Dosing

Question 1

DOAC Dosing for VTE prevention after surgery?

Answer 1

Rivaroxaban: 15mg daily, 35d for hip, 14d for knee
Apixaban: 2.5mg BID 35d hip, 14d knee
Dabigitran: 110mg immediately, then 220mg daily reduced to 150mg if >75yrs old. hip 35d knee 14d

Question 2

DOAC dosing for VTE treatment?

Answer 2

Rivaroxaban: 15mg BID for 3 weeks, 20mg daily for 3-6 months
Apixaban: 10mg BID x 7d, 5mg BID 3-6m
Dabigitran: must recieve 5-10d SQ anticoagulant, then begin prevent dosing 150 mg BID
Edoxaban: 60mg once daily after bridging for 5-10 days
- 30mg if <60kg

Question 3

DOAC dosing for recurrent VTE prevention

Answer 3

Rivaroxaban: 10-20mg daily w/ food after 6 months treatment doses
Apixaban: 2.5mg BID after treatment doses
Dabigitran: 150mg BID or 110mg BID if bleed risk
Edoxaban: 60mg OD, 30mg OD if <60kg

Question 4

Warfarin adjustments for target INR of 2-3 / 2.5-3.5:
<1.5 / <2
1.5-1.9 / 2 - 2.4
2-3 / 2.5 - 3.5
3.1-3.5 / 3.6 - 4
3.6-4.9 / 4.1- 4.9
5-9
>9

Answer 4

Extra dose, increase weekly dose 10-20%
increase weekly dose by 5-10%
No change
decrease weekly dose by 5-10%
hold 1 dose, decrease weekly dose 10-20%
hold 2 doses, decrease weekly dose 10-20%
URgent evaluation

Question 5

Tinzaparin dosing prophylaxis / VTE / dialysis line patency

Answer 5

Prophylaxis: 75u/kg or baseline of 4500u
VTE: 175u/kg
Dialysis line patency: 2500u

Question 6

Tinzaparin dosing accuracy?

Answer 6

Rounded to nearest dose size 2500, 4500, 8000, 10000,12000

Question 7

Dosing for ACEI in HF? Start dose/ Target dose
How to titrate?

Answer 7

Enalapril: 1.25-2.5 mg BID ->10mg BID 20mg BID in Class 4
Lisinopril: 2.5-5mg daily ->20-35mg daily
Ramipril: 1.25-2.5mg BID -> 5mg BID
Titrations: double dose every 1-3 weeks

Question 8

Dosing for ARB in HF? start -> target

Answer 8

Candesartan: 4-8mg daily -> 32mg daily
Valsartan: 40mg BID -> 160mg BID

Question 9

Dosing for ARNI (Entresto) in HF starting -> target
Titration?

Answer 9

50-100mg BID -> 200mg BID
double dose 3-6 weeks, 6 weeks in high risk hypotension

Question 10

Dosing for BB in HF starting -> target?

Answer 10

Carvedilol: 3.125mg BID -> 25mg BID or 50mg BID (>85kg)
Bisoprolol: 1.25mg daily -> 10mg daily
Metoprolol: 12.2-25mg daily -> 200mg daily
Titrate: double dose 2-4 weeks

Question 11

Dosing for MRA in HF start -> target?

Answer 11

Spironolactone: 12.5mg daily -> 25-50 mg daily
Eplerenone: 25mg daily -> 50mg daily
Titrate double dose 4-8 weeks

Question 12

Dosing for SGLT2I, which is has EDS for HF?

Answer 12

Dapagliflozin: 10mg daily –> HF EDS
Empagliflozin: 10mg daily –> EDS for Diabetes only

Question 13

Ivabradine dosing?

Answer 13

5mg BID x 2 weeks, check Resting HR:
>60bpm 7.5mg BID
50-60 BPM 5 mg BID
<50 BPM 2.5mg BID

Question 14

DIgoxin dosing in HF?

Answer 14

0.0625mg to 0.25mg OD

Question 15

Vericiguat dosing in HF?

Answer 15

2.5mg OD x 2 weeks -> 5mg OD x2 weeks -> 10mg OD based on BP and symptoms

Question 16

Hydralazine/ Isorbide Dinitrate dosing?

Answer 16

10-20mg TID -> 40mg biD

Question 17

Loop Diuretic dosing?

Answer 17

Furosemide: 20-40mg OD-BID -> Max of 200mg/day

Question 18

Metolazone dosing HF?

Answer 18

2.5mg 2-3x week, 5-10mg inpatient

Question 19

DOAC dosing in AFIB?

Answer 19

Double therapy:
Dabigitran: 110-150mg BID
Rivaroxaban: 15mg OD
Edoxaban: 30-60mg OD
Apixaban: 2.5-5mg BID
Triple:
Ribaroxaban: 2.5mg BID
Apixaban: 2.5-5mg BID

Question 20

Treatment for chronic symptomatic AV block?

Answer 20

Pacemaker

Question 21

Dosing of Mg sulfate for torsade de Pointes?

Answer 21

2g IV then DC cardioversion

Question 22

V Tac treatment (non-drug)

Answer 22

Implantable Cardioverter Defibrillator