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PR3154 > dose > Flashcards

dose Flashcards

1
Q

DVT UFH doses

A

80 units/kg –> 18units/kg/hr infusion

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2
Q

DVT LMWH dose

A

enoxaparin 1mg/kg Q12H or 1.5mg/kg OD

  • enoxaparin renal <30ml/min = 1mg/kg OD
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3
Q

DVT riva dose

A

15mg BD 3wks —> 20mg OD 6mnths —> 10mg OM (prophy)

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4
Q

DVT apix dose

A

10mg BD 7d —> 5mg BD 6mnths —> 2.5mg BD (prophy)

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5
Q

DVT rTPA dose

A

100mg over 2h or 0.6mg/kg over 15mins (max 50mg)

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6
Q

DVT UFH prophylaxis

A

5000units Q8-12h

[medically ill, non-ortho, ortho -TKR, THR 10-14d~35d]

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7
Q

DVT enoxaparin prophylaxis

A

40mg OD until ambulatory

or 30mg BD - surg TKR,THR 10-14d ~ 35d

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8
Q

DVT dabigatran prophylaxis

A

Haemostasis achieved

1-4h post surg 220mg/day (10d TKR)
(28-35d THR)

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9
Q

DVT renal dabi

A

Crcl 30-50ml/min (caution) 150mg OM same duration as above

Crcl <50ml/min + PGPi (avoid)

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10
Q

DVT riva prophy

A

10mg OD

TKR: 2wk
THR: 5wk
medically ill for 31-39d

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11
Q

DVT apix prophy

A

Haemostasis achieved, 12-24h post surg

2.5mg BD (10-14d TKR)
(32-35 days THR)

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12
Q

DVT riva renal

A

Crcl < 30ml/min (avoid)

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13
Q

DVT apix renal

A

Crcl 15-29ml/min (caution)

HD (avoid)

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14
Q

DVT edoxaban renal

A

30mg/day
* Crcl 30-50ml/min
* or BW <60kg

If renal function >95ml/min (too good, tx failure)

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15
Q

DVT LMWH renal

A

Severe renal (crcl <30ml/min): 1mg/kg OD

  • same for cancer, preg

prophy:
* Mod renal (30-50ml/min): 30mg BD
Consider anti-Fxa levels

  • Severe renal = 20-30mg OD
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16
Q

AF dabig dose

A

150mg BD.
- 110mg BD (if =/>80yo/ use PGPi/ high risk of bleed)
- no crcl dose adj unless CI <30ml/min

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17
Q

AF riva dose

A

20mg OD
- crcl 30-50ml/min = 15mg OD
- crlc <15 ml/min = CI

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18
Q

AF apix dose

A

5mg BD
- 2.5 mg BD (if any 2: Age =/> 80yo, Weight =/<60kg, Scr =/> 1.5mg/dL/ 132.6mmol/L)

crcl 15-29: 2.5mg BD
crcl <15ml, HD is approved by no dose???

19
Q

AF edoxaban dose

A

60mg OD
- 30mg OD (any: crcl 30-50/ weight =/>50kg, concomitant: werapamil, quinidine, dronedaron)

Crcl <15ml/min = not recomm

20
Q

AMI PCI UFH

A

2000-5000 units (no more than 50-70 units/kg) to achieve ACT of 250 – 300 seconds;

repeat bolus (max 10 000 units) as needed to maintain ACT throughout PCI.

21
Q

AMI PCI LMWH

A

If < 75yo, bolus IV 30mg followed by SQ 1mg/kg Q12H

if ≥75yo, omit bolus, followed by SQ 0.75mg/kg Q12H

duration of 48h and up to 8d or until revascularisation.

22
Q

AMI SAPT

A

Load 300mg (no load if currently on aspirin)
f/b: 100mg OM (lifelong)

23
Q

DAPT clopidogrel doses

A

clopidogrel (CCS) Load 300mg (6h onset) or 600mg (2h onset)
f/b: 75mg OM

extended therapy (beyond 12mnth): 75mg OD

24
Q

DAPT ticagrelor dose

A

Load: 180mg
f/b : 90mg BD ~ 12mn
extended therapy (beyond 12mnth): 60mg BD —non MAF

25
Q

DAPT eptifibatide dose

A

Double bolus of 180ug/kg iv
(10min interval)

Follow: infusion 2.0ug/kg/min for 72h

short t1/2, need infusion.

26
Q

fibrinolytics AIS

A

within 3hr/ 4.5hr

0.9mg/kg (max 90mg)

27
Q

stroke VTE prophylaixs

A

LMWH within 48h. after 24h of rTPA
- due to immobile state
- monitor bleedign risk within 72hr

40mg OD until ambulatory

28
Q

when and how long is DAPT administered in AIS

A

within 24h - 48h (if given rTPA)
ASAP if not rTPA eligible

(90d: major ICAS, non-cardioembolic)

(21d: minor stroke, high risk TIA)

29
Q

high intensity statins

A

atorvastatin 40-80mg

rosuvastatin 20-40mg

add in ezetimbe if LDL > 1.8mmol/L

30
Q

HBP control

A

ACEi
CCB
thiazide diuretic

31
Q

management of pernicious anemia/ vit 12 deficiency anemia

A
  • IM, SC vit B12 1000ug daily for 1 wk
  • Follow: 1000 ug weekly x 4wks
  • Follow: 1000ug mnthly for life

PO often insufficient

  • PO Vit B12, 1000ug ~ 2000ug daily
    Absorbed by mass action, not rely on intrinsic factor action
    *or when IF not that low
32
Q

folate deficiency tx

A

1mg/d folate for 1-4mnths

Or

Until hematologic recovery, normal Hb
Multivitamin (sangobion, ferrous gluconate)

33
Q

tx for Fe deficiency

A

Sufficient Fe = 1000 - 1500mg of elemental Fe for complete supplementation

Ferrous gluconate tab 30mg sangobion (12%)
Iron polymaltose 100mg Maltofer (100%)
(20-30 ~~ 200mg). 3-6 mnths to replenish

34
Q

management of aplastic anemia

A

1) Withdraw causative drug

2) improve peripheral blood counts Transfusion of erythrocytes and PLT

  • Granulocyte-macrophage CSF: sargramostim,
  • G-CSF: filgrastim, pegfilgrastim
  • IL-14

3) minimise risk for infections
* Ab prophylaxis, antifungal
* Neutrophil count <500 cells/mm3

4) Haematopoietic stem cell transplant (HSCT)

5) Immunosuppressants while bone marrow recovers
* Glucocorticoids
* Ciclosporin
* Cyclophosphamide
* Azathioprine
* Antithymocyte Ig

35
Q

do not heavily transfuse

A

iron overload

require Fe chelation
- Defoxamine
- Deferasirox

36
Q

tx for HIT

A

1) Hold offending drug
Recover in 1-2 days. Complete in 1wk
Ab may persist for years, do not restart. avoid indefinitely

2) KIV corticosteroid if severe

3) Heparin-induced thrombocytopenia
*DOAC: dabigatran (off-label)

37
Q

tx for immune thrombocytopenia

A

1) Withdraw causative drug

2) Immunosuppressants (KIV)
- Glucocorticoids
- Ciclosporin
- Cyclophosphamide
- Azathioprine
- Antithymocyte Ig

3) Transfusion of PLT
Clinically sig bleeding

38
Q

agranulocytosis tx

A

1) Withdraw causative drug
- blood count usually returns to norm in 2-4wks (~4-24days)

2) Prophylactic administration of hematopoietic GF
* GM -CSF: sargramostim
○ More potent, more ADR as it stimulates diff type of blood cells
* G-CSF: filgrastim (sc 300mcg/day), pegfilgrastim

  • Weekly monitor WBC count
    • Esp for pt with clozapine
39
Q

tx for hemolytic anemia

A

1) Withdraw causative drug

  • RBC transfusion for pt with low Hb
  • Haemodialysis in acute RF
  • Steroids, Ig in serious cases
  • Autoimmune hemolytic anaemia
    Rituximab (human anti-C20 Mab) used
40
Q

drugs that cause megaloblastic anemia + tx

A
  • Antimetabolite = Hold off drug
    ○ MTX, chemotherapy
  • Co-trimoxazole = Folinic acid 5-10mg QDS
    ○ Esp in folate/ vit B12 deficient
  • Phenytoin, phenobarbital = Switch drug/ folic acid
    ○ Inhibit folate absorption or catalyse folate catabolism
    § Folic acid 1mg/day but may decr phenytoin efficacy
41
Q

drugs to tx anemia (nutrient, erythropoeisis)

A
  • Nutrients
    ○ Vit B12, folate deficiency
    ○ Fe deficiency
  • Erythropoiesis-stimulating agents
    ○ darbepoetin alfa, epoetin alfa
42
Q

tx for leukemia, myelodysplastic syndromes & lymphoma

A

○ Corticosterois, immunosuppressants, cytotoxic (chemo), targeted synthetic drugs, biologics

○ Supportive therapies for cytopenia
- anemia, neutropenia, thrombocytopenia

43
Q

neutropenia drugs

A

Myeloid GF

  • granulocyte colony sitmulating factor (G-CSF)
    ○ recombinant human GCSF – filgrastim
    ○ Filgrastin covalently conjugated with PEG – pegfilgrastin
  • GM-CSG (macrophage)
    ○ recombinant human GCSF – sargramostim
44
Q

thrombocytopenia tx drugs

A

Megakaryocyte GF/ plt-stimulating agents
* Recombinant IL-11: oprelvekin
* Fc-fusion protein thrombopoietin receptor agonist (romiplostim)

  • PO nonpeptide thrombopoietin receptor agonist (eltrombopag)

PR3154 (11 decks)

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