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Project - USMLE Step 3 > Hematology/Oncology > Flashcards

Hematology/Oncology Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the MOA for heparin?

A

Potentiate the effects of Antithrombin to primarily inhibit clotting factors 2a and 10a

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2
Q

What lab values should be followed when a patient is on heparin? (2)

What is considered therapeutic levels?

A

PTT (60-90 seconds is therapeutic)

Antifactor Xa levels

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3
Q

What is the half life of standard heparin and when will it cease to have an effect on a patient?

A

Standard heparin half life is 1 hour. Cease to have an effect on a patient in 4 hours.

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4
Q

What is the half-life for LMWH?

A

3-24 hours

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5
Q

What are the indications for heparin use?

A
  1. Venous Thrombosis: DVT, PE
  2. Acute Coronary Syndromes: Unstable angina, MI
  3. Afib in acute setting
  4. After vascular bypass grafting
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6
Q

What is the dosing for standard heparin?

A

Bolus initiated with 70-80 U/kg and followed by continuous infusion 15-18 U/kg/hr infusion)

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7
Q

When is heparin dosing not needed?

A

When the heparin is given subcutaneously.

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8
Q

What are the adverse effects of heparin?

A

Bleeding
Heparin induced thrombocytopenia
Possible osteoporosis
Rebound hypercoagulability after removal due to depression of antithrombin 3

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9
Q

What blood disorders are contraindications to heparin? (2)

A

Hemophilia and thrombocytopenia

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10
Q

How is heparin reversed? (2)

A

Protamine sulfate

If the patient has severe bleeding, give FFP

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11
Q

How does the MOA of LMWH differ from Heparin?

A

LMWH mostly inhibits 10a but not 2a as much as heparin

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12
Q

What are some names of LMWH?

A

Enoxaparin
Dalteparin
Tinzaparin

-PARIN

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13
Q

What labs need to be monitored with LMWH?

A

None, given subcutaneously

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14
Q

What is a contraindication for use of LMWH?

A

Severe kidney disease

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15
Q

What is the MOA of Warfarin? What factors does it affect?

A

Vitamin K antagonist. Leads to a decrease of clotting factors C, S, 2, 7, 9, 10

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16
Q

What lab values should be monitored on patients on warfarin?

A

PT (causes prolongation)

INR (causes an increase)

17
Q

How long does warfarin take to take effect?

A

4-5 days.

18
Q

How should warfarin should be bridged?

A

Start heparin. Once PTT becomes therapeutic, start warfarin. Check INR after 4 days to make sure it is between 2-3.

19
Q

What is considered a therapeutic PTT for patients on heparin?

A

60-90 seconds

20
Q

What is the INR goal for patients on warfarin and mechanical valves?

A

INR of 2.5-3.5

21
Q

What are the adverse effects of warfarin? (3)

A
  1. Hemorrhage. Do not use in patient susceptible to falls (alcoholics)
  2. Rare skin necrosis if protein C (which depends on vitamin K) drops
  3. Teratogen
22
Q

What is the mechanism of action for clopidogrel?

A

Blocks ADP to a specific platelet ADP receptor P2Y12 which reduces platelet activation and aggregation

23
Q

What lab value does clopidogrel affect?

A

Bleeding time increases

24
Q

What are the indications for anti-platelets like clopidogrel? (3)

A

Acute Coronary Syndrome like unstable angina, stable angina, STEMI, NSTEMI

Pretreatment for patients undergoing PCI

Treatment for patients for 1 year post-stents

25
Q

What is the loading dose for clopidogrel in patients who are about to undergo PCI?

A

600 mg

26
Q

What is the post-PCI dose of clopidogrel for patients?

A

75 mg/day for 12 months

27
Q

What are the side effects of antiplatelets clopidogrel?

A

Bleeding, bruising, purpura

28
Q

What is the MOA of -xaban inhibitors?

A

Inhibit clotting factor 10a. Similar to heparin, but does not affect 2a like heparin and does not have any effect on anti-thrombin

29
Q

What are the indications for -xaban inhibitors?

A

DVT prophylaxis in surgical patients and stroke prophylaxis patients

30
Q

What is the MOA for argatroban, dabigatran?

A

Direct thrombin inhibitors

31
Q

What are the indications for argatroban and dabigatran?

A

Used for the treatment of heparin induced thrombocytopenia

Project - USMLE Step 3 (82 decks)

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