Anticoagulation Flashcards
What factors does warfarin inhibit?
What things to know about dosing of unfractionated heparin?
What are the safety notes and other warnings for unfractionated heparin?
2,7,9,10.
Prophylaxis dosing is 5000 units q8-12, Treatment of VTE is 80 units/kg bolus then 18 units/kg/hr. Treatment of ACS is 60 units/kg bolus and then 12 units/kg/hr. Use actual body weight.
Antidote is protamine. monitor via aPTT 1.5-2.5 x control, q6h checks until therapeutic. Watch for bleeding. hyperkalemia and osteoporosis with long term use.
What is enoxaparin dosing?
What are lovenox’s BBW and other things to know?
What to know about HIT?
30 mg SC q12h or 40 mg daily. <30 CrCl is 30 mg sc daily. Treatment is 1 mg/kg q12h or 1.5 mg/kg sc daily for inpatient. CrCl > 30 is 1 mg/kg. Use actual body weight. Treatment for STEMI is 30 mg IV bolus then 1 mg/kg. Same with renal stuff. Patients >75 year is 0.75 and no bolus.
Antidote is protamine, do not get rid of air bubble, neuraxial anesthesia(epidural and spial), risk of hematomas and subsequent paralysis, watch for hyperkalemia.
prothrombotic state, IgG drug reaction,unexplained drop in platelet count(>50% from baseline), argatroban recommended, do not start until >150,000 on platelets. if urgent cardiac surgery or PCO is required use bivalrudin
What things to know about the Factor Xa inhibitors?
What to know about dosing?
What is the conversion between anticoagulants?
BBW: neuraxial anesthesia are at risk of hematomas and subsequent paralysis. Edoxaban has reduced efficacy in CrCl >95. CI’d in active bleed, not recommended in patients with prosthetic heart valves. No monitoring required. Antidote is andexxa.
Apixaban is 5 mg BID for nonvalvular Afib, 10 mg BID for 7 days x 5 mg PO BID for treatment of DVT/PE. Rivaroxaban needs to be taken with fooed if >15 mg, 15 mg PO BID x 21 then 20 mg po daily CrCL <30 avoid use. Edoxaban is >95 CrCl /min do not use/ start 5-10 daus after parenteral anticoagulation. If miss Xarelto can take two 15 at once if taking 15 mg twice dialy, otherwaise take immedidately on day or skip
READ Rivaorxaban when INR <3, Edoxaban <2.5, Apixaban and dabigatran <2.
Do we avoid CYP 3A4 drugs with apixaban and rivaroxaban?
What to know about dabigatran?
What to know about argatroban or bivalrudin(angiomax)?
Yes.
if miss take unless it is within 6 hours. Start after 5-10 days of parenteral anticoagulation, do not use with mechanical prosthetic heart valves, antidote is praxbind, swallow whole, do not administer via NG tube, keep in original container and discard 4 months after opening. watch for dyspepsia and gastritis like symptoms.
safe for patients with history of HIT.
What to know about warfarin?
What are the warfarin tablet colors?
What to know about protamine?
Racemic mixture, s enantomier is more potent. Health patient 10 mg for first 2 days then adjust to INR, lower doses (<5) for elderly, CI’d in pregnancy except with mechanical heart valves, tissue necrosis/gangrene, HIT, bleeding, skin necrosis, purple toe syndrome, antidote is vitamin K.
Pink, Lavender, Green, Brown, Blue, Peach, Teal, Yellow, White. Please let greg brown bring peaches to your wedding
1 mg protamine will reverse 100 units of heparin. reverse the amount of heprain given in the last 2-2.5 hours, max dose is 50, 1 mg protamine per 1 mg of enoxaparin.
What to know about warfarin reversal agent?
Warfarin reversal guidelines?
Vitamin K, Phytonadione, mephyton, factor 3 PCC(Kcentra). Administer kcentra with vitamin K, watch for hypersensitivity reactions to vitamin K including anaphylaxis, no SC.
<4.5 without bleedin, skip dose or reduce and monitor. 4.5-10 without bleeding, hold dose, >10 without bleeding, oral vitamin K. major bleeding, IV PCC.
