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questions 1 Flashcards

1
Q

what should the dose of Aspirin be if also on an antiplatlet?

A

75-100mg (81mg dose)

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2
Q

what is the dose of protamine for the resversal of Heparin

A

1mg of protamine for every 100 units of heparin (up to 50mg) give slow IV over 10 mins

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3
Q

what is the dose of protamine for the reversal of Dalteparin

A

1mg IV for every 100 anti-Xa units of Dalteparin

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4
Q

what is the dose of protamine for the reversal of enoxparin?

A

1mg IV for every 1mg of enoxaparin in the previous 8 hours (if more than 8 hours but less than 12 hours since last dose may only need to give 1/2 (0.5mg/1mg of enoxaparin)

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5
Q

what drug is used for patients with heparin induced thrombocytopenia (HIT)

A

Bivalirudin (angio max)

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6
Q

what is the dose of Bivalirudin for HIT?

A

0.15mg/kg/hour continuous IV infusion

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7
Q

what is the dose of Bivalirudin for PCI (percutaneous Coronary intervention thrombosis) Prophylaxis

A

0.75mg/kg bolus then 1.75mg/kg/hr IV infusion

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8
Q

what is the dose of heparin for thromboembolic disorder (prophylaxis) the 1st trimester of pregnancy?

A

5000-7500 units subQ every 12 hours

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9
Q

what is the dose of heparin for thromboembolic disorder (prophylaxis) in the 2nd trimester of pregnancy

A

7500-10000 units SQ every 12 hours

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10
Q

what is the dose of heparin for thromboembolic disorder (prophylaxis) in the 3rd trimester of pregnancy

A

10000 units SQ every 12 hours

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11
Q

can warfarin and heparin be use while breast feeding?

A

yes!

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12
Q

what is the equation to calculate INR?

A

[PT of the patient/ PT of the normal range mean] ^ISI

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13
Q

Calculate CHADSVASc sore.

A 
Congestive heart failure   - 1
Hypertension - 1
Age > 75 - 2
Diabetes - 1
Stroke (TIA) -2 
Vascular disease - 1
Age 65-74 -1
Sex - FEMALE - 1     (0 if you are a male)
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14
Q

what is the therapy recommendations for pts with a CHADS VASC score of 0

A

dont give then anything

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15
Q

what is the therapy recommendation for pts with CHASDVASc score of 1

A

OAC (DOAC > warfarin) or Aspirin 81mg or no therapy

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16
Q

what is the therapy recommendation for pts with CHADSVACs score of 2

A

Oral anticoagulation recommended (DOAC preferred over warfarin)

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17
Q

which board governs regulation of labs?

A

The Centers for Medicare & Medicaid Services (CMS)

regulates all laboratory testing (except research) performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA)

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18
Q

Is CLIA state or federal?

A

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 are United States federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research.

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19
Q

Which regulation established the laboratory standard in the US?

A

The OSHA Laboratory Standard (Occupational Exposure to Hazardous Chemicals in Laboratories, 29 CFR § 1910.1450) is the primary regulation, but laboratory personnel and EHS staff should understand its relationship to the hazard communication standard.

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20
Q

What types of labs have to register with CLIA?

A

all labs examining “materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings.”

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21
Q

What are the 3 levels of CLIA testing?

A

Waived tests
moderate complexity tests
high complexity tests.

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22
Q

What is a CLIA-waived laboratory test?

A

Point of Care Testing, are low complexity tests (including Hemoglobin and Hematocrit) that may be performed by other personnel with proper training.

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23
Q

what Vit k dependent protein has the longest 1/2 life

A

PROTHROMBIN (Factor II). - 60 hours

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24
Q

what Vit K dependent protein has the shortest 1/2 life

A

Factor VII and protein C (3-6 hours)

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25
Q

which genetic thrombophilia work up can be affected by warfairn

A

Protein C and S deficiency

APS (lupus anticoagulant), antithrombin

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26
Q

how to congestive HF exacerbations effect warfarin/INR

A

increase response to warfarin Increases INR

BECAUSE: increase in hepatic congestion and decreased warfarin catabolism.

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27
Q

how normal blood clots when a blood vessel is injured

A
  1. platelets are drawn to site of injury and from a loose c plug
  2. Factor V enzyme reactions on the surface of the platelets generate fibrin, fibrin holds the platelets together (CLOT)
  3. when there is enough fibrin APC ( protien c) inactivates factor V stopping the clot from growing
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28
Q

what is factor V Leiden

A

is when pts have a mutation in their factor V gene , that is resistent to APC.

therefore APC has a harder time stopping the clot from growing. (APC resistance)

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29
Q

how much does your risk of VTE go up with heterozygous vs homozygous Factor V leiden

A

homo: goes up by 25-50 fold
hetero: 5-7 fold

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30
Q

how does cimetidine effect warfarin

A

inhibits hepatic microsomal activity, decreaseing the metabolic clearance of warfarin (INCR INR)

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31
Q

what are major medications that inhibit metabolism of warfarin (increase INR/bleeding risk)

A

Amiodarone Garlic
Cimetidine Ginger
Aspirin Ginseng
Dapsone Gingko biloba
Erythromycin Green tea
Metronidazole
Indomethacin
Cotrimoxazole

Fluconazole
Amiodarone
Bactrim
Flagyl

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32
Q

What are the major medications that induce metabolism of warfarin (decrease INR)

A

rifampin
barbiturates
carbamzeprine
phenytoin

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33
Q

which enantiomer of warfarin is the most potent

A

S -is 5x more potent than R producing the anticoagulation affect

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34
Q

which enantiomers of warfarin is protein bound, which is bound mainly to albumin

A

S- albumin

R- protein

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35
Q

what is the major enzyme that metabolizes warfarin

A

CYP2C9: those who have mutations in this

CYP2C92 and CYP2C93 require sig less warfarin dose

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36
Q

which enantiomers of warfarin is effect the most by CYP2C9

A

S

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37
Q

which enantiomer of warfarin does amiodarone affect

A

S

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38
Q

what do you recommend to a patient with bleeding gums

A

press firmly on the part of the gum that is bleeding for 30 mins
Dont: drink hot beverages, use straw, spit, rinse, smoke for 24 hours

avoid hard foods 1-2 days, if bleeding does not stop in 1-2 days contact your dentist or doctor

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39
Q

what do you recommend to a patient with nose bleeding

A

squeeze your nostrils together with your fingers below the bone. Hold it for 5 mins straight, if that doesnt work try a decongestant nose spray

  • put 2 squirts in the bleeding nostril
  • squeeze your nostrils together for 15 mins
  • do it again if you’re still bleeding
  • go to the ER if it doesnt stop after 3 tries
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40
Q

what is the alternative therapy for pts with heparin allergy

A

(lepirudin), bivalirudin, and argatroban

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41
Q

What type of HIT is NON-immune

A

HIT Type 1

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42
Q

what is the treatment for type 1 HIT?

A

Do not discontinue heparin

(slight fall in platelt count within 1st 2 days after heparin plts >100,000, returns to normal with continued heparin admin)

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43
Q

which type of HIT is immune

A

TYPE 2

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44
Q

Do we need to discontinue Heparin for HIT 2?

A

YES

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45
Q

what is the most commonly acquired thrombophillia?

A

Antiphospholipid antibody syndrome

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46
Q

what are some ways a patient can acquire a thrombophilia

A
  • pregnancy
  • HIV
  • SLE (systemic lupus erythematosus)
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47
Q

what is the only DOAC that is approved for PPX of VTE in acute medically Ill pts at risk for thrombosis and what is the dose

A

Rivaroxaban 10mg daily while inpt.

after discharge continued fro 31-39 days

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48
Q

what is the the only DOAC that is approved for the risk reduction of MACE (CV death, MI, and chronic CAD/PVD) and what is the dose

A

Rivaroxaban 2.5mg BID

+ Aspirin 81mg daily

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49
Q

what are the two DOAC that require lead in with parentral agents for 5-10 days prior to start for the TX of VTE

A

Dabigatran and Edoxaban

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50
Q

what would you do if warfarin pt has INR >10 and no active bleeding.

A

Hold warfarin and give 2.5mg mg Orally to decrease risk of hemorrhargic complications.

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51
Q

what are the factors that warfarin works on? which also are the vit K dependent factors

A

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

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52
Q

if pt has active bleeding on warfarin what are the reversal agents that you can give?

A
  1. Vit K IV (5-10mg)

2. K-centra (4FPPC)

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53
Q

why is PCC preferred over FFP

A

PPC doesnt need to be cross matched

  • no fluid overload
  • no bld borne pathogens,
  • allergic reactions
  • also has decrease ICH compared to FFP
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54
Q

what is the difference between 4F PCC and 3FPCC

A

4FPCC: has factors II, VII, IX, X and protein C &S

4FPCC: also has heparin so dont use in pt with HIT

3FPCC : ONLY has II, IX, X = so not as effective

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55
Q

what is the dose of 4FPCC (Kcentra) with the following INR readings

INR 2-3.9
INR 4-6
INR >6

A

INR 2-3.9 = >25 IU/Kg
INR 4-6 = > 35 IU/Kg
INR >6= > 50 IU/Kg

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56
Q

what is the reversal agent of fondaparinux

which one and what dose (if there is one)

A

there is one specific for it but you can use Recombinant factors VII

10-40mcg/kg/IV

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57
Q

what is the dose of IV Vit K

A

5-10mg/ml (1mg/min in at least 50ml infused over 30-60mins to decrease risk of reactions)

dont use SQ d/t irratic abs
IM= hematoma

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58
Q

what is the pregnancy category for
protamine?
Vit K?

A

protamine and Vit K = C

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59
Q

what is the onset of action of protamin

A

5mins

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60
Q

what are the risks (ADE with protamine)?

A

angiodemia
pulmonary edema
thrombocytopenia

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61
Q

what are the factors in Fresh frozen plasma ? FFP

A

II, VII, IX, X

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62
Q

what is the onset of action of FFP

A

1-4 hours

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63
Q

how is k-centra supplied

A

500-1000 unit vials

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64
Q

what is the difference between
Kcentra PCC4
Belulin PCC3
Profiline PCC3

A

Kcentra PCC4:II, VII, IX, X and protein C&S
room temp or fridge

Belulin PCC3: II, VII very little , IX, X (needs to be thawed cause it has to be refrigerated

Profiline PCC3: II, VII Very little, IX, X
room temp or fridge

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65
Q

what is the onset of action for
Oral VITK
IV VITK

A

Oral VITK : 12-24 hours
IV VITK : 4-12 hours

it can take up to 12-48 hours before we see effects

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66
Q

what are the 2 antidotes for fibrinogic/thrombolyutic (tpa, tenekplase) agents

A

aminocaproic acid
transexamic acid

Clotting promoter
It can treat conditions that cause excessive bleeding. It can also control bleeding during or after surgery.

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67
Q

what is the dose of transexamic acid?

A

1g IV 10mins then

1g over 8 hours

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68
Q

what is the dose of amiocaproic acid?

IV
PO

A

4-5g IV over 1 hours then
1g IV over 8 hours

PO: 5g 1st hour then 1g every hour for 8 hours

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69
Q

how do you switch from UFH to LMWH or fondaparinux

A

stop UFH 1-2 hours after 1st dose of LMWH or fonda

70
Q

how do you swtich from UFH to DOAC

A

START DOAC a tthe same time that UFH is discontinued

71
Q

how do you go from LMWH to UFH

A

start UFH within 6 hours of the next schedule time for LMHW dose

72
Q

how do you go from DABI to parentral agent ?

A

if CrCL > 30ml/min: Stop DABI and start parentral agent at next schedule time for Dabi dose

CrCl <30ml/min: stop DABI and wait 24 hours before starting parentral agent

73
Q

For pts that have to be on DAPT (due to High CAD risk like MI < 6wks ago, baremetal or drug eluding stent < 6wks) and must have surgery now can’t wait until DAPT is no longer indicated what should you do for low bleeding risk procedures?

A

take DAPT until 1 day prior to procedure

74
Q

For pts that have to be on DAPT (due to High CAD risk like MI < 6wks ago, baremetal or drug eluding stent < 6wks) and must have surgery now can’t wait until DAPT is no longer indicated what should you do for HIGH bleeding risk procedures?

A
  • stop ASA 7 day prior
  • stop plavix (APP) 5 days prior
  • bridge with GP IIb/IIIa
    Tirofliban: stop 3-6 hours prior to procedure
    epitifibade: stop 4-12 hours piror to procedure
75
Q

For pt with acute coronary syndrome (STEMI) what is the duration of therapy that is recommended with anticoagulant?

A

therapy with any anticoag for 48 hours or until PCI

MAX 8 days

76
Q

what are the 2 main anticoagulants for the tx of NSTE_ ACS and STEMI?

A

UFH and LMWH

77
Q

what is the dose of LMHW for NSTE-ACS

A

1mg/kg BID until PCI

78
Q

what is the dose of LMHW for STEMI?

A

<75 30mg IV bolus then 15 later 1mg/kg BID

> 75 NO BOLUS then 0.7mg/kg BID

79
Q

what other parentral agents can be used for NSTE-ACS or STEMI?

A

Fondaparinux
Bivalrudin

these are mainly as adjunctive therapy or if the pt also has HIT

80
Q

what is the Bivalrudin dose for
NSTE-ACS?
STEMI?

A

0.1mg/kg. then 0.25mg/kg/hr

STEMI: 0.75mg/kg bolus then 1.75mg/kg/hr

81
Q

what is the most common valvualar issues from most to least ?

A

Mitral regurgitation (backward flow) > Aortic regurg >Aortic stenosis (increase resistance to flow) > mitral stenosis

82
Q

what are the risk factors for VTE in pts with prosthetic heart valves?

A
  1. atroventricular position
  2. prior VTE
  3. Multiple prosthetic valves
  4. AFIB
  5. mitral stenosis
  6. Ejection Fractions < 35%
83
Q

what are the HIGH VTE risk valves

A
  1. prosthetic mitral valves (mechanical)
  2. cage and ball valve
  3. aortic tiliting disc valve

if pt has had thrombotic even in the past 6 months

84
Q

Moderate VTE risk for valves

A

bileaflet aortic valve with 1 of the following

AFIB, storke, TIA, HTN, CHF, DM, Age >75

85
Q

Low VTE risks for valves

A

any bileaflet aortic valve

86
Q

what is recommended for all bioprosthetic heart valve pts
Mitral:
Aortic:

A

Mitral: VKA for 3 months then low dose ASA
Aortic: ASA

Same thing for repair and replacement

87
Q

Mitral clip is a catheter directed procedure to attach a clip to help mitral valve close more completely. Mainly for pts with severe HF (III,IV) that cant undergo heart surgery: what is the recommended anticoag therapy

A

ASA 325 for 6- 12 months

or

plavix 1 month

88
Q

There are 2 types of LVAD (Axial flow and centrifugal) what is the preop recommendation for LVAD

post op?

A

stop warfarin and any anticoagulant 5 days prior and bridge with UFH

POST OP start HEPARIN day 1 and ASA if possible. Dont start warfarin until all the tubes are out.

89
Q

LVAD cans alert what coag factors and how

A

decrease: F XI and XII

90
Q

what disease can LVADs cause

A

it causes hemolysis because of the turbulant flow = Von Willebrand disease = plt dysfunction

91
Q

can you use DAPT for pts that are undergoing cardioversion/ablation?

A

NO wait until DAPT is no longer required

92
Q

how long after cardioversion/ablation should pt remain on anticog therapy

A

at least 3 months

93
Q

if you have to stop anticoag therapy for cardioversion/ablation what can you bridge with?

A

Aspirin

94
Q

How long is VKA recommended before and after a cardioversion?

A

3 wks before

4 wks after

95
Q

watchman procedure is sucessful if it has less that what % leak

after 45 days of VKA what anticoag regimen is recommended?

A

sucessful if less than 5% leak

after 45 days - start plavix and aspirin 325 for 6mths

after 6mths still no leak Aspirin 325 ONLY

96
Q

what are the 10 risk factors for VTE

A
  1. Advance age
  2. prolonged immobility
  3. pregnancy/postpartum
  4. obesity
  5. cancer
  6. frail/chronic illness
  7. thrombophillia
  8. prior VTE
  9. hormone therapy
  10. medical illness (IBS, nephroci syn, vasculitius)
97
Q

for acute PE you can possibily use thromblyics either systemic or catheter directed. what are the two thrombolytics that can be used?

A
  1. Alteplase

2. tenecteplase

98
Q

what is the dose of alteplase?

A

10mg IV bolus then 90mg IV over 2 hours

50-100mg Bolus for Cardiac arrest

99
Q

what is the dose of tenecteplase?

A 
<60kg - 30mg 
60-70 - 35mg 
70-80 - 40mg
80-90 - 45mg 
>90 = 50mg.

ALL IV BOLUSS

100
Q

what are the abosulte CI for thrombolytics (7)

A
  1. active bleeding
  2. previous ICH
  3. structrual intracranial disease
  4. ischemic stroke < 3 mths
  5. brian/spinal surgery < 3mths
  6. head trauma < 3 mths
  7. bleeding conditions
101
Q

IVC filters are recommended for all pts that have CI for anticoag therapy what are some reasons why they would have CI?

A

massive PE tx with thrombolysis
Chronic PE Tx with thrmboendartrectomy
recurrent VTE despite adequate anticoag and inablity to increase anticoag

102
Q

what is the most common thromophilic state?

A

Factor V lieden

103
Q

What factors do Factor V Liden prevent inactivation of?

A

V and VIII therefore the these two factors stick around longer and increase thrombosis

104
Q

what is the difference between TYPE 1 and TYPE II Protein C deficiency?

A

TYPE1: general decrease in the amt of protein C (decrease synthesis)

TYPE II: the amount protein C is unchanged but there are less functioning ones (dysfxn)

105
Q

what does the level of protein C activity assay have to be in order to show deficiency?

A

<55%

106
Q

Protein S deficiency is found as both bound and free and normally found 60% bound and 40% free which two factors does it prevent the inactivation of?

A

V and VIII (just like protein C deficency)

107
Q

what is the difference between Protein S deficiency TYPE I, II, III

A

TYPE I - both free and bound are decreased
TYPE II- the total number of protein is unchanged but they dont work (dysfunction) - rare

TYPE III - total number is the same but Disproportionally bound (more BOUND than Free)

108
Q

what can decrease protein S? (6)

A
  1. Pregnancy
  2. liver disease
  3. estrogen therapy
  4. Warfarin therapy
  5. DIC
  6. Nephrotic syndrome
109
Q

what does Protthrombin 20210 gene mutation do?

A

dominate gene mutation on factor II therefore it increases the levels of prothrombin by 30% = more clots

110
Q

Antithrombin deficiency is when you are deficient in antithrombin (natural anticoagulant) that decreases/inactivates what factors?

A 
II
IX
X
XI
XII
111
Q

what is the difference in type I and type II antithrombin?

A

Type I: decrease activity

Type II: abnormal function (mainly mutation at the thrombin binding site)

112
Q

what are the 8 types of acquired antithrombin deficiency?

A
  1. Sepsis
  2. pregnancy
  3. liver disease /fatty liver
  4. DIC
  5. acute thrombosis
  6. Chemotherapy
  7. nephrotic syndrome
  8. Heparin therapy
113
Q

how do you diagnosis APS (antiphospholipid antibody syndrome)?

A

pregnancy morbidity or vascular thrombosis

+
a positive test of one the following

  1. lupus anticoagulant
  2. Beta 2 glycoprotein antibodies
  3. cardiolipin antibodies

you then have to confirm 12 wks later

114
Q

Systemic lupus erythematousus can cause which thrombophilia?

A

APS (antiphospholipid syndrome)

115
Q

how does dysfibrinogenemia work?

A

mutation on the fibrinogen = doesnt work well (decrease fibrin formation)

116
Q

which thrombophilia can effect Pt/INR therefore try and use chromogenic X activity assay?

A
  1. Dysfibrinogenemia (PT is prolonged)

2 APS

117
Q

how long do you have to discontinue anticoagulant before testing for thrombphilia?

A

2 wks

118
Q

preganancy can increase which factors

A

II, VII, VIII, X

119
Q

what are the acquired thrombophillia in pregnancy?

A

protien S deficency

antithrombin deficiency

120
Q

which thrombophllia causes both venous and arterial clots?

A

Lupus anticoagulant

Antiphosphlipid anticoagulant

121
Q

what are the two thrombphillias that are identified using genetic testing?

A

factor V liden and

prothrombin gene G20210 A mutation

122
Q

which anticoagulants can affect Lupus anticoagulant testing?

and how it is +/-

A

ALL OF THEM (heparin, LMWH, warfarin, DTI, DOAC)

MAKE IT A False positive +

123
Q

which anticoagulants affect Beta glycoprotein 1 antibody testing and anticardiolpin antibodies?

A

NONE of them

124
Q

which anticoagulants affect testing for factor V Lieden?

A

NONE (genetic testing)

125
Q

which anticoagulants affects testing for prothrombin gene muatation

A

NONE (genetic testing)

126
Q

which anticoagulants affects testing for activated protein C resistance?

A

NONE

127
Q

which anticoagulant affects protein S and Total antigen testing?

A

warfarin

128
Q

Factor Xa inhibitors (riva, apixa, edox) can falsely increase which thrombphillia assay?

A

protein C antigen

129
Q

Direct thrombin inhibitors can falsely increase which thromphillia assay?

A 
antihrombin activity (NOT antigeN)
Protein C and S activity ( NOT ANTIGEN)
130
Q

warfarin can decrease which thrombophillia assay?

A

Anthrombin activity

and any protein C and S activity or antigen assay

131
Q

LMWH can decrease which thrombophillia assay?

A

Antithrombin activity and antigen

132
Q

LMWH can increase which thrombophillia assay

A

protein C and S activity

133
Q

Heparin can decrease which thrombophillia assay?

A

antithrombin activity and antigen

134
Q

heparin can increase which thrombphillia assay

A

protein S activity

135
Q

what is HIT type 1?

A

non-immune reaction due to plt aggregation which can cause modest decrease in plts

rarely doe they go below 100

136
Q

what is HIT TYPE II

A

plt activating immune complex = IgG binds to heparin =PF4 complex which take about 5 days from initial heparin exposure to do

  1. bind to monocytes/endothellia cells = tissue factor production = thrombosis
  2. release of microparticles = thrombosis
  3. lease to plt aggregation and consumption = thrombocytopenia
137
Q

what are the arterial and venous complications for HIT

A

arterial: MI, Stroke, limb ischemia
venous: PE, DVT, venous limb gangrene (esp when HIT happened in the presence of warfarin, thats why you have to reverse warfarin)]

more venous than arterial

138
Q

what are the cutaneous manifestations of HIT

A

skin necrosis at heparin injection site

warfarin induced necrosis

bilateral adrenal hemorrhage

139
Q

what is the only FDA approve tx for HIT?

A

argatroban at 2mcg/kg/min

140
Q

To monitor argatorban what does the aPTT and ACT need to read for HIT?

A

aPTT: 1.5-3x baseline
ACT: 60-90 seconds

141
Q

If pt has a prior hx of HIT and needs to be bridge what parentral agent is recommended.

HIT ab present
HIT ab NOT present

A

ab present: argatroban/bilvalrudin

non present: fondaparinux

142
Q

what is the dosing of Bilvalrudin for PI with or without HIT (FDA approved for PIC and cardiac surgery)

A

BOLUS 0.75mg/kg

1.75mg/kg/hour

if CrcL <30ml/min: bolus is the same: 1mg/kg/hr
hemodialysis: bolus is the same: 0.5mg/kg/hr

143
Q

what is the preferred anticoagulant for acute VTE in pregnancy? and what is the dose

A

LMWH at 1mg/kg BID

144
Q

what is the dose of UFH in pregnancy? for acute VTE

A

1: 333 units/kg bolus then 250mg units/kg BID

  1. 80units/kg bolus then 18 units/kg/hr IV
    (after 5 days of IV can convert to BID/TID SC dosing)

must have anti-Xa level between 0.3-0.7u/ml

145
Q

when do you stop LMWH prior to delivery of baby?

A

24 hours prior to planned delivery and epidural

146
Q

when do you stop SC UFH prior to delivery of baby?

A

24 hours prior to planned delivery and epidural

147
Q

when do you stop IV UFH prior to delivery of baby?

A

4-6 hours prior to planned delivery and look at CBC before epidural

148
Q

when should you resume LMWH after delivery of baby?

A

Vaginal 4-6 hours post deliver
cesarean: 6-12 hours post delivery

( must be at least 24 hours from epidural or 4 hours from catheter removal)

149
Q

when should you resume UFH post partdum?

A

Vaginal 4-6 hours post deliver
cesarean: 6-12 hours post delivery

must be at least 1 hour from epidural or catheter removal

150
Q

which anticoagulants are pregnancy cat B

A

Argatroban
fonaparinux
LMWH

151
Q

what is the diagonistic test for pregnant women?

A

duplex ultrasound: Accurate non-invasive

D-Dimer is useless : these levels are naturally elevated in pregnant women

152
Q

what is the antiplatelet of choice if elderly pt has to be on triple therapy ?

A

Plavix

153
Q

which immunomodulary drugs can increase risk of thrombosis?

A

Thalidomide
Lenalidomide

for multiple myeloma when used with dexamethasone can increase risk of thrombosis

154
Q

thrombocytopenia in cancer pts is mainly cause by what? (4 causes)

A
  1. chemotherapy
  2. bone marrow cancer
  3. infection
  4. liver disease
155
Q

what plt count do you need to decrease LMHW therapy?

A

when PLT is less than 50,000

156
Q

what is the most common cause of non-bacterial thrombic endocarditis? what is the tx and duration

A

adenocarcinoma is the most common cause

UFH (can consider LMWH but NEVER WARFARIN)= continued indefinitely due to reoccurrence

157
Q

what is the most frequently used anticoagulant in children with DVT-PE?

A

LMWH

158
Q

When should you draw Anti-Xa levels to monitor LMWh therapy?

A

4 hours after the 3rd and 4th dose.

159
Q

what is the Treatment dose of LMWH for VTE in premature neonates?

A

2mg/kg BID

160
Q

what is the Treatment dose of LMWH for VTE in full term neonates? (<1 month of age)

A

1.7mg/kg BID

161
Q

what is the Treatment dose of LMWH for VTE in infants 1-3 months?

A

1.5mg/kg BID

162
Q

what is the Treatment dose of LMWH for VTE in infants >3 months?

A

1mg/kg BID

163
Q

what is the PPX dose for children less than < 2 months?

A

0.75mg/kg BID

164
Q

what is the PPX dose of children greater than >2 months ?

A

0.5mg/kg BID

165
Q

what is the dose of warfarin for children who will be started as inpt?

A

0.2mg/kg daily (7.5mg MAX dose daily)

166
Q

what is the only DOAC that must be taken orally and should not be adminstered through an enternal feeding tube?

A

Dabigatran

167
Q

which DOAC see a 20% decrease in concentration when given with antacids>

A

Dabigatran

168
Q

what are the 1/2 life of these factors (put them in order from most to least)

II
VII
IX
X

Protein C
Protein S

A

Most to least

II- 72 hours 
protein S: 60 hours 
X: 27-48 hours 
IX: 21-30 hours 
protein C 9 hours 
VII: 4-6 hours
169
Q

what factors does Heparin inhibit?

A 
XII
XI
X
IX
II

V and VIII

170
Q

how often do you need to measure apTT for heparin for VTE treatment and what is the goal

A

every 6 hours

1.5-2.5x control

171
Q

what is the dose of Dalteparin for the tx of VTE?

A

<56 : 10,000 units daily

>56 kg: 18,000 units daily

172
Q

PPX of dalteparin dose?

A

5000 units daily

CACP (8 decks)

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