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Dosing Exam 1 > IV Anticoagulants > Flashcards

IV Anticoagulants Flashcards

1
Q

Heparin MOA

A

Binds with antithrombin to inactivate factor II and X

Also inactivates IX, XI, and XII

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2
Q

Heparin onset

A

SQ-20-30 minutes

IV- immediately

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3
Q

Heparin PK/PD

A

No renal dose adjustment

Recommended anticoagulant in dialysis patients

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4
Q

Heparin VTE Treatment dose

A

80 units/kg IV, then 18 units/kg/hr IV

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5
Q

Heparin ACS treatment dose

A

60 units/kg IV, then 12 units/kg/hour IV

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6
Q

Heparin is dosed based on:

A

Total body weight

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7
Q

Heparin Titration

A

Stop at Q6 hour aPTT check after 2 aPTTs in range –> daily aPTT checks

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8
Q

Therapeutic heparin indications, monitoring of efficacy and monitoring of AE?

A

VTE, afib, ACS
aPTT/anti-Xa per protocol
Platelets, Hgb/Hct

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9
Q

Prophylaxis heparin indications, monitoring of efficacy and monitoring of AE?

A

VTE prevention
None
Platelets, Hgb/Hct

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10
Q

Lovenox (enoxaparin) MOA

A

Binds with antithrombin to inactivate X and II (mainly X)

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11
Q

Lovenox Onset and duration

A

Peaks 3-5 hrs

Last ~12 hours

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12
Q

Lovenox requires ____ and is dosed on ____

A

Renal adjustment

Total body weight

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13
Q

Lovenox Therapeutic used when and dose

A

ACS, VTE (PE/DVT)

1mg/kg SQ q12h

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14
Q

Lovenox Alt Dose

A

1.5 mg/kg SQ daily

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15
Q

Lovenox prevention of VTE dose for medical/surgical if CrCl greater than 30

A

40 mg SQ daily

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16
Q

Lovenox prevention of VTE/propylaxis dose for knee replacement if CrCl greater than 30

A

30 mg SQ BID

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17
Q

Lovenox therapeutic dose for medical/surgical if CrCl less than 30
What if CrCl greater than 30?

A

1 mg/kg SQ daily

1 mg/kg SQ Q12h

18
Q

Lovenox prevention of VTE/propylaxis dose if CrCl less than 30

A

30 mg daily

19
Q

Lovenox monitoring

A

Anti-Xa

20
Q

Monitoring is indicated when used in:

A

Pregnancy
Extremes of weight (less than 45 or greater than 190 kg)
CrCl less than 30
High risk of bleeding or VTE

21
Q

**Anti-Xa monitoring is ordered

A

4 hours after dose for peak concentration

dose adjustments = order after 4 hrs

22
Q

Fragmin (dalteparin) MOA

A

Binds with anti-thrombin to inactivate factor X and II

23
Q

Fragmin Onset and excretion

A

Peaks 1-2 hrs

Renally excreted

24
Q

Fragmin Onset and excretion

A

Peaks 1-2 hrs

Renally excreted

25
Q

Fragmin VTE Prophylaxis during acute illness dose

A

5000 units SQ daily

26
Q

Reversal of Heparinoids Agent =

A

Protamine sulfate

27
Q

Protamine sulfate dose to reverse Heparin

A

1 mg neutralizes ~100 units of heparin

MAX = 50 mg

28
Q

Protamine sulfate dose to reverse Enoxaparin

A

Anti-Xa activity will never be completely neutralized

Dependent on last dose administered

29
Q

Thrombocytopenia includes:

A

Thrombocytopenia (50% platelet fall or less than 150)
Timing (5-10 days after heparin use)
Thrombosis

30
Q

Arixtra (fondaparinux) MOA

A

Inhibit Factor Xa
Can be used in HIT
Must be renally adjusted

31
Q

Arixtra Prophylaxis Dosing

A

2.5 mg SQ daily

32
Q

Arixtra Treatment Dosing

A

Less than 50 kg: 5 mg SQ daily
50-100kg: 7.5 mg SQ daily
Greater than 100: 10 mg SQ daily

33
Q

Argatroban MOA

A

Direct thrombin inhibitor

34
Q

Agratroban Indication

A

Prevention/treatment of thrombosis in HIT pts

PCI intervention pts with HIT or history of HIT

35
Q

Agratroban Monitoring and other considerations

A

aPTT
Prolongs INR
Renal dose adjustment

36
Q

Warfarin + Argatroban

A

For at least 5 days before discontinuation of argatroban

37
Q

D/C Less than 2 mcg/kg/min infusion of argatroban if

A

INR greater than 4

Repeat INR 4-6 hrs later and restart if INR is less than 2

38
Q

D/C Greater than 2 mcg/kg/minute infusion of argatroban if:

A

Reduce dose to 2 mcg/kg/min
Check INR 4-6 hrs after adjustment (stop if INR greater than 4)
Then recheck 4-6 hrs and restart if INR is less than 2.

39
Q

Angiomax (bivalirudin) MOA

A

Direct thrombin inhibition

Renal adjust for CrCl less than 30

40
Q

Angiomax Monitoring

A

HIT- aPTT

PCI- ACT

Dosing Exam 1 (8 decks)

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