Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NAPLEX STUDY > Anticoagulation > Flashcards

Anticoagulation Flashcards

1
Q

UFH

A

binds to antithrombin and block factor Xa and IIa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

LMWH

A

binds to antithrombin and blocks factor Xa and IIa with more Xa blocking than IIa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Direct thrombin inhibitors: IV (argatroban and bivalirudin) PO (dabigatran)

A

directly blocks thrombin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Direct factor Xa inhibitors (rivaroxaban, apixiban, edoxaban)

A

directly blocks factor xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Indirect factor Xa inhibitor: fondaparinux

A

binds to antithrombin to block factor xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

warfarin

A

inhibits factors II, VII, IX, and X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

DOACs vs Warfarin

A

-DOACs have less drug interactions, less bleeding, and shorter DOA than warfarin
- DOACs are adjusted based on kidney/liver function and not INR
-DOACs are preferred for stroke prevention in AF - unless there is mitral stenosis or MVR
-DOACs are preferred for VTE tx unless patient has antiphospholipid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Vitamin K

A

vitamin K is required for the activation of clotting factors II, VII, IX, and X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

antithrombin (AT)

A

inactivates thrombin (factor IIa) and other proteases (like factor Xa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

hematuria

A

blood in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

hematemesis

A

blood in vomit caused by bleeding from the GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

UFH: ppx VTE

A

5000 IU SQ Q8-12H

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

UFH: tx of VTE

A

80 IU/kg IV bolus; 18 IU/kg/hr infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

UFH: tx of ACS/STEMI

A

60 IU/kg IV bolus; infuse 12 IU/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

UFH dosing

A

use TBW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

UFH: aPTT/anti-Xa monitoring

A

check 6 hours after initiation and every 6 hours until therapeutic, then every 24 hours and with every dose change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

UFH: aPTT/anti Xa therapeutic range

A

-aPTT: 1.5-2.5 x control
-anti Xa: 0.3-0.7 IU/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

HIT

A

PLT decrease > 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

heparin antidote

A

protamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

heparin lock flushes

A

used to keep IV lines open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

LMWH: ppx VTE

A

30 mg SC Q12H or 40 mg SC daily
-CrCl < 30 mL/min: 30 mg SC daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

LMWH: tx of VTE and UA/NSTEMI

A

1 mg/kg SC Q12H or 1.5 mg/kg SC daily (only for inpatient VTE tx)
-CrCl < 30 mL/min: 1 mg/kg SC daily
-use TBW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

LMWH: tx of STEMI in patients < 75 YOA

A

-30 mg IV bolus + 1 mg/kg SC dose followed by 1 mg/kg SC Q12H
-CrCl <30 mL/min: 30 mg IV bolus plus a 1 mg/kg SC dose then followed by 1 mg/kg SC daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

LMWH: tx of STEMI in patients < 75 YOA

A

0.75 mg/kg SC Q12H with no bolus - max of 5 mg for the first two SC doses only
-CrCl < 30 mL/min: 1 mg/kg SC daily with no bolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

LMWH safety

A

-neuraxial anesthesia (epidural, spinal) are at risk of hematoma and subsequent paralysis
-do not use in HIT
-Anti-Xa level recommended in pregnancy
-monitoring may be done in obesity, LBW, and renal insufficiency
-do not expel air bubble from syringe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

when to obtain peak in enoxaprin monitoring

A

peak anti-Xa levels 4 hours post SC dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

LMWH antidote

A

protamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

management of HIT

A
  1. stop all forms of heparin and LMWH - if on warfarin d/c warfarin and administer vitamin K
  2. use rapid acting non-heparin anticoagulants (argatroban)
  3. do not start warfarin therapy until the platelets have recovered to > 150K
  4. if urgent cardiac surgery or PCI is required - use bivalirudin
29
Q

Apixaban: nonvavular AF

A

5 mg PO BID
-unless > 80 YOA, BW < 60 kg, or SCr > 1.5 mg/dL, then give 2.5 mg BID

30
Q

Apixaban: tx of DVT/PE

A

initial: 10 mg PO BID x7 days then 5 mg PO BID
- can give 2.5 mg PO BID after least 3 months of initial tx dosing

31
Q

Apixaban: ppx DVT

A

2.5 mg PO BID x12 days after knee or x35 days after hip; give first dose 12-24 hrs after surgery

32
Q

rivaroxaban (xarelto)

A

doses > 15 mg must be taken with food

33
Q

rivaroxaban: nonvalvular AF

A

CrCl > 50: 20 mg QD with evening meal
15-50: 15 mg QD with evening meal

34
Q

Rivaroxaban: tx of DVT/PE

A

-initial: 15 mg PO BID x21 days, then 20 mg PO QD with food
-avoid use in CrCl < 30

35
Q

edoxaban

A

do not use in those with non-valvular AF and CrCl > 95 mL/min
-reduced efficacy

36
Q

antidote for apixiban and rivaroxaban

A

andexanet alfa

37
Q

fondaparinux

A

contraindicated in those with CrCl <30 mL/min

38
Q

converting from warfarin to another oral anticoagulant, stop warfarin and convert to:

A

-Rivaroxaban when INR < 3
-Edoxaban when INR < 2.5
-Apixaban when INR < 2
-Dabigatran when INR < 2

39
Q

From DOACs to warfarin

A

stop DOAC and start parenteral anticoagulant and warfarin at the next scheduled dose

40
Q

from dabigatran to warfarin

A

start warfarin 1-3 days before stopping dabigatran

41
Q

dabigatran and parenteral anticoagulant

A

always bridge with parenteral anticoagulants for 5-10 days if used for treatment (not needed for ppx)

42
Q

antidote for argatroban and bivalirudin

A

no antidote

43
Q

warfarin and pregnancy

A

contraindicated unless they have mechanical valve

44
Q

CYP2C9*2 or *3 alleles and/or polymorphisms of VKORC1 in warfarin

A

increase risk of bleeding

45
Q

goal INRs

A

-most 2-3
-2.5-3.5 for mechanical heart valve

46
Q

S-warfarin

A

3-5 times more potent than R-warfarin

47
Q

carbamazepine, phenobarbital, phenytoin, rifampin, st. johns

A

decrease INR

48
Q

amiodarone, azole antifungals, flagyl, and bactrim

A

increase INR

49
Q

warfarin and amiodarone

A

when starting amiodarone decrease the dose of warfarin by 30-50%

50
Q

warfarin and tamoxifen

A

avoid use

51
Q

Please Let Greg Brown Bring Peaches To Your Wedding

A

Pink - 1 mg
Lavender - 2 mg
Green - 2.5 mg
Brown/Tan - 3 mg
Blue - 4 mg
Peach - 5 mg
Teal - 6 mg
Yellow - 7.5 mg
White - 10 mg

52
Q

foods high in vitamin k

A

spinach, broccoli, brussel sprouts, cabbage, beef liver, kale

53
Q

increases bleeding risk with warfarin

A

garlic, ginkgo, ginseng, glucosamine, vitamin E, high dose fish oils, willow bark, and wintergreen

54
Q

decrease effectiveness of warfarin

A

st. johns wart

55
Q

protamine for UFH reversal

A

1 mg will reverse 100 units of heparin
-reverse amount given in the last 2-2.5 hours; max dose 50 mg

56
Q

protamine for LMWH reversal

A

1 mg per 1 mg of enoxaprin

57
Q

dabigatran reversal

A

idarucizumab (praxbind)

58
Q

K centra

A

factors II, VII, IX, X, Protein C, Protein S
-administer with vitamin K

59
Q

INR above therapeutic range but < 4.5 w/out bleeding

A

reduce or skip warfarin dose, monitor INR

60
Q

supratherapeutic INR of 4.5-10 without bleeding

A

-routine vitamin K is not recommend
-hold 1-2 doses of warfarin
-resume warfarin at lower dose when INR is therapeutic

61
Q

INR > 10 without bleeding

A

-hold warfarin
-oral vitamin K 2.5-5 mg
-resume dose when INR is therapeutic

62
Q

major bleeding

A

-hold warfarin
-give vitamin K 5-10 mg by slow IV injection and four-factor prothrombin complex concentrate (PCC)

63
Q

peri-operative anticoagulant management

A

stop warfarin approx 5 day before major surgery
-those mechanical valve, AF or VTE at high risk for thromboembolism, bridge with LMWH or UFH
-d/c therapeutic LMWH 24 hrs before surgery

64
Q

VTE: those without cancer

A

dabigatran and other DOACs are preferred over warfarin for the first 3 months

65
Q

VTE: those with cancer

A

DOACs are preferred

66
Q

AF > 48 hr

A

anticoagulate for at least 3 weeks prior to and 4 weeks after cardioconversion

67
Q

AF < 48 hr

A

start full therapeutic anticoagulation, preform cardioversion, and continue full anticoagulation for at least 4 weeks

68
Q

CHA2DS2-VASc

A

estimate risk of stroke in AF

69
Q

HAS-BLED

A

bleeding risk

NAPLEX STUDY (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions