban, bivalirudin, dabigatran

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7
Q

Heparin VTE tx and prophylaxis dosing

A

Prophylaxis: 5000 units q8-12h

Treatment: 80 units/kg bolus then 18 units/kg/hr

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8
Q

Heparin ACS/STEMI dosing

A

lower than vte; 60 units/kg IV bolus then 12 units/kg/hr

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9
Q

Which meds are dosed via IBW if obese

A

acyclovir, aminophylline, levothyroxine

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10
Q

Which meds are does via IBW regardless of obesity

A

theophylline

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11
Q

Which meds are does via adjusted body weight if obese

A

Aminoglycosides

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12
Q

What is HIT defined as?

A

Unexplained drop in platelet 50% from baseline

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13
Q

What is the warfarin tablet color pneumonic

A 
Please - pink 1
Let - Lavender 2
Greg- Green 2.5
Brown - Brown/Tan 3
Bring - Blue - 4
Peaches - Peach 5
To - Teal - 6
Your - Yellow 7.5
Wedding - White 10
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14
Q

Starting doses for warfarin

A

Healthy give 10mg for 1st 2 days, in elderly start less then 5

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15
Q

What is used to reverse UFH/LMWH and dosing

A

protamine.

  • UFH: 1 mg reverses 100 units with a max of 50mg. Reverse the amount given in the last 2 hours.
  • LMWH - 1 mg per 1 mg of lovenox
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16
Q

dabigitran reversal agent

A

praxbind/Idrucizumab

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17
Q

Apixaban and rivaraxoban reversal agent

A

andexanet alpha/Andexxa

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18
Q

Warfarin reversal

A

vitk or phytonadione (Mephyton), Kcentra (four factor prothrombin complex concentrate, novosevenRT/Factor VIIa recombinant

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19
Q

CHA2DS2VASC meaning

A 
C- CHF
H - HTN
A - Age > 75 --2
D - Diabetes
S2 - Stroke/TIA -2
V - Vascular Disease
A - Age 65-74
S - Sex = female
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20
Q

CHADS2 interpretatioin

A

No anticoag recomended if 0 in males or 1 in females. Maybe give anticoag if 1 in males or 2 in females. If greater than that for sure give oral coag.

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21
Q

What anti coag can you give in pregnancy

A

LMWH over UFH

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22
Q

Lovenox generic and MOA

A

Enoxaparin

  • low molecular weight heparin
  • binds to Antithrombin which inactivates xa and IIa but prefers xa
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23
Q

eliquis

A

apixaban

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24
Q

xarelto

A

rivaroxaban

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25
Q

apixaban dosing

A

afib: 5mg bid UNLESS older than 80, BW <60kg, or SCR >1.5 then half dose

DVT tx: 10mg po bid x 7 then 5mg po bID

26
Q

Rivaroxaben dosing

A

take with food, if for afib with evening meal

DVT tx: 15mg PO BID x 21, then 20mg PO daily

27
Q

Which DOACS have renal function contraindications?

A

Rivaroxaban: If CrCL < 30 then avoid use

Edoxaban: If CrCL <95 then avoid use

28
Q

Heparin monitoring and frequency of labs and interpretation of monitoring labs

A

aptt or antixa 6 hours after initiation then every 6 hours until therapeutic

aptt is 1.5 - 2.5 control

29
Q

What to stop if HIT occurs

A

warfarin, all heparins

30
Q

what platelet count may you resume warfarin if HIT occurs?

31
Q

What is a good choice for HIT?

A

Argibotran, Bivalirudin

direct thrombin inhibitors

32
Q

Pradaxa

A

dabigitran

33
Q

Angiomax

A

Bivalirudin

34
Q

What should be used in prosthetic heart valve

35
Q

Which is the SUBQ 10a inhibitor

A

Fondaparinux

36
Q

Dabigitran Side effects

A

Dyspepsia, gastritis like symptoms

37
Q

dabigatran storage

A

original container, must use within 4 months

38
Q

dabigitran administration

1) take within how many hours of next dose
2) how long after iv anticoag
3) can you crush?

A

must take within 6 hours of next scheduled dose, start 5-10 days after parenteral (IV) anticog, swallow capsules whole no NG tube

39
Q

warfarin contraindications and warnings

A

contraindications: Pregnancy (unless mechanical heart valve)
warnings: tissue necrosis/gangrene

40
Q

3a4 inducers

A

PS PORCS

phenytoin, smoking, phenobarbital, oxcarbazepine/triptal, rifampin, carbamexapine/tegratol, st. john’s wort

41
Q

3a4 inhibitors

A

PACMAN G

PI, azoles, cyclosporine/neoral, cimetidine, cobistat, macrolides (clarithromycin and arithromycin), amiodarone, nondhp CCB (diltiazem and verapamil)

42
Q

CYP 1A2 substrate

A

warfarin R (also 3a4), theophylline

43
Q

CYP 2c9 substrate

A

warfarin s

44
Q

important c29 inducer

A

rifampin (pretty much PSPORCS works here too)

45
Q

Important 2c9 inhibitors

A

M - Metranidazole, macrolides
A - Amiodarone, Azoles
T - TMP/SMX

46
Q

apixaban and rivaroxaban are substrates of what

A

pgp and cyp3a4

47
Q

coumadin

A

warfarin (1/2)

48
Q

Jantoven

A

Warfarin (2/2)

49
Q

what drug to drop warfarin dose

A

amiodarone, decrease dose by 30-50%

50
Q

How long do you bridge warfarin for

A

5 days and then until inr >2 for 24 hours

51
Q

Once INR is stable how often do you test?

A

every 12 weeks

52
Q

phytodione

53
Q

mephyton

A

vitamin k or phytonadione

54
Q

vitamin k boxed warning and side effects

A

hypersensitivity reactions, possible anaphylaxis

55
Q

If the INR is <4.5 but above therapeutic range what do you do

A

skip or reduce dose and monitor

56
Q

If INR is between 4.5 and 10 but there is no bleeding what do you do

A

give oral vitamin k and hold

57
Q

If patient is bleeding regardless of INR

A

give slow IV warfarin and PCC

58
Q

How long to stop warfarin before surgery and after

A

5 days before, 12-24 hours after, may bridge

59
Q

how long to treat for VTE

A

3 months if caused by any of the reversable risk factors

60
Q

preferred tx in cancer patients

61
Q

If someone has had afib for more than 48 hours give anticoag for how long before and after cardioversion

A

3 weeks prior to, 4 weeks after while in NSR

My own Naplex (39 decks)

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