Anticoagulation

Question 1

Define embolus

Answer 1

a clot or piece of clot that travels to another location

Question 2

Where does warfarin work in the clotting cascade

Answer 2

inhibits factors 2,7,9,10

Question 3

Where does UFH and LMWH work in the clotting cascade

Answer 3

inhibits Xa and Thrombin or 2a

Question 4

What is UFH activity with Xa and 2a

Answer 4

has equally activity

Question 5

What is LMWH activity with Xa and 2a

Answer 5

Has more Xa activity than 2a

Question 6

Where do DTIs work in the clotting cascade

Answer 6

inhibit thrombin or 2a

Question 7

List direct Xa inhibitors (3)

Answer 7

Rivaroxaban
Edoxaban
Apixaban

Question 8

List indirect Xa inhibitor

Answer 8

Fondaparinux

Question 9

List DTIs (3)

Answer 9

Argatroban
Bivalrudin
Dabigatran

Question 10

Which DTIs and PO and which IV

Answer 10

PO
-Dabigatran
IV
-Argatroban
-Bivalrudin

Question 11

Warfarin MOA

Answer 11

vitamin K antagonist. Vit K is required for activation of clotting factors 2,7,9,10 without vit K the liver produces the clotting factors but they have reduced coagulant acivity

Question 12

Antithrombin does what?

Answer 12

inactivates thrombin and other proteases like factor Xa involved in blood clotting

Question 13

MOA of UFH, LMWH, fondaparinux

Answer 13

bind to antithrombin causing a conformational change which increases AT activity 1000-fold

Question 14

DTI MOA

Answer 14

bind to thrombin directly decreasing the amount of fibrin available for lcot formation

Question 15

important point about IV DTIs

Answer 15

they do not cross-react with heparin-induced thrombocytopenia (HIT) antibodies

Question 16

UFH antidote

Answer 16

protamine

Question 17

LMWH dose for ppx of VTE

Answer 17

30 mg Q12 or 40mg Q24

Question 18

LMWH dose for ppx of VTE with CrCl <30

Answer 18

30mg Q24

Question 19

LMWH dose for treatment of VTE

Answer 19

1mg/kg Q12

Question 20

LMWH dose for treatment of VTE with CrCL <30

Answer 20

1mg/kg Q24

Question 21

LMWH antidote

Answer 21

protamine

Question 22

Define HIT

Answer 22

immune-mediated IgG drug reaction that has a high risk of venous and arterial thrombosis

Question 23

antidote for apixaban and rivaroxaban

Answer 23

andexanet alfa

Question 24

Conversion between warfarin and DOAC

Answer 24

stop warfarin and convert to: 
Rivaroxaban when INR < 3
Edoxaban when INR <2.5
Apixaban when INR < 2
Dabigatran when INR <2 
"read"

Question 25

Antidote for dabigatran

Answer 25

idarucizumab

Question 26

Goal INR for most indications

-DVT, Afib

Answer 26

2-3

Question 27

Goal INR for mechanical mitral valve or 2 mechanical heart valves

Answer 27

2.5-3.5

Question 28

Which foods does warfarin have increased bleeding with?

Answer 28

5 G's
Ginger
Ginkgo
Ginseng
Glucosamine

Question 29

St. John’s Wort and Warfarin

Answer 29

decrease effectiveness of warfarin

Question 30

High INR is bleeding or clotting?

Answer 30

bleeding

Question 31

For pt with cancer and VTE which treatment is preferred

Answer 31

LMWH

Question 32

CHA2DS2VASc

Answer 32

CHF
HTN
Age >75
DM
Stroke
Vascular Disease
Age 65-74
Sex-Female

Question 33

Prevention and treatment of VTE in pregnancy

Answer 33

LMWH