IR Pharm

Question 1

how to treat acute hypertensive crisis during intervention on pheochromocytoma or paraganglioma

Answer 1

5 mg IV phentolamine followed by continuous infusion to titrate blood pressure

Question 2

what can be given to reduce post-embolization inflammation

Answer 2

steroid taper 7-10 day (medrol dose pack)

Question 3

post-embolization syndrome management

Answer 3

1. pain control
2. IV hydration
3. antiemetics

Question 4

can NOACs be used for patients with mechanical valves

Answer 4

no

Question 5

Postoperatively when can LMWH be resumed

Answer 5

24 hours after the procedure

Question 6

Recommendations for Dosing and Monitoring Bridge therapy with enoxaparin

• what is the therapeutic dose
• what is the low dose regimen
• what level of creatinine requires dose adjustment

Answer 6

1. 1 mg/kg twice daily or 1.5 mg/kg daily
2. 30 mg twice daily
3. <30 ml/min

Question 7

guidelines for warfarin reversal with no significant bleeding

Answer 7

• greater than 3 but less than 5 with no bleeding: lower dose or hold dose
• greater than 5 but less than 9 with no bleeding: hold 1-2 doses, or hold dose and give vit K 1.25-2.5 mg PO, if rapid reversal needed give vit K 5 mg
• if 9 or greater, hold dose and give vit K 2.5-5mg PO

Question 8

guidelines for warfarin reversal with serious bleeding

Answer 8

hold dose, give vit K 1-10 mg IV via slow infusion and supplement with FFP, prothrombin complex concentrates (PCC), or recombinant factor VIIa

Question 9

recommended route of vitamin K administration

Answer 9

PO

• IV can cause anaphylaxis
• IM can cause a hematoma
• sub Q is less predictable

Question 10

recommendations for the use of anticoagulation bridge therapy

Answer 10

1. high risk for VTE: bridge anticoagulant with therapeutic dose of subQ LMWH or IV UFH
2. Moderate risk: bridge with therapeutic dose of subQ LMWH, therapeutic dose of IV UFH, or low dose subQ LMWH
3. Low risk: bridge with low dose subQ LMWH or just hold anticoagulant

Question 11

• when should warfarin be stopped prior to a procedure
• when can warfarin be resumed

Answer 11

• 5 days
• 12 to 24 hours

Question 12

How to administer factor VII for warfarin reversal

Answer 12

• 15-90 mcg/kg IV
• vitamin K should be administered at the same time to stimulate factor production

Question 13

benefits and risks with using factor VII for warfarin reversal

Answer 13

• it works faster than vitamin K
• can cause increased risk of thromboembolism, short half-life, very expensive

Question 14

how to reverse heparin with protamine

Answer 14

Protamine for IV heparin infusion
- 1-1.5 mg per 100 units of heparin given if heparin just given
- 0.5-0.75 mg per 100 units of heparin if heparin given 30-60 minutes ago
- 0.25-0.375mg per 100 units of heparin if heparin given > 2 hours ago

Question 15

when placing G tubes, how long does it take for IV glucagon to take effect and how long does it last for

Answer 15

The glucagon generally takes effect in 30 to 45 seconds and lasts 7 to 10 minutes,