Cardiology

Question 1

Highest valve risk of clotting

Answer 1

Mitral > aortic

Question 2

AC after Bioprosthetic Valves:

• Aortic
• TAVR
• Mitral

Answer 2

Aortic: ASA 81 mg x 3 mons
TAVR: ASA 81 mg + clopidogrel 75 mg x 6 mons, then ASA indefinetly
Mitral: Warfarin 2-3 INR x 3 months, then ASA 81 mg indefinetly

Question 3

AC after Mechanical Valves:
Mitral
Aortic

Answer 3

Mitral: 2.5-3.5 INR with warfarin
Aortic: 2-3 INR with warfarin

+ ASA 81mg indefinetly

Question 4

VTE treatment with edoxaban and dabigatran

Answer 4

Requires 5 days of parental AC then initiate

Question 5

Cancer-related VTE treatment options

Answer 5

LMWH
Xarelto
Edoxaban

Question 6

Fondaparinux VTE treatment doses

Answer 6

< 50kg: 5 mg
50 - 100 kg: 7.5 mg
> 100 kg: 10 mg

Question 7

AC if on strong CYP3A4 Inhibitors (PI’s, ketoconazole)

Answer 7

Avoid Xarelto

50% dose reduction with Eliquis

Question 8

Calculate protamine dose to reverse UFH

Answer 8

1 mg protamine - 100 units of UFH

Calculate UFH in past 3 hrs:
100% UFH in past hour
50% UFH in previous hour
25% UFH in previous hour
Convert to mg protamine

Question 9

Calculate protamine dose to reverse enoxaparin

Answer 9

If Lovenox given in past 8 hours:
1mg protamine = 1 mg enoxaparin

If Lovenox given > 8 hours, give 0.5 mg protamine = 1 mg enoxaparin

Question 10

AC reversal agents

Answer 10

Protamine = UFH, enoxaparin
Pradaxa = Idarucizumab
Xa inhibitors = PCC, andexanet alfa
Warfarin = rapid use 4PCC, or PO vitamin K 5 mg if INR > 10 OR INR 4.5-10 if risk factors. Otherwise omit.

Question 11

Bariatric surgery AC of choice

Answer 11

enoxaparin 40 mg BID

Question 12

AC of choice in CABG

Answer 12

LMWH > Heparin due to risk of HIT

Question 13

AC of choice in Knee/hip replacement

Answer 13

Both:

• Apixaban 2.5 mg BID 12-24hr post-op
• Xarelto 10 mg daily 6-10 hours post-op
• Lovenox 30 mg BID (can use 40 mg daily in HIP ONLY)
• Fondaparinux 2.5 mg SC qd
• Dabigatran approved for hip only

Knee - about 10 days
Hip - about 4-6 weeks

Question 14

AC of choice in medically ill / critical ill

Answer 14

Medical: UFH SC q8H > q12h, Xarelto 10 mg qd, enoxaparin 40 mg daily, fondaparinux 2.5 mg daily

Critical: LMWH or UFH

Question 15

Surgery hold times for DOACS and warfarin

Answer 15

Low risk: 1 day before, restart 1 day after
Mod-high risk: 2 days before, restart 3 days after

Warfarin: hold 5 days before, may bridge with enoxaparin

Question 16

HAS-BLED scoring

Answer 16

HTN
Abnormal renal/liver (1pt each)
Stroke
Bleeding (active or history)
Labile INR (less than 60% within therapeutic range)
Elderly (age > 65)
Drugs (NSAIDS) or Etoh (> 8 drinks/week) (1pt each)

> 3 is risk of bleed

Question 17

EKG changes for hypo and hyperkalemia

Answer 17

Hypokalemia: U waves (can be seen in DKA)
Hyperkalemia: T wave, wide QRS