Anticoagulation Flashcards
Which of the following groups of laboratory parameters need to be monitored during heparin therapy?
Answer
A.) Hematocrit, hemogloblin, platelets, and PT
B.) Hematocrit, hemoglobin, platelets, AST, and ALT
C.) SCr, platelets, aPTT, and PT
D.) Hematocrit, hemoglobin, platelets, and aPTT
E.) Platelets, aPTT, PT, and SCr
D
A female patient who is pregnant has been admitted to the hospital with a DVT. The physician will begin heparin therapy. What is the mechanism of action of heparin?
Answer
A.) Heparin potentiates factor V B.) Heparin potentiates factor IXa C.) Heparin potentiates factor Xa D.) Heparin potentiates antithrombin III E.) Heparin inhibits clotting factors II, VII, IX, & X
D
What would be expected to occur if a patient on warfarin with a stable INR is started on fluconazole?
A.) The INR would increase and the patient may clot.
B.) The INR would increase and the patient may experience bleeding.
C.) The INR would decrease and the patient may clot.
D.) The INR would decrease and the patient may experience bleeding.
E.) The INR would not change.
B
A 66 year-old male with hypertension, renal disease and degenerative joint disease. In his younger years, Mr. Al-Hadeen was a football player and has lived with the pain of a hip injury for many years. He enters the hospital for elective hip replacement surgery. His creatinine clearance is 25 mL/min. The physician orders enoxaparin 30 mg SC BID for DVT prophylaxis. Choose the correct statement:
A.) The dose is correct as ordered. B.) The dose should be 60 mg SC daily. C.) The dose should be 45 mg SC daily. D.) The dose should be 30 mg SC daily. E.) The patient should receive heparin for DVT prophylaxis.
D
A 70 year-old patient has been using warfarin therapy in the hospital. She had a deep vein thrombosis (DVT) in her right lower leg. She is being discharged, and the outpatient pharmacist who is going to dispense her warfarin is checking her medication profile for drug interactions. The pharmacist notes that the patient is using medications which increase the risk of bleeding. She will counsel the patient on increased bleeding risk. Which of the following medications can increase her bleeding risk? (Select ALL that apply.)
A.)Co-enzyme Q10 B.) Clopidogrel C.) Amiodarone D.) Ginkgo biloba E.) Lithium
B, C, D
What would be expected to occur if a patient on warfarin with a stable INR is started on phenobarbital? (Select ALL that apply.)
A.)The INR would increase. B.) The INR would decrease. C.) The patient may clot. D.) The patient may experience bleeding. E.) The INR would not change.
B, C
The physician plans to start Ms. Tirrell, a 75 year old female on enoxaparin, but would like to order a laboratory test to monitor efficacy of enoxaparin therapy. Which of the following could be recommended?
A.) aPTT Q6H B.) INR daily C.) Peak anti-Xa, 4 hours after the dose D.) Trough anti-Xa, before the next dose E.) There is no laboratory test to monitor efficacy of enoxaparin therapy
C
Remember:
In most cases, monitoring is not required.
BUT monitoring with peak anti-Xa levels is required in pregnant women.
May be done: obesity, elderly, renal impairment .
A patient is being started on Pradaxa. Choose the correct statement regarding Pradaxa:
Answer
A.) Once a bottle of Pradaxa is opened, the capsules must be used within 15 days.
B.) Once a bottle of Pradaxa is opened, the capsules must be used within 60 days.
C.) Once a bottle of Pradaxa is opened, the capsules must be used within 90 days.
D.) Once a bottle of Pradaxa is opened, the capsules must be used within 120 days.
E.) If Pradaxa capsules are transferred to an amber container, they are good up to 2 months.
D
Take with a full glass of water and swallow the capsules WHOLE.
Once opened, the capsules are good for 120 days!
A pharmacist working in an inpatient medical ward of the local hospital is responsible for monitoring anticoagulation therapy. She routinely obtains laboratory parameters and adjusts the doses of low molecular weight heparins (LMWHs), as needed. In which of the following clinical situations is it appropriate to monitor the level of anticoagulation with LMWH therapy? (Select ALL that apply.)
A.) Patients with a myocardial infarction
B.) Significant renal impairment
C.) Pregnant patient with PE
D.) Pregnant patient with mechanical heart valves
E.) Extremes of body weight
B, C, D, E
Remember monitoring is REQUIRED: in pregnancy who are on LMWH.
Monitoring may be done:
- ) Obesity
- ) Low body weight
- ) Pediatrics
- ) Elderly
- ) Renal insufficiency
Select the correct mechanism of action for Pradaxa:
A.) Oral direct Factor IIa inhibitor B.) Injectable direct thrombin inhibitor C.) Vitamin K antagonist D.) Oral Factor Xa inhibitor E.) Inhibits Factor Xa and Factor IIa via antithrombin
A
Dabigatran (Pradaxa) is a oral DIRECT THROMIN (lla) inhibitor.
What is the purpose of using a heparin “lock-flush,” such as HepFlush?
A.) To provide systemic anticoagulation prophylaxis
B.) To provide systemic anticoagulation treatment
C.) To keep IV lines open
D.) To prevent HIT
E.) To dilute other medications going through the same IV line
C
A patient has developed heparin-induced thrombocytopenia (HIT). He requires anticoagulation therapy for a pulmonary embolism. Which of the following agents would not pose a risk for HIT in this patient?
A.) Enoxaparin
B.) Argatroban
C.) Dalteparin
D.) Heparin
B
Argatroban is the DOC for HIT.
In HIT: STOP all heparin/MWH/warfarin.
If the patient was on warfarin, administer Vitamin K.
What would be expected to occur if a patient on warfarin with a stable INR is started on amiodarone?
A.) The INR would decrease and the patient may experience bleeding.
B.) The INR would increase and the patient may clot.
C.) The INR would increase and the patient may experience bleeding.
D.) The INR would decrease and the patient may clot.
E.) The INR would not change.
C
Remember amiodarone is an INHIBITOR, therefore it would increase the INR/increase bleeding risk.
When starting amiodarone; decrease dose of warfarin by 30-50%.
Henry Wong is receiving a heparin drip. What is the name of the test used to monitor heparin for efficacy?
A.) Potentiation factor B.) Factors IIa, VIIa, IXa and Xa test C.) Anti-XIa levels D.) International normalized ratio (INR) E.) The activated partial thromboplastin time (aPTT)
E
UFH is monitored with aPTT levels; It measures how long it takes your blood to clot.
It is taken 6 hours after initiation and every 6 hours until therapeutic range of 1.5-2.5 x control (patient’s baseline), then every 24 hours.
Which of the following is a possible side effect from the long-term use of UFH therapy?
A.) Gingival hyperplasia B.) Osteoporosis C.) GERD D.) Hair growth E.) Hypokalemia
B
and could cause HYPERkalemia not hypokalemia (FYI)
