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CACP > Parenteral Anticoagulants > Flashcards

Parenteral Anticoagulants Flashcards

1
Q

what class of anticoagulants contain a specific pentasaccharide sequence at the end?

A

UFH

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2
Q

how does UFH work

A

pentrasaccharide portion of the compound bind to AT (antithrombin)

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3
Q

what factors doe UFH work on?

A 
XIIa 
XIa
IX
Xa
and thrombin
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4
Q

what is the VD of UFH?

A

0.07L/KG

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5
Q

what parenteral agent is renally cleared at high doses?

A

UFH

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6
Q

what is the 1/2 life of UFH?

A

30-150mins

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7
Q

what are the two LMWH injections that are availabe in the US?

A

Enoxaparin

Dalteparin

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8
Q

how does the LMWH work?

A

indirectly inhibit clotting factors Xa and IIa by binding to AT (antithrombin)

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9
Q

what factors does LMWH inhibit

A

Xa

thrombin

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10
Q

what is the bioavalility of enoxaparin and dalteparin

A

enoxaparin: 92-100%
dalteparin: 87%

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11
Q

what is the time to peak of enoxaparin

A

3-5 hours

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12
Q

what is the time to peak for dalteparin?

A

4 hours

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13
Q

how is enoxaparin and dalteparin eliminated?

A

renally

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14
Q

what is the 1/2 life of enoxaparin?

A

4.5-7 hours

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15
Q

what is the 1/2 life of dalteparin?

A

3-5 hours

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16
Q

what factor does fondaparinux inhibit?

A

factor Xa

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17
Q

what is the bioavalibity of fondaparinux?

A

100%

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18
Q

what is the Vd of fondaparinux

A

7-11 L

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19
Q

what is the 1/2 life of fondaparinux

A

17-21 hours

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20
Q

what is the initial dosing for UFH for treatment of VTE

A

bolus 80units/kg (Max 5000units)

then 18units/kg infusion

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21
Q

what is the dose of UFH for STEMI/NSTEMI

A

bolus 60units/kg. (Max 4000units)

then 12 units/kg infusion (max 1000 units)

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22
Q

what is the dose of UFH for AFIB?

A

bolus 60units/kg. (Max 5000units)

then 12 units/kg infusion (max 1000 units)

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23
Q

what is the dose of UFH for pts with CABG

A

80-360units/kg

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24
Q

what is the dose of UFH for pts with cardiac AF ablation?

A

50-150units/kg

25
Q

what are the labs that you would want to monitor inpts that are using UFH

A

APTT

anti Xa

26
Q

what are the anti Xa levels for UFH
PPX:
treatment:

A

PPX: 0.1-03
TX: 0.3-0.7

27
Q

when do you draw aPTT and anti Xa levels for UFH (timing)
BOLUS:
Infusion:

A

post bolus: 6-8 hours

infusion: 4-6 hours

28
Q

what is the PPX dosing for VTE for enoxaparin?

A

30mg BID or 40mg daily

29
Q

what is the TX dosing for VTE for enoxaparin?

A

1mg/kg BID or 1.5mg/kg daily

30
Q

what is the STEMI dose for enoxaparin?

A

< 75 30mg IV bolus then 1mg/kg (BID)

> 75 NO BOLUS 0.7mg/kg (BID)

31
Q

what is the dose of dalteparin for VTE PPX

A

5000 units daily

32
Q

what is the dose of dalteparin for VTE Treatment?

A

100units/kg BID

200units/kg Daily for 1 month then 150units/kg daily

33
Q

what is the dose of fondaparinus for VTE PPX?

A

2.5mg Daily

34
Q

what is the TX dose of fondaparinux for VTE tX?

A

<50kg: 5mg daily
50-100kg: 7.5mg daily
>100kg: 10mg daily

35
Q

what is the dose of fondaparinux for ACS?

A

2.5mg Daily

36
Q

For pts with CrCl less than 30ml/min what is the PPX and TX dose of enoxaparin?

A

PPX: 30mg daily
TX: 1mg/kg daily

37
Q

Can fondaparinux be use in pts with CrCl less than 30ml/min?

A

NO - contraindicated

38
Q

what are the anticoagulants of choice in pt undergoing HD?

A

Heparin

warfarin

39
Q 
For patients that are overweight what is the recommended dose of  for VTE TX
Enoxaparin 
Fondaparinux 
UFH 
Dalteparin?
A

Enoxaparin: 1mg/kg BID
Fondaparinux: 10mg daily
UFH: 80units/kg bolus then 18units/kg

40
Q

For pts with Morbid obesity what are the recommended doses for VTE PPX

Enoxaparin
Fondaparinux
UFH
Dalteparin?

A

Enoxaparin: 40mg BID
Fondaparinux: 2.5mg daily
UFH: 7500 units TID
Dalteparin: 7500 units daily

41
Q

what parentral agent is contraindicated for pts that weight less than 50kg?

A

Fondaparinux

42
Q

In what cases are parentreral Direct thrombin inhitbtors used?

A
  1. HIT
  2. ACS/PCI
  3. Antithrombin deficency
  4. heparin allergy
  5. no response to heparin
43
Q

what are the 2 parenteral Direct thrombin inhibitors

A

argatroban (Acova)

Bilvalirudin (Angiomax)

44
Q

what is the brand name for bilvalirudin

A

angiomax

45
Q

what is the dose of argatroban for HIT?

A

2mcg/kg/min.

adjust to aPTT of 1.5-3x baseline aPTT

46
Q

what are the labs that need to be monitored for agatroban and bilvalirudin?

A

aPTT

ACT (activated clotting time)

47
Q

which Direct thrombin inhibitor is more likely to cause false elevated INRs?

A

Argatroban

48
Q

what is the dose of argatroban for MI?

A

100mcg/kg IV bolus then 1-3mcg/kg/min

49
Q

what is the DTI of choice in pts under going cardiac bypass and cardiac catherterization?

A

Bivalirudin

50
Q

what DTI can be eliminated via hemodialysis?

A

Bivalirudin

51
Q

T or Fase the rise of INR during parenteral DTI infusion is false elevation and does not reflect any anticoagulation effect

A

TRUE

52
Q

How does hypothermia effect bivalirudin elimination?

A

reduces it

53
Q

what are the common ADE with argatroban?

A 
chest pain/hypotension
Diarrhea 
vomiting 
headache
back ache
dypnea
54
Q

what is the common ADE with heparin?

A

thrombocytopenia

increase liver amiotransferase level

55
Q

what is the common ADE for enoxparin (LOVENOX)?

A 
Diarrhea/nausea
anemia
hemorrhage 
thrombocytopenia 
increase LFTs
Fever
56
Q

what are the Common ADE for Dalteparin(FRAGMIN)

A

Hematoma
bleeding from nose
irration at local site of injection

57
Q

what are the common ADE for fondaparinux (ATRIXA)

A

injection site rash

fever

58
Q

what is the dose of bivaliruding (angiomax) for HIT?

A

0.15mg/kg/hour IV

adjust aPTT to 1.5-2.5 x baseline

CACP (8 decks)

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