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naplex test prep > Anticoagulation > Flashcards

Anticoagulation Flashcards

1
Q

Aransesp

A

darbepoetin alfa

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2
Q

Darbepoetin alfa side effects

A

Arthralgia, HTN, MI, stroke

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3
Q

Praxbind

A

Idarucizumab

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4
Q

Savaysa

A

Edoxaban

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5
Q

Dabigatran administration

A

Swallow with a full glass of water

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6
Q

UFH Monitoring

A

Hematocrit, hemoglobin, aPTT, platelets

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7
Q

HIT treatment

A

Discontinue heparin, if on warfarin - disconitnue and give vitamin K, start anti-thrombin (argatroban, bivalirudin)

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8
Q

Elemental iron in ferrous sulfate, ferrous sulfate (dried), and ferrous fumarate

A

20%, 30%, 33%

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9
Q

Antidote for iron overdose

A

IV deferoxamine or PO deferasirox (dexrazoxane is for doxorubicin)

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10
Q

Enoxaparin renal dosing

A

CrCl < 30 – daily dosing

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11
Q

Which IV iron formulation has highest risk of anaphylaxis?

A

Iron dextran

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12
Q

When to use warfarin over DOACs

A
  1. troke prevention in Afib if there is moderate-to-severe stenosis or a mechanical heart valve
  2. VTE treatment if the patient has antiphospholipid syndrome or a mechanical heart valve
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13
Q

Which warfarin enantomer is more potent and which enzyme is responsible primarily for its metabolism?

A

S-warfarin, CYP2C9

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14
Q

Which drugs are inducers of warfarin metabolism?

A

DECREASE INR: carbamazepine, phenobarbital, phenytoin, rifampin, SJW

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15
Q

Which drugs are inhibitors of warfarin metabolism?

A

INCREASE INR: amiodarone, fluconazole, metronidazole, Bactrim

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16
Q

How to bridge warfarin with heparin for acute DVT/PE?

A

Start warfarin on same day as heparin and continue both for at least 5 days, discontinue heparin once INR has been > 2 for 24 hours (2 levels)

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17
Q

How often to check INR in stable patients

A

Usually 4 weeks but if consistently stable, 12 weeks

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18
Q

Warfarin Colors

A

Please Let Greg Brown Bring Peaches To Your Wedding - pink, lavendar, green, brown, blue, peach, teal, yellow, white - 1, 2, 2.5, 3, 4 , 5, 6, 7.5, 10

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19
Q

Main interactions with factor Xa inhibitors

A

CYP3A4 inducers

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20
Q

Apixiban dosing

A

5 mg BID (afib), 10 mg BID x7d then 5 mg BID (DVT treatment)
2.5 mg BID if Scr > 1.5, age > 80 or weight < 60 (need 2)

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21
Q

Rivaroxaban dosing

A

15 mg BID x21d then 20 mg daily (treatment)
Avoid use if CrCl < 30

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22
Q

Rivaroxaban administration

A

Take with food, DO double up on doses

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23
Q

Edoxaban dosing

A

Do not use if CrCl > 95

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24
Q

UFH Dosing

A

5000 units SQ Q8-12H (VTE ppx)
80 units/kg IV bolus + 18 units/kg/hr (VTE treatment)
60 units/kg IV bolus + 12 units/kg/hr (STEMI/NSTEMI)

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25
Q

LMWH Dosing

A

30 mg BID or 40 mg daily (VTE ppx)
1 mg/kg Q12H (NSTEMI)
30 mg IV bolus (STEMI, age < 75)
0.75 mg/kg Q12H (STEMI, age > 75)
Do daily dosing if CrCl < 30

26
Q

UFH side effects

A

Bleeding, HIT, hyperkalemia

27
Q

LMWH side effects

A

Bleeding, HIT, anemia

28
Q

UFH monitoring

A

aPTT or anti-Xa 6 hr post infusion and Q6H after (goal 0.3-0.7)

29
Q

LMWH monitoring

A

Anti-Xa 4 hours post dose (only if pregnant, obese, low weight, renal dysfunction)

30
Q

Heparin reversal (and dosing)

A

Protamine
1 mg = 100 units UFH
1 mg = 1 mg LMWH

31
Q

Dabigatran reversal

A

Idarucizumab (Praxbind)

32
Q

Apixiaban/Rivaroxaban reversal

A

Andexanet alfa (Andexxa)

33
Q

Warfarin reversal parameters

A

INR < 4.5: skip warfarin
INR 4.5-10: skip 1-2 doses of warfarin
INR > 10: PO vitamin K
Any serious bleeding regardless of INR: IV vitamin K + Kcentra

34
Q

Warfarin bridging prior to surgery

A

Discontinue warfarin 5 days prior to surgery
Start heparin up until 24 hours prior (LMWH) or 4-6 hours prior (UFH) if high risk of thromboembolism
Restart warfarin 12-24 hours post-op

35
Q

Duration of VTE treatment

A

Provoked: 3 months
Unprovoked: AT LEAST 3 months
(can add aspirin when d/c’ing in these patients)

36
Q

Afib anticoagulation – undergoing cardioversion

A

Anticoagulation 3 weeks prior and 4 weeks aftter (if started > 48 hours prior or unknown duration)
Start anticoagulation upon presentation and continue after cardioversion for 4 weeks (if started < 48 hours prior)

37
Q

CHADS-VASc

A

CHF-1
HTN-1
Age 75 or older-2
Diabetes-1
Stroke-2
Vascular disease-1
Age 65 -74-1
Sex (female): 1
Score of at least 2 (don’t consider sex)

38
Q

HAS-BLED

A

HTN (SBP > 160)-1
Abnormal liver or kidney-1-2
Stroke-1
Bleeding tendency-1
Labile INR-1
Elderly (> 65)-1
Drugs (aspirin, NSAIDs)-1-2

39
Q

Conversion from warfarin to anti-xa or dabigatran (INR cut offs)

A

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

40
Q

PO iron administration

A

Take on an empty stomach, avoid H2RAs/PPIs

41
Q

Iron recommendation for pregnant women

A

All should take 30 mg/day

42
Q

What supplement helps iron absorption

A

Vitamin C (acidic environment)

43
Q

IV iron dose need to replenish iron stores

A

1000 mg

44
Q

IV iron appropriat for?

A

Hemodialysis, receiving ESAs, unable to tolerate PO, severe anemia (Hgb < 7), alternative to blood transfusion in those who can’t receive for religious reasons

45
Q

What anemic deficiency leads to neurologic symtpoms

A

Vitamin B12

46
Q

Pernicious anemia

A

Lifelong B12 replacement

47
Q

Causes of B12/folate anemia

A

Alcoholism, poor nutrition, GI disorders, pregnancy, long-term use of metformin, PPIs/H2RAs

48
Q

When to initiate ESA in anemia of CKD?

A

Hgb < 10

49
Q

Which ESA has a longer half-life

A

Darbepoetin

50
Q

Drugs to avoidf in G6PD deficiency

A

Dapsone, methylene blue, nitrofurantoin, primaquine, pegloticase, rasburicase, quinidine, quinine, sulfonamides

51
Q

Sickle cell RBC turnover

A

10-20 days

52
Q

Sickle cell - when to blood transfusion

A

Stroke, severe anemia, chest syndrome

53
Q

Goal hemoglobin with blood transfusion in sickle cell and why

A

No higher than 10 - can cause iron overload (treat with iron antidote deferasirox or deferiprone)

54
Q

Only cure for sickle cell

A

Bone marrow transplant

55
Q

Vaccines for children with sickle cell

A

Hib, pneumococcal, meningococcal

56
Q

Antibiotic prophylaxis in sickle cell

A

Birth to age 5: give penicillin (continue indefinitely if surgical removal of spleen or invasive pneumo infection despite antibiotics)

57
Q

Hydroxyurea MOA

A

stimulates production of fetal hemoglobin

58
Q

Indication for hydroxyurea

A

adults with 3 more more moderate-severe pain crises in 1 year

59
Q

Warnings with hydroxyurea

A

Myelosuppression, hazardous, teratogenic

60
Q

L-glutamine MOA

A

amino acid shown to reduce acute complications of sickle cell through oxidative stress

61
Q

Voxelotor MOA

A

inhibits HgbS polymerization

62
Q

Crizanlizumab MOA

A

inhibits adhesion of sickle RBCs to vessels

naplex test prep (12 decks)

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