Stevenson: A fib, DVT, PE

Question 1

What is the problem in atrial fibrillation?

Answer 1

the top portion of the atria is not squeezing/contracting, which leads to stasis of the blood in the atria

Question 2

This is the only anti-coagulation drug used in A fib patients with mechanical or artificial valves

Answer 2

coumadin

**cannot use any of the novel anti-coags

Question 3

3 novel alternatives to coumadin

Answer 3

pradaxa
eliquis
xarelto

Question 4

Pradaxa is a (blank) inhibitor

Answer 4

thrombin

Question 5

Eliquis and xarelto are (blank) inhibitors

Answer 5

factor 10a

Question 6

What is the CHADSS score used for? What does each component stand for?

Answer 6

used to determine if A fib patients need to be put on a blood thinner;
Congestive heart failure
HTN
Age (>75)
Diabetes
Stroke 2pts
Stroke (TIA) 2pts

Question 7

If the CHADSS score is > 1, what does this mean??

Answer 7

the patient needs to be put on a blood thinner, but not aspirin

Question 8

If the CHADSS score <1, the patient can be put on (blank)

Answer 8

aspirin

Question 9

What is the difference between clearance of Pradaxa and Eliquis?

Answer 9

Pradaxa is only cleared renally, so it cannot be used in patients with renal failure;
Eliquis is cleared via stool, kidney and liver, so can be used in cases of renal failure

Question 10

How does a pulmonary embolism present?

Answer 10

mild chest pain
tachycardia
hypoxia
SOB
hypotension

Question 11

For sudden onset of pulmonary embolism, what drug should be used? Which drugs should not be used? Why?

Answer 11

use IV heparin (not subcutaneous heparin);
do NOT use novel anticoags like pradaxa, eliquis, and xarelto because these meds are active for longer periods of time (12-24 hours) so that once you administer ad dose, you cannot take the patient off the meds to insert a central line or a catheter, etc

Question 12

What is the dosing for apizapam (Eliquis)

Answer 12

10mg bid for 7 days

then5mg bid for up to 6 monthg

Question 13

What is the dosing for rivaroxaban (Xarelto)?

Answer 13

15mg bid for 3 weeks

20mg od for 3, 6, or 12 months

Question 14

What is the dosing for lovenox (enoxaparin)?

Answer 14

150mg bid for 6 months

Question 15

What do you use for DVT?

Answer 15

lovanox subcutaneously

**no IV