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Block 7; Week 4-Michelle > Stevenson > Flashcards

Stevenson Flashcards

1
Q

What is atrial fibrillation?

A

this is a condition where a patient’s atria isn’t contracting properly.
can get tachycardia induced cardiomyopathy (weakened heart)

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2
Q

Why is it that a fib increases the risk of blood clot formation?

A

heart rate is too fast–swirling of blood in atria

not contracted out sufficiently

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3
Q

Where do blood clots form in the heart?

A

usu the left appendage of the left atria

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4
Q

What are the 2 types of stroke? Frequency of each?

A

Hemorrhagic: 20% of strokes. more fatal.
Embolic: 80% of strokes

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5
Q

Warfarin in high doses is?

A

Rat Poison

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6
Q

When people have mechanical valves & have a fib…there is only one anticoagulant that can be used. Which one?

A

Warfarin

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7
Q

What is the leading cause of cardioembolic stroke?

A

non-valvular atrial fibrillation

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8
Q

T/F Risk of intracranial bleeding with anticoagulation therapy increases with age in nonvalvular AF.

A

True.

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9
Q

What is Lovanox?

A

liquid low molecular weight heparin
subcu admin
factor Xa inhibitor

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10
Q

What are NOAC? Give 3 examples.

A

novel oral anticoagulants
Pradaxa
Xarelto
Eliquis

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11
Q

What are some contraindications to taking Pradaxa?

A

major GI bleeds

renal failure b/c excreted renally

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12
Q

What is the mechanism of pradaxa?

A

direct thrombin inhibitor

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13
Q

What are the mechanisms of Xarelto & ELiquis?

A

Factor 10a inhibitors

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14
Q

What INR is therapeutic for a fib patients?

A

2-3

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15
Q

What could be bad about an a fib patient on an anticoagulant eating a bunch of leafy greens in the summer?

A

Vit K!!
could change INR to closer to 1 & more coagulable.
Could form a clot & throw it.

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16
Q

What is the rating system for patients with atrial fibrillation to see if they need an anticoagulant?

A 
CHADSS2
Congestive Heart Failure
HTN
Age >75 yo
Diabetes
TIA (2 pts)
Stroke (2 pts)
More than 1-->put them on an anticoagulant.
17
Q

HOw is Eliquis excreted?

A

renal
stool
liver
**can be given to patients with renal failure b/c of the 3 different excretion methods.

18
Q

HOw long does it take for warfarin to become therapeutic?

A

4-6 days

don’t just send a DVT pt w/ warfarin

19
Q

What % of PE patients die?

A

25%

20
Q

HOw long does it take for the novel drugs to become therapeutic?

A

60-90 minutes

  • *don’t use after a serious surgery or right before a serious surgery b/c bleeding could happen
  • *don’t use right after a bunch of polyp removal after a colonoscopy
21
Q

PATCHHH is used for codes. WHat does it stand for?

A 
PE
acidosis
tension pneumothorax
cardiac tamponade
hypovolemia
hypoxemia
hyperkalemia
22
Q

What are some symptoms of PE?

A

hypoxic-sudden SOB
circulatory collapse-hypotensive
arrhythmia

23
Q

Pt presents to the ER w/ a PE. He has prostate cancer that has been treated for 1 mo with chemo & radiation. He has acute SOB & he dropped at home. Intubated. Found arrhythmia. What do you treat him with?

A

heparin IV.
Not subcu!
Or Lovanox w/ 12 hours dosing.

24
Q

Why don’t you want to use warfarin or novel agents to treat the previous patient?

A

warfarin: takes 4-5 days to work
novel: could cause him to bleed out if he needs a central line or something.

25
Q

When would you use heparin subcutaneously?

A

to prevent a DVT or PE

26
Q

32 yo woman presents with a hx of breast cancer and a swollen calf. What do you treat her with?

A
  • *Xarelto: 15 mg twice a day. 20 mg twice a day after 2 weeks.
  • *Eliquis: 10 mg twice a day. Transition to 5 mg twice a day
  • *Heparin or Lovanox for 5 days–>bridge to pradaxa or warfarin.
27
Q

Why is it that cancer patients are more likely to get PEs?

A

cancer can lend itself to a hyper coagulable state

28
Q

How is Lovanox administered?

A

subcutaneously
not IV
often used prophylactically for hospitalized patients

29
Q

For a 23 yo woman…Creatinine of 1. What is their GFR?

A

GFR=120

30
Q

For a 75 yo man…Creatinine of 1. What is their GFR?

A

GFR=60

Block 7; Week 4-Michelle (5 decks)

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