Heparin Flashcards
1
Q
Treatment dose of heparin
- Continue IV Infusion
- Weight based:
A
Continuous IV infusion:
- 5000-10,000 units bolus => then 1000U/hr. Titrate base on APTT
Weight based:
- LD: 80 units/kg
- MD: 18 units/kg/hr
Check aPTT Q6H or QID
2
Q
Prophylaxis dose of heparin
A
5000 - 10000 units SC Q8-12H
- Does not change PTT => no monitor
- SQ in lower abdomen, inner thigh, upper arm (rotate sites)
3
Q
Indication of heparin
A
- Thrombosis
- Embolism treatment/prophylaxis
4
Q
MOA
A
- Interferes with intrinsic pathway
- Act indirectly via a plasma cofactor anti-thrombin II => inhibit thrombin IIa and FXa.
- Neutralize activated clotting factors: 2, 9, 10, 11, 13.
5
Q
Route heparin is given
A
- IV (treatment)
- SC (prophylaxis)
- NEVER IM
6
Q
Dosage Form
A
- 1000, 2500, 5000, 7500, 10000, 20000 units/mL
7
Q
Monitoring parameter of Heparin
A
APTT: 1.5-2.5 x normal = 45-70s
- Check prior, 6H after initiation and 6H after any dose change
- After 2 consecutive w/in level => Q24H
CBC: Hgb, Hct, Platelet
- Monitor bleeding & HIT
8
Q
Renal dosing adjustment
A
NO
9
Q
ADEs
A
- Hypersensitivity
- Hemorrhage: avoid all ASA products
- Thrombocytopenia (HIT): monitor platelet
- HyperK (suppression of aldosterone)
- Osteoporosis (if use chronically)
10
Q
DDIs
A
Increase risk of bleeding
- Anti-platelet
- Thrombolytics
- Warfarin
- Cefoperazone
- Cefotetan
- Herbs: ginger, garlic, horse chectnut, feverfew, Vit E
- Ginseng: decrease INR
11
Q
OSA
- IV
- SC
A
- IV: Works immediately => good for rapid anticoagulation desired
- SC: works in 20-30min
12
Q
CI
A
Pt w/ potential to bleed more easily:
- Consume large amt of EtOH
- Actively bleeding
- Thrombocytopenia
- Intracranial hemorrhage
- Severe Hypertension
- Ulcerative lesions of GI tract
- Hx of HIT
13
Q
What is HIT
A
- Heparin induce thrombocytopenia => platelet count drops may fall < 100,000/mm3
- Occurs 5-14 days after starting heparin. Can occur up to 3 weeks after heparin d/c
14
Q
Drugs use for prevention/treatment of thrombosis in HIT
A
Direct thrombin inhibitor: directly inhibit clotting FIIa (thrombin) both bound and circulating
- Agatroban IV: Novastan => Liver dose adj
- Lepirudin IV: Refludan => Renal dose adj
- Bivalirudin IV: Angiomax => for PCI
- Desirudin (SC): Iprivask
- Dabigatran (PO): Pradaxa