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Clinical Pharmacy 4 > Anticoagulation > Flashcards

Anticoagulation Flashcards

1
Q

At one point do you start to get concerned about troponin levels?

A
  • in the 100s
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2
Q

____ failure will increase the troponin levels

A

renal

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3
Q

How long after an MI does the troponin stay positive?

A
  • stays positive for the first 5-7 days
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4
Q

What is a type 2 MI?

A
  • when you’ve worked harder than your coronary arteries can delivery oxygen - this can happen to marathon runners even
  • when your myocardial cells die they release troponin - released when not enough oxygen gets to your heart
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5
Q

ST segment elevation is indicative of what?

A
  • STEMI
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6
Q

What do STEMIS need?

A
  • bypass surgery or emergency PCI
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7
Q

STEMIs have _____ thickness myocardial walls

A

full

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8
Q

NSTEMI has ____ thickness myocardial walls

A

partial

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9
Q

Is creatinine clearance ever set?

A

NO

  • if the creatinine is increasing, then we say the creatinine clearance is decreasing (BAD)
  • if the creatinine is decreasing, then we say that the creatinine clearance is increasing (GOOD)
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10
Q

If you are producing zero urine, what is your GFR?

A

you don’t have a GFR

you need to have urine production to have an active GFR

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11
Q

Apixiban right now is not recommended under what?

A

25 mL/min

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12
Q

What is the major question to be asked when thinking to start someone on ticagralor?

A
  • if they have a bleed risk

- also if they can afford it

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13
Q

What is heparin reversed by?

A
  • protamine
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14
Q

Are there any agents that are reversals for asa or clopridogrel?

A

NO

- have to let it wash out of the body

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15
Q

When would you not give a statin?

A

if you saw that the CKs were elevated

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16
Q

What are 2 things you should watch when you add an ACE inhibitor?

A
  • watch kidney function and watch K
17
Q

81 mg ASA will never cause a reduction in _________

A

renal prostagladins

- these have an effect on dilating the renal arteries

18
Q

If you see a change in the Cr, get rid of ______

A

ACEI

19
Q

When would you not give someone rosuvastatin?

A
  • if you saw CKs elevated, you would not give a statin
20
Q

With an ACE inhibitor, watch what?

A
  • watch K and watch kidney function
21
Q

What is the main risk behind using ASA alone?

A

have a higher risk of stent thrombosis

22
Q

______ does nothing to prevent stent thrombosis

A

Clopridogrel

23
Q

Leg clots are made up mostly of ______

A

fibrin

24
Q

Why could you not use 2 anti platelets for a DVT?

A
  • because leg clots are made up mainly of fibrin with little/no platelets
25
Q

How long should a DOAC be used for after a STEMI?

A
  • 3 months
26
Q

How long should a DOAC be used for a.fib?

A

for LIFE

27
Q

What would the benefit be of adding a PPi onto a DOAC?

A
  • reducing the bleed risk

- need to be careful however, because the PPis inhibit the 2C19 enzyme and stop the metabolism of clopridogrel

28
Q

How long would you keep someone on a PPi for?

A
  • the duration that they are on triple therapy, and then you stop the PPi after that
29
Q

What is the reversal agent for dabigitran?

A
  • praxbind (idrucizumab)
30
Q

What is andexante alpha?

A
  • the Xa receptor binder that will replace the binding site for the DOAC
  • should be able to have an anti-Xa monitoring agent
31
Q

What DOAC has the least amount of bleeding risk of all?

A

apixiban

32
Q

What DOAC has the higher risk of bleeding?

A
  • rivaroxaban
33
Q

What are the positive endpoints associated with tripe therapy

A
  • resolution of and no chest pain
34
Q

What are the negative endpoints that are associated with triple therapy?

A
  • presence of blood in the stool or urine, nose bleeds, bruising, cuts that take a long time to heal, or headache that is worse than normal
35
Q

What lab tests do we need to measure when giving someone triple therapy?

A
  • platelets, hemoglobin, and creatinine, urea and WBC
36
Q

How does renal failure cause bleeding

A

increase in urea makes platelets dysfunctional and can make the person bleed severely

37
Q

What are very important counselling points to educate a patient on when they’re using triple therapy?

A
  • avoid use of NSAIDs
  • inform all HCPs that you are using an anticoagulant/ anti platelet
  • educate on s/s of bleeding
  • avoid contact sports
  • monitor alcohol intake (can increase risk of bleeding)
  • avoid herbal products that exacerbate the bleeding (St. John’s Wort for example)
  • don’t miss a dose, and don’t double dose if you forget

Clinical Pharmacy 4 (7 decks)

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