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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Indication of heparin

A
  • Thrombosis

- Embolism treatment/prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Route heparin is given

A
  • IV (treatment)
  • SC (prophylaxis)
  • NEVER IM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dosage Form

A
  • 1000, 2500, 5000, 7500, 10000, 20000 units/mL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Renal dosing adjustment

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ADEs

A
  • Hypersensitivity
  • Hemorrhage: avoid all ASA products
  • Thrombocytopenia (HIT): monitor platelet
  • HyperK (suppression of aldosterone)
  • Osteoporosis (if use chronically)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

OSA

  • IV
  • SC
A
  • IV: Works immediately => good for rapid anticoagulation desired
  • SC: works in 20-30min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly