Clinical Questions Flashcards
What are some signs of internal bleeding?
Hematemesis (bloody vomit)
Hematuria (blood in urine)
acute drop in hemoglobin (>/= 2 g/dL)
blood from the anus
What is the antidote of Heparin
Protamine
What are the uses for heparin?
Prophylaxis of VTE
VTE treatment
Treatment of ACS/STEMI
What weight do you use to dose heparin?
TBW
What is the antidote for enoxaparin?
Protamine
How do you store enoxaparin?
Store at ROOM temperature
**Do not rub injection site!!!!!!!
What is the treatment of HIT?
-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
When should you stop warfarin to convert to all the DOACs?
READ
Stop Warfarin with each medication when INR…
Rivaroxaban < 3
Edoxaban </= 2.5
Apixaban < 2
Dabigatran < 2
Which anticoagulants are CYP substrates?
Rivaroxaban
Apixaban
Warfarin
When converting from dabigatran to warfarin how many days of crossover should there be?
1-3 days of crossover of warfarin
How do you convert from Apixaban or Rivaroxaban to warfarin?
Stop DOAC then start parenteral + warfarin bridging the next scheduled dose
What CYP enzymes must you watch out for with warfarin?
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
What other medications when in combination with anticoagulation can have a MAJOR bleeding risk?
NSAIDs
Antiplatelet
SSRI
SNRI
What drugs are major clotting risk with anticoagulation?
estrogen and SERMs
***avoid use with tamoxifen and raloxafene!
What natural supplements have an increase risk for bleeding?
Gs
Gingko
Ginger
Ginseng
Glucosamine
Garlic
Dong quai (natural estrogen)
Vitamin E
High-dose Fish Oil
Willow bark
Wintergreen Oil
What are the different colors of the warfarin tablets?
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)
What foods are HIGH in vitamin K? What will they do to the INR?
Spinach
Broccoli
Brussel sprouts
Cabbage
Beef Liver
Kale
DECREASE INR by blocking warfarin
Patients with stable INR can come into clinic how often?
every 12 weeks (3 months)
A patient’s INR was 10 today in clinic with no signs or symptoms of bleeding. What should the treatment be?
Hold warfarin 1-2 doses, resume warfarin at a lower dose
A patient’s INR today was 12 with no signs of bleeding. What should be the treatment?
Oral Vitamin K 2.5-5 mg
Hold warfarin
A patient’s INR today was 7 with severe bruising and nose bleed. What is the treatment?
Hold warfarin
Give IV Vit K 5-10 mg
How soon should you stop warfarin therapy before a major surgery?
5 day before stop warfarin
What are risk factors to developing a DVT?
Modifiable:
- acute illness
immobility
Meds (estrogen, SERMS, ESA)
Obesity
Pregnancy
Recent surgery
Non-modifiable:
Increasing age
Cancer
Previous VTE
Deficiency (thrombophilia)
HTN, HF
When is an anticoagulation therapy indicated for atrial fibrillation?
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
What is the recommended VTE prophylaxis in pregnant women?
LMWH
