Cardiac Anticoagulant

Question 1

Preferred agent for reversing Xa inhibitors (apixaban rivaroxaban(

Answer 1

andexanet alfa

Question 2

Agent to reverse dabigatran (direct thrombin (factor IIa) inhibitor)

Answer 2

idarucizumab (praxbind)

Question 3

Cockroft formula

Answer 3

Question 4

Ideal Body weight

Answer 4

Question 5

Adjusted body weight

Answer 5

Question 6

CHA2DS2-VASc

Answer 6

Question 7

hasbled score

(3 or higher is considered an increased risk of bleeding)

Answer 7

Question 8

Scoring for CHADS2-VASc

Answer 8

Question 9

Reversing enoxaparin with protamine

Answer 9

1 mg of exoxaparin is equal to 100 antiXa units

1 mg of protamine will reverse 1 mg of enoxaparin

1 mg of protamine will reverse 100 units of heparin

if over 8 hours give 1/2 of the protamine dose (enoxaparin)

if over 2 hours give 1/2 of the protamine dose (heparin)

Question 10

When do you transition from warfarin to apixaban?

Answer 10

wait until INR falls to less than 2

Question 11

When should edoxaban not be used?

Answer 11

When CrCl is greater than 95 ml/minute

Question 12

What are the 1st line treatment options for VTE

Answer 12

1. rivaroxaban
2. apixaban
3. warfarin plus LMWH bridge
4. edoxaban with LMWH predosing
5. dabigatran with LMWH predosing

Question 13

CHEST guidelines on VTE treatment

Answer 13

DOACS are recommended over vitamin K antagonist such as warfarin, for VTE treatment without an associated cancer diagnosis

Question 14

If pt on warfarin and being started on amiodarone, the dose should be reduced by how much percent?

Answer 14

30 to 50 %

Question 15

Triggers for vasoocclusive crisis in patients with sickle cell disease

Answer 15

infections, dehydration, stress, changes in weather

Question 16

When is AC therapy recommended for patients with AF?

Answer 16

CHA2DS2VASc

score oft two or more in men

score of three or more in women

except those with moderate to severe mitral stenosis or a mechanical heart valve

Warfarin- DOC in end-stage renal chronic kidney disease

Dabigatran, rivaroxaban, apixaban, edoxaban are all preferred over warfarin for cardioembolic stroke prevention in patients indicated for AC therapy

Question 17

Warfarin affects which vitamin K dependent clotting factors

Answer 17

2, 7, 9 and 10

Question 18

warfarin reversal

Answer 18

4 factor PCC (Kcentra) 5000 units

(50 units/kg) not to exceed 5,000 units

also vitamin K 10 mg IV

(subcut has erratic and unpredictable absoprtion

Question 19

apixaban and rivaroxaban reversal

Answer 19

Andexanet alfa

Question 20

what is needed for Vitamin B 12 be absorbed?

Answer 20

Intrinsic factor

Question 21

Approved VTE prophylaxis in knee replacement surgery

Answer 21

apixaban and rivaroxaban

Question 22

Approved VTE prophylaxis in hip replacement surgery

Answer 22

apixaban, rivaroxaban, dabigatran

Question 23

What interacts with iron?

Answer 23

fluroquinolones, levothyroxine and tetracyclines

Question 24

What can increase the absorption or bioavailability of the elememental iron?

Answer 24

Vitamin C

Question 25

Dosing for rivaroxaban for VTE

Answer 25

15 mg BID po BID for 21 days followed by 20 mg daily

Question 26

Common medications with causing thrombocytopenia

Answer 26

chemo agents heparin linezolid LMWH quinine ranitidine ticlopidine valproic acid vancomycin

Question 27

What class is apixaban?

Answer 27

Xa inhibitor (DOAC) BID dosing

Question 28

What class is dabigatran

Answer 28

Direct Thrombin inhibitor

Question 29

What class is prasugrel

Answer 29

P2Y12 antagonist (ADP inhibitor)

Question 30

Types of macrocytic anemia

Answer 30

folic acid (B9) and cyannocobalamin (vitamin B12 )

Question 31

what are fat soluble vitamins?

Answer 31

ADEK

Question 32

Which has greater degree of platetelet inihibition?

Answer 32

prasugrel and ticagrelor more than clopidogrel

Question 33

What are the DOACs

Answer 33

apixaban, edoxaban, rivaroxaban

Question 34

FDA approved to chelate iron

Answer 34

deferasirox (exjade) deferiprone (Ferriprox) deferoxamine (desferal What is NOT dexrazoxane (Zinecard)

Question 35

what is the half life of amiodarone?

Answer 35

60 days

Question 36

When to hold apixaban?

Answer 36

For low risk procedures: dermatologic or dental procedures (root canal, multiple tooth extraction): hold one day prior and restart the next day For high risk procedures: hold 2 days prior then restart 2 to 3 days after the procedure

Question 37

what is the onset of action for 4 factor PCC what about vitamin K or phytonadione what about FFP?

Answer 37

10 minutes for 4 factor PCC 4 to 6 hours for IV and 18-24 hours for oral (vitamin K) slower by 6.5 hours compared to 4PCC

Question 38

When does Rh incompatibility occur?

Answer 38

When Rh negative Mom is exposed to Rh positive fetus, leading to the mother's development of Rh antiboides

Question 39

In immune mediated HIT what percentage reduction of platelets is usually seen?

Answer 39

30 to 50 percent