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NAPLEX > Anticoagulation > Flashcards

Anticoagulation Flashcards

B/G, Indication, MOA. Facts

1
Q

Heparin

MOA

Prophy

Txt of VTE and ACS

Antidote

SE

Monitoring

A

MOA: binds to AT then inactivates thrombin factor 2a and 10a. prevent fibrin conversion.

Prophy: 5k sc q8-12

Txt VTE: 80u/kg bolus then 18 u/kg infusiob

TxtACS: 60u/kg bolus then 12u/kg infusion

Antidote: Protamine (1mg will reverse 100u. max 50mg)

SE: Bleeding, Thrombocytopenia, HIT, Hyper K, osteoporosis (long term)

Monitor: aPTT q 6 hrs (1.5x - 2 control) or anti-Xa, Plt, Hgb, Hct

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2
Q

Enoxaparin

Brand

BBW

MOA

Prophy

Txt of VTE

SE:

Monitor

A

Brand: Lovenox

Boxed warnings: spinal puncture; risk of hematomas and paralysis

MOA: binding to AT and have a greater affinity to Xa than 2a

Prophy: 30mg sc q 12h or 40mg qd (Crcl less than 30: 30mg SC qd)

Txt of VTE: 1mg/kg sc q 12 or 1.5mg/kg sc qd (CrCl less than 30: 1mg/kg sc qd)

SE: bleeding, thrombocytopenia, HyperK, Increase LFTs

Monitor: Scr Anti-Xa (in pregnancy)

Antidote: Protamine
DO NOT EXPEL THE AIR BUBBLES

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3
Q

Deltaparin

Brand?
MOA

A

Fragmin

MOA: binding to AT and have a greater affinity to Xa than 2a

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4
Q

HIT

A

Can lead to a prothrombotic state.

Dx: unexplained drop in PLT (50% from baseline)

Stop all forms of heparins; stop warfarin and start vit K)

Start argatroban

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5
Q

Apixaban

Brand, BBW, MOA, Afib, Txt of DVT/PE, warning

A

B: Eliquis

BBW: risk of hematomas and paralysis with spinal puncture (ALL direct Xa inhibitors); risk of thrombotic events with premature d/c

Warning: not recommended in prosthetic heart valve. (Use warfarin)

MOA: Direct Xa inhibitor

Afib: 5mg BID; Unless pt is 2 of 3: over 80, under 60kg, or SCr 1.5 then 2.5 BID

Txt of DVT/PE: 10mg BID x 7d then 5mg BID

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6
Q

Betrixaban

Brand, indication, warning

A

Brand: Bevyxxa

Warning: not recommended in prosthetic heart valve. (Use warfarin)

indicated for prophylaxis of DVT prophy in hospital and extended care

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7
Q

Edoxaban

Brand, warning, Afib dosing

A

Brand: Savaysa

BBW: reduce efficacy in CrCl greater than 95 ml/min

Warning: not recommended in prosthetic heart valve. (Use warfarin)

AAfib: CrCl over 95; do not use
51-95: 60mg qd
15-50: 30mg qd
less than 15 do not use

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8
Q

Rivaroxaban

Brand, Afib, DVT, Missed dose, DI

A

Xarelto, Xarelto Starter pack (use for DVT txt)

doses above = to or above 15 take with food

Afib: CrCl> 50ml/min; 20mg qd WITH FOOD
15-50: 15mg qd WITH FOOD

Txt of DVT/PE: 15mg po BID x 21 days then 20mg qd.

BID Missed dose: if taking 15mg BID then ta)ke both as soon as you remember then resume.

DI: A major 3A4 substrate and p-gp

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9
Q

Fondaparinux

Brand; Contraindication

A

Arixtra

CrCl less than 30: do not use

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10
Q

Conversion between AntiCoag

A

going from warfarin to another Anticoag:

R: Rivaroxaban when INR is less than 3
E: Edoxaban when INR is less than 2.5
A: Apixaban when INR is less than 2
D: Dabigatran when INR is less than 2

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11
Q

Dabigatran

brand, afib, se, antidote, counseling point

A

Pradaxa
MOA: Direct 2a inhibitor

afib: 150mg BID
15-30 crcl: 75mg bid
less than 15 do not use.

SE: gastritis-like symptoms

Antidote: Praxabid (Idarucizumab)

CP: Take with full glass of water! KEEP IN OG CONTAINER IF dose is less than 6 h skip

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12
Q

Argatroban

Indication, MOA

A

Indication: HIT or PCI at risk for HIT

MOA: Direct thrombin inhibitor

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13
Q

Bivalirudin

Brand, indication MOA

A

Angiomax

Indication: ACS undergoing PCI (preferred if undergoing cardiac surgery)

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14
Q

Desirudin

Brand, Indication

A

Iprivask

VTE prevention after hip arthrolplasty

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15
Q

Warfarin

Brand, MOA, active enatiomer, SE

A

Coumadin, Jantoven

MOA: competitively inhibit VKORC1 to decrease SNOT and protein C&S

S-enatiomer more potent

SE: skin tecrosis, Purple toe syndrome
Highly protein bound 99%

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16
Q

Warfarin

Dosing, Warnings, Goal Antidote

A

Healthy pt: 10mg qd x 2 days then adjust

start 5mg or less in: Elderyl, 3a4 inhibitors, liver disease, HF, malnorished.

warnings: HIT (contraindicated as monotherapy in HIT) Presence of 2C92/3 or polymorphism of VKORC1

INR: 2-3 ;2.5-3.5 for mechanical mitral valve or 2 mechanical heart valve

antidote vit k

17
Q

Warfarin color

A 
Pink 1mg
Lavender 2mg
Green 2.5mg
Brown 3mg
Blue 4mg
peach 5mg
Teal 6mg
yellow 7.5 mg
white 10mg
18
Q

5 G’s that increases bleeding risk

A

Garlic, Ginseng, ginko, ginseng, glucosamine

19
Q

Warfarin use in DVT

A

Begin warfarin with parenteral anticoag for a min of 5 days AND until INR is greater than 2 for at least 24 hours

20
Q

Protamine

A

1mg will reverse 100u of heparin

21
Q

Idarucizumab

brand, use

A

Praxabind

pradaxa antidote

22
Q

Vitamine K/Phytonadione

Brand, SE, SC, IM

A

Mephyton
SE: Anaphylaxis
SC route not recommended due to variable absorption
IM route causes hematoma

23
Q

Four Factor Prothrombin Complex Concentrate

Brand, Factors, coadmin with?

A

kCENTRA
Has factors SNOT and protein C&S

Admin Vit K at the same time

24
Q

Factor 7a recombinant

A

NovoSeven RT

25
Q

Vit K use

A

INR above 4.5 reduce or skip warfarin dose

4.5-10 w/o bleeding: Hold 1 - 2 doses of warfarin

10 w/o bleeding: Hold warfarin. Give ORAL vit K 2.5 - 5mg

Major bleeding from warfarin: Hold warfarin.. Give Vit K 5 - 10mg by SLOW IV and Kcentra

26
Q

bridging therapy

A

means stop warfarin therapy and using LMWH or UFH for short period to prevent clotting

27
Q

VTE Risk factors

A

Surgery, Immobility, Cancer/chemotherapy, pregnacy, ESA, Estrogen, hx of VTE, major trauma.

28
Q

Long Distant travel prophy

A

Use exercise. not aspirin or anticoag

29
Q

VTE Txt

A

Should be treated for 3 months

W/o cancer: R.E.A.D are preferred over warfarin for DVT or PE

W/ Cancer: LWMH are preferred over all anticoags (including warfarin)

Aspirin is recommended for 2nd prophy is VTE was unprovoked

30
Q

CHADS2

A 
CHF = 1 , HTN = 1, Age >75 = 1, Diabetes = 1
S = stroke or TIA = 2

score of:
0 = no therapy
1 = oral anticoagulation rather than anti platelets
2 or more: oral anticoags indefinitely.

31
Q

CHA2DS2VASc

A

Age 75 yo or older = 2, Vascular disease (prior MI. PAD, aortic plaque) = 1, Age = 65 - 74 years Sex Category female = 1

Score of:
0 = No anticoag
1 = ASA may be cosidered
2 or more = Oral coag is recommended. (R.E.A.D)

NAPLEX (13 decks)

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