dosing for exam 2

Question 1

UFH for prevention of VTE

Answer 1

5000 units SC q8-12h

Question 2

UFH for treatment of VTE

Answer 2

remember “80 and 18 regimen”
80 units/kg bolus then 18 units/kg/hr infusion, adjust to aPTT

Question 3

UFH for treatment of ACS

Answer 3

“60 and 12 regimen”
60 units/kg bolus, 12 units/kg/hr adjust to aPTT

Question 4

UFH during PCI

Answer 4

50-100 units/kg IV bolus to target ACT 200-250 s. titrate to aPTT or anti-Xa. duration <48 hr, d/c at end of PCI

Question 5

morphine

Answer 5

2-4 mg IV q 5 min prn

Question 6

nitroglycerin SL

Answer 6

0.4 mg q 5 min x 3

Question 7

nitroglycerin IV

Answer 7

5-200 mcg/min as continuous IV infusion, titrate q5min to relief of pain/blood pressure

Question 8

metoprolol for ACS

Answer 8

25 mg po bid

Question 9

enalapril for ACS

Answer 9

2.5-5 mg po daily, target dose 10-20 mg po daily

Question 10

eplerenone for ACS

Answer 10

25-50 mg po qd

Question 11

statin for ACS

Answer 11

atorvastatin 80 mg (remember: high intensity regardless of LDL)

Question 12

metoprolol for rate control

Answer 12

2.5-5 mg IV bolus; up to 3 doses

Question 13

diltiazem for rate control

Answer 13

0.25 mg/kg IV bolus; 5-15 mg/hr infusion

Question 14

digoxin for rate control

Answer 14

12-15 mcg/kg per IBW (dose 6-8 hr apart)

Question 15

amiodarone for rate control

Answer 15

150 mg IV bolus; 0.5-1 mg/min infusion

Question 16

flecainide for cardioversion

Answer 16

200-300 mg po

Question 17

propafenone for cardioversion

Answer 17

600 mg po

Question 18

ibutilide for cardioversion

Answer 18

1 mg IV over 10 min; may repeat 1 mg

Question 19

amiodarone for cardioversion

Answer 19

150 mg IV bolus over 1 hr; then 1 mg/min x 6 hours, then 0.5 mg/min x 18 hours, then 400 mg po bid or tid for 7-10 days, until LD of 10 g reached

Question 20

amiodarone for maintenance of NSR

Answer 20

200 mg daily

Question 21

dronedarone for maintenance of NSR

Answer 21

400 mg daily

Question 22

dofetilide for maintenance of NSR

Answer 22

125-500 mcg bid

Question 23

flecainide for maintenance of NSR

Answer 23

50-150 mg bid

Question 24

magnesium sulfate for torsades

Answer 24

1-2 gm IV over 15 min, may repeat as needed, may follow with infusion of 0.5-1 gm/hr

Question 25

amiodarone for VT treatment

Answer 25

150 mg IV, then 1 mg/min x 6 hr, then 0.5 mg/min x 18 hr

Question 26

lidocaine for VT treatment

Answer 26

1-1.5 mg/kg IV load, then repeat 5-10 min later with 0.5-0.75 mg/kg, then maintenance infusion of 1-4 mg/min

Question 27

protamine for UFH reversal

Answer 27

1 mg protamine per 100 units heparin, slow infusion over 5-15 min, max is 50 mg in 10 min

Question 28

protamine for enoxaparin reversal

Answer 28

1 mg protamine per 1 mg enoxaparin, slow infusion over 5-15 min, max is 50 mg in 10 min

Question 29

enoxaparin for VTE prophylaxis

Answer 29

30 mg SQ q12h
(renal adjustment q24h)

Question 30

enoxaparin for VTE treatment

Answer 30

1 mg/kg SQ q12h
(renal adjustment q24h)

Question 31

enoxaparin for ACS

Answer 31

1 mg/kg SQ q12h

Question 32

fondaparinux for VTE prophylaxis

Answer 32

2.5 mg SQ qd

Question 33

fondaparinux for VTE treatment

Answer 33

5 mg SQ qd (<50 kg)
7.5 mg SQ qd (50-100 kg)
10 mg SQ qd (>100 kg)