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Anticoagulation > Clinical Questions > Flashcards

Clinical Questions Flashcards

1
Q

What are some signs of internal bleeding?

A

Hematemesis (bloody vomit)
Hematuria (blood in urine)
acute drop in hemoglobin (>/= 2 g/dL)
blood from the anus

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2
Q

What is the antidote of Heparin

A

Protamine

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3
Q

What are the uses for heparin?

A

Prophylaxis of VTE
VTE treatment
Treatment of ACS/STEMI

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4
Q

What weight do you use to dose heparin?

A

TBW

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5
Q

What is the antidote for enoxaparin?

A

Protamine

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6
Q

How do you store enoxaparin?

A

Store at ROOM temperature

**Do not rub injection site!!!!!!!

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7
Q

What is the treatment of HIT?

A

-STOP all heparin and LMWH
-STOP warfarin and induce vitamin K
- immediate treatment should be RAPID-acting non-heparin anticoagulants (Argatroban)

  • initiate warfarin when platelets are >/= 150,000

-if urgent cardiac surgery or PCI, bivalirudin is preferred

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8
Q

When should you stop warfarin to convert to all the DOACs?

A

READ
Stop Warfarin with each medication when INR…

Rivaroxaban < 3
Edoxaban </= 2.5
Apixaban < 2
Dabigatran < 2

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9
Q

Which anticoagulants are CYP substrates?

A

Rivaroxaban
Apixaban
Warfarin

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10
Q

When converting from dabigatran to warfarin how many days of crossover should there be?

A

1-3 days of crossover of warfarin

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11
Q

How do you convert from Apixaban or Rivaroxaban to warfarin?

A

Stop DOAC then start parenteral + warfarin bridging the next scheduled dose

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12
Q

What CYP enzymes must you watch out for with warfarin?

A

CYP2C9 inducers and inhibitors!!!!

inhibitors: metonidazole, Bactrim, tamoxifen, fluconazole, AMIODARONE

inducers: phenobarbital, phenytoin, carbamazepine, rifampin

***avoid use with tamoxifen, significantly reduce warfarin dose before starting Amiodarone

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13
Q

What other medications when in combination with anticoagulation can have a MAJOR bleeding risk?

A

NSAIDs
Antiplatelet
SSRI
SNRI

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14
Q

What drugs are major clotting risk with anticoagulation?

A

estrogen and SERMs

***avoid use with tamoxifen and raloxafene!

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15
Q

What natural supplements have an increase risk for bleeding?

A

Gs
Gingko
Ginger
Ginseng
Glucosamine
Garlic

Dong quai (natural estrogen)
Vitamin E
High-dose Fish Oil
Willow bark
Wintergreen Oil

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16
Q

What are the different colors of the warfarin tablets?

A

Please Let Geoffrey Brown Bring Peaches To Your Wedding

Pink (1mg)
Lavender (2mg)
Green (2.5mg )
Brown (3mg)
Blue (4 mg)
Peach (5mg)
Teal (6 mg)
Yellow (7mg)
Wedding (10mg)

17
Q

What foods are HIGH in vitamin K? What will they do to the INR?

A

Spinach
Broccoli
Brussel sprouts
Cabbage
Beef Liver
Kale

DECREASE INR by blocking warfarin

18
Q

Patients with stable INR can come into clinic how often?

A

every 12 weeks (3 months)

19
Q

A patient’s INR was 10 today in clinic with no signs or symptoms of bleeding. What should the treatment be?

A

Hold warfarin 1-2 doses, resume warfarin at a lower dose

20
Q

A patient’s INR today was 12 with no signs of bleeding. What should be the treatment?

A

Oral Vitamin K 2.5-5 mg
Hold warfarin

21
Q

A patient’s INR today was 7 with severe bruising and nose bleed. What is the treatment?

A

Hold warfarin
Give IV Vit K 5-10 mg

22
Q

How soon should you stop warfarin therapy before a major surgery?

A

5 day before stop warfarin

23
Q

What are risk factors to developing a DVT?

A

Modifiable:
- acute illness
immobility
Meds (estrogen, SERMS, ESA)
Obesity
Pregnancy
Recent surgery

Non-modifiable:
Increasing age
Cancer
Previous VTE
Deficiency (thrombophilia)
HTN, HF

24
Q

When is an anticoagulation therapy indicated for atrial fibrillation?

A

CHA2DS2-VASc Score
CHF
HTN
Age >/= 75
Diabetes
Stroke
Vascular Disease (PAD, CAD, prior MI)
Age 65-74
Sex - female

Score >/= 2 for females = consider Anticoag
Score>/= 1 males = considerAnticoag

Score >/= 3 for females = Anticoag recommended
Score>/= 2 males = Anticoag recommended

25
Q

What is the recommended VTE prophylaxis in pregnant women?

A

LMWH

Anticoagulation (5 decks)

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