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Fall 2024 > Pharm PAD > Flashcards

Pharm PAD Flashcards

1
Q

What is the biggest risk factor for PAD

A

Smoking

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2
Q

What is the pharmacologic treatment for smoking cessation

A

NRT - nicotine replacement therapy
Bupropion ER
Varenicline

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3
Q

What is risk factor management for patients <75 with clinical ASCVD diagnosis?

A

high intensity statin

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4
Q

What should be administered to patient with HTN and PAD

A

ACE or ARB

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5
Q

What should be given to patients at risk for PAD with low bleeding risk

A

Aspirin or clopidogrel

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6
Q

When is anticoagulation therapy (warfarin) indicated for PAD?

A

Only when other indication is present like mechanical heart valve, atrial fibrillation

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7
Q

How do you diagnose PAD?

A

Ankle brachial index

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8
Q

What do the ABI results mean?

A

> 1.4 - arteries non-compressible
1.0-1.40 - Normal
0.91-0.99 - borderline
<0.9 - abnormal

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9
Q

What are the medical therapy options for PAD?

A

Antiplatelet
Statin
Antihypertensive
Oral anticoagulation

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10
Q

What is the recommended antiplatelet therapy for symptomatic Class I PAD

A

Aspirin alone (75-325) or Clopidogrel alone (75)

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11
Q

What should be prescribed for patients that have PAD, a high CVD risk, and no increased bleed risk

A

Aspirin + clopidogrel

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12
Q

Should aspirin be used in asymptomatic patients with PAD

A

Controversial

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13
Q

What can be used for claudication treatment specifically?

A

Cilostazol; Pentoxifylline not recommended

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14
Q

Cilostazol drug info

A

Indication - intermittent claudication
Dose - 100mg PO bid
Antiplatelet agent
CI: CHF
ADE: bleeding, headache, diarrhea

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15
Q

What should be used in the case of an acute embolism or thrombosis that is limb threatening?

A

intra-arterial thrombolytic therapy - plasminogen activators

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16
Q

What are the plasminogen activators?

A

Streptokinase
Urokinase
rTPA - alteplase
Reteplase

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17
Q

Which plasminogen activator is most effective

A

rTPA > streptokinase

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18
Q

What makes streptokinase a poorer option than rTPA

A

lower fibrin specificity which causes increased bleeding risk

Longer half life = more bleeding (18 min)

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19
Q

What are the contraindications to using plasminogen activators?

A

Increased bleeding risk

Chronic occlusive dz s/t atherosclerotic dz

Thrombosis or a surgical bypass graft placed < 14 days prior

Acute embolic occlusion of a suprapopliteal vessel

Open surgical bypass

Endovascular mechanical thromboembolectomy may be more expedious

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20
Q

How is rTPA administered?

A

Bolus then continuous infusion through a catheter

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21
Q

How should chronic venous insufficiency be treated non-pharm?

A

Compression stockings and elevation of the legs

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22
Q

How should varicose veins be managed not pharm?

A

Compression stockings
Exercise/weight loss
Surgical intervention:
-Sclerotherapy
-Laser treatment
-Catheter assisted procedures using radiofrequency or laser energy
-High ligation and vein stripping
-Endoscopic vein surgery

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23
Q

What are the treatment approaches for DVT treatment?

A

Overlapping treatment approach
Transition treatment approach
Oral monotherapy

24
Q

Describe the overlapping treatment approach with DVT treatment

A

Either LMWH + warfarin bridge OR unfractionated heparin + warfarin bridge

25
Q

Describe the transition treatment approach with DVT treatment

A

LMWH to dabigatran OR edoxaban

26
Q

Describe the oral monotherapy approach to DVT treatment

A

Rivaroxaban - 3 week high dose OR apixaban - 1 week high dose

27
Q

Unfractionated heparin dosing

A

IV bolus 80 units/kg THEN
18 units/kg/hour

28
Q

LMWH dosing

A

Enoxaparin 1mg/kg SQ every 12 hours

29
Q

Fondaparinux dosing

A

*only if CrCl >30
Weight based:
<50kg - 5mg SQ every 24 hrs
50-100kg - 7.5mg SQ every 24 hrs
>100kg - 10mg SQ every 24 hrs

30
Q

Warfarin inhibits production of?

A

II, VII, IX, X and protein C and S

31
Q

How to handle warfarin dosing?

A

If below 2.0, booster dose and increase maintenance dose

If 3.1-3.4, hold 1/2 to 1 dose and decrease weekly maintenance

If 3.5-3.9, hold 1 dose and decrease weekly maintenance

If>=4.0, Hold until INR within target (1-2 doses) and decrease weekly maintenance

32
Q

Warfarin and NSAIDs

33
Q

Warfarin and trimethoprim/sulfamethoxazole or metronidazole

A

warfarin dose reduction 25-40%

34
Q

Warfarin and rifampin

A

reduced warfarin effects

35
Q

Warfarin and azole antifungals

A

warfarin dose reduction 25-30%

36
Q

Warfarin and amiodarone

A

warfarin dose reduction 33-55%

37
Q

Warfarin and St John’s Wort

A

AVOID - reduced warfarin effects

38
Q

Warfarin and alcohol

A

increased bleeding risk

39
Q

warfarin and smoking

A

reduced warfarin effects

40
Q

Warfarin and Vit K

A

reversal agent

41
Q

What diseases alter warfarin levels

A

Hyper/hypothyroidism
Heart failure
Liver disease

42
Q

When should levels be checked after initiating warfarin

A

INR within 4 days, no later than 7 days

INR monitoring 1-4 weeks for stabilization

43
Q

How to manage warfarin with procedures

A

invasive - bridge with LMWH
minimally invasive: possible adjustment of warfarin dose to maintain INR at lower therapeutic range

44
Q

What is the reversal for warfarin

A

Hold dose
Vitamin K
Factor Prothrombin Complex Concentrate if life-threatening bleed (add to vit K)

45
Q

dosing of transition treatment approach meds

A

Dabigatran - 150mg BID after 5-10 days of injectable anticoagulation

Edoxaban - 60mg daily after 5-10 days of injectable anticoagulation

46
Q

Durations of anticoagulation for DVTs depending on situation

A

-first episode & provoked - 3 months
-first episode and unprovoked - >= 3 months
-first episode w/ inherited/acquired thrombophilia - >= 3 months
-First episode of cancer-assoc. VTE - 3-6 months
-Second VTE - indefinite therapy

47
Q

What is the reversal agent for unfractionated heparin

48
Q

What ratios of protamine and anticoags

A

1mg neutralizes 100 units heparin
1mg neutralizes 1mg enoxaparin
*If LMWH >8 hours ago - 0.5mg for 1mg of enoxaparin

49
Q

What products can be used to reverse warfarin

A

Vitamin K
FFP
PCC

50
Q

Algorithm to for anticoagulation reversal

A

If signs and symptoms of bleeding w/ warfarin - vitamin K 10mg

If not ^ and INR < 5.0:
omit next dose of warfarin and restart at a reduced dose

If not ^ and INR 5-9:
Evaluate bleed risk (separate card)

If not ^ and INR >9:
omit next 1-3 doses of warfarin & administer vit K
Check INR 12-24 hrs and repeat Vit K as needed
Restart at a reduced dose once therapeutic

51
Q

If INR 5-9 and risk factors of bleeding risk

A

Omit next 1-3 doses and administer vit K
Restart at reduced dose

52
Q

If INR 5-9 and no increased bleeding risk but increased risk of thromboembolic complications

A

Omit next 1-3 doses of warfarin
Consider vit K
Restart at reduced dose

53
Q

INR 5-9 and no increased bleeding risk or risk of thromboembolic complications

A

Omit next 1-3 doses AND administer vit K
Restart at reduced dose

54
Q

Reversal of dabigatran

A

PCC
Idarucizumab

55
Q

Reversal of direct Xa inhibitors

A

aPCC
4PCC
Andexanet alpha

Fall 2024 (34 decks)

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