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Cardio-Renal I Midterm > Therapeutics - VTE (Hughes) > Flashcards

Therapeutics - VTE (Hughes) Flashcards

(78 cards)

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1
Q

define DVT (deep vein thrombosis)

A

blood clot in 1 of large veins (usually in les of arm)

can partly or completely block flow of blood thru the vein

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2
Q

if DVT is not treated, what can happen

A

it can move or break off into the lungs, causing a pulmonary embolism - can die from it

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3
Q

thrombus vs embolus

A

thrombus - clot that stays in blood vessels

embolus - when clot breaks off and travels to another part of the body

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4
Q

what is “virchow’s triad”

A

risk factors for thrombo embolism

stasis
vessel wall injury
hypercoaguability

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5
Q

clotting factors form a clot in a __

A

vein

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6
Q

why are clots typically in veins and not arteries?

A

lot less pressure in veins

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7
Q

primary complication of DVT

A

PE

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8
Q

DVT and PE are a concern after….

A

hip and knee replacements

there is a reimbursement penalty from medicare if the pt gets one

NEED PROPHYLAXIS

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9
Q

factor II vs IIa

A

II - prothrombin
IIa- thrombin

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10
Q

name some clotting inhibitors

A

antithrombin
protein C and protein S
plasminogen
plasmin

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11
Q

factor I and Ia

A

I - fibrinogen
Ia - fibrin

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12
Q

are antiplatelets used to treat DVT

A

NO - used for ARTERY clots

for vein thrombi — anti coagulation factors (anticoagulants)

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13
Q

true or false

if someone has high levels of proteinC and proteinS, there are less likely to get blood clots

A

TRUE

these prevent blood from clotting too much

a deficiency is called “hypercoagulability

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14
Q

surfaces that contact the blood can cause clotting

name 2

A

catheters, a tumor

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15
Q

RAMS

A

risk assessment models for clots

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16
Q

symptoms of pulmonary embolism

A

fast breathing and heart rate, pain when breathing cough

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17
Q

name a specific drug that is a risk factor for clots

A

estrogen

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18
Q

symptoms of deep vein thrombosis

A

leg swelling (1 side), heat, pain, tenderness

but lot of clots are asymptomatic!

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19
Q

tests for DVT

A

D-dimer (blood test) tells us if there’s fragments of a clot

GOLD STANDARD is duplex/doppler ultrasound

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20
Q

true or false

patients with deep vein thrombosis are always treated inpatient

A

FALSE - can be treated outpatient

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21
Q

true or false

PE’s are generally treated as inpatient

A

TRUE

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22
Q

gold standard for diagnosing PE

A

CT angiography

but bad thing is you need contrast dye – may have SE and potential allergic reaction

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23
Q

_____ should be evaluated for the risk of VTE

A

every hospitalized patient

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24
Q

nonpharmacologic ways to prevent VTE

A

graduated compression stockings (move leg around), leg exercises

NOT VERY EFFECTIVE - “may” work

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25
when may a patient only be given nonpharm prophylaxis for VTE
when bleeding risk is too high
26
true or false pharmacologic prophylaxis for VTE is generally very effective
TRUE
27
guideline recommendation for acutely medically ill patient for VTE prophylaxis
-pharmacologic better than mechanical prophylaxis over no parenteral
28
according to the guidelines, which pharmacologic class is recommended for VTE prophylaxis
LMWH is recommended over DOAC (unless there's some reason you can't use a LMWH - then u may use a doac)
29
name 3 LMWH
enoxaparin (lovenox) dalteparin (fragmin) tinzaparin (INNOHEP)
30
name 4 DOACs
eliquis (apixaban) xarelto (rivaroxaban) dabigatran (pradaxa) edoxaban (savaysa)
31
heparin can be used for prophylaxis of VTE what does this mean any safety concern?
LOW DOSE unfractionated heparin 5,000 units SUBQ Q8-12 HOURS it's available as lot of diff concentrations - so have to be very careful
32
disadvantage of LMWH vs low dose unfrac. heparin for VTE prophylaxis
more expensive per dose
33
dosing of lovenox for VTE prophylaxis what about if crcl less than 30mL/min?
normal - 30mg SUBQ Q12 OR 40mg SUBQ QD CrCl less than 30 - 30mg SUBQ QD
34
dosing of fragmin (dalteparin) for VTE prophylaxis
2500-5000 units subq QD
35
true or false fondaparinux cannot be used for VTE prophylaxis
FALSE - it can, just not in CrCl less than 30 or if they weigh less than 50kg
36
dose of fondaparinux for VTE prophylaxis
2.5mg subq qd (as prefilled syringe)
37
ONLY doac indicated for generally medically ill patients for VTE prevention
rivaroxaban 10mg PO QD 31-39 days
38
which DOAC is LEAST dependent on the kidneys for elimination
apixaban! no dose adjustment necessary
39
can edoxaban be used for prophylaxis of VTE
NO - not approved
40
can warfarin be used for VTE prophylaxis if so, what is goal INR
YES - for hip or knee replacement surgery goal INR is 2-3
41
3 general indications in which we can use DOACs for VTE prevention
-exented prevention for recurrent VTE -acut medically ill (only xarelto) -post op for hip/knee replacement (MAIN(
42
true or false xarelto must be taken with meals
false - doesnt matter
43
route administration dabigatran
PO
44
frequency xarelto and eliquis and dabigatran
xarelto - QD eliquis - BID dabigatran - QD
45
monitoring for VTE prevention therapy:
they do not affect any coagulation labs - not reason to check them except warfarin - need to monitor INR just monitor for signs of bleeding, and make sure it's working by pt not getting clot!
46
as mentioned, for VTE prophylaxis, we do not need to monitor for signs of efficacy. however,,,
we need to monitor for toxicity
47
what number is "normal" INR? what is goal INR for warfarin?
1 is normal for warfarin - 2.5 -- range of 2-3 may need higher to have efficacy in certain conditions like mitral valve replacement
48
formula for INR
PT (prothrombin time) of patient /PT of reference plasma
49
the lab value of anti-xa activity can be used to monitor the extent of antithrombitic effect for........... is it done routeinely?
LMWH's not done routinely - only in obesity or pregnancy
50
which drug do we monitor APTT
heparin, and ONLY for the treatment dosing - not the low dose for prevention
51
true or false aPTT is not standardized across all labs
true each lab must calibrate -- have nomograms to achieve
52
true or false INR is used for warfarin only
TRUE
53
aPTT monitoring is used for ___ and ____ ONLY
heparin and IV thrombin inhibitors
54
thrombolytics, went used for treatment of VTE, are given how often?
only once
55
3 different general approaches to VTE treatment
1. initial therapy and long term therapy using a single agent 2. initial therapy and long term therapy using DIFFERENT agents (bridge when changing to warfarin - temp overlap) 3. initial therapy and then long term therapy using DOACs
56
explain the bridged therapy in treating VTE
start with parenteral + warfarin (parenteral can be heparin, LMWH, or fondaparinux) for at LEAST 5 days, and then drop the parenteral, and continue just the warfarin for months
57
explain the strategy for VTE treatment of using initial therapy and then DOACs but with NO bridge
start with parenteral (heparin, LMWH, fondaparinux) and then switch to either dabigatran or edoxaban
58
explain the 1st of the 3 VTE treatment strategies
can just use xarelto or eliquis or fondaparinux or LMWH for months
59
guidelines for long term agents for patients that do NOT have cancer what if they DO have cancer
1st - DOAC, then warfarin, then LMWH have cancer - DOAC, LMWH, warfarin or unfrac heparin
60
the duration of therapy for VTE treatment depends on.....
the risk of recurrence for example, was it unprovoked? -- would need long therapy (but if high bleeding risk - only 3 months) was it provoked by durgery or a period of stasis? - just give for 3 months
61
give 3 scenarios in which the duration of VTE treatment would be EXTENDED
-unprovoked and low bleeding risk recurrence active cancer
62
in anyone that stops getting anticoagulation treatment for VTE, what should be considered?
giving aspirin
63
*****when do we not give fondaparinux
creatinine clearance less than 30!
64
true or false fondaparinux can be used for both initial AND long term therapy for VTE treatment
true
65
what is the general monitoring when administering any anticoagulant
bleeding, periodic CBC, platelet, serum creatinine
66
should we check the coagulation panel when administering fondaparinux
no need to, but does elevate anti-xa if we do check
67
true or false fondaparinux is NOT associated with HIT
true
68
black box warning fondaparinux and what can be done to rpevent
hematoma/bleeding when used during and after a lumbar puncture, epidural, or spinal anasthesia --- have to space out before procedure!!!!
69
fondaparinux can cause thrombocytopenia it should be discontinued and not used if the platelets fall below....
100,000
70
can heparin be used for long term therapy for VTE treatment
no -- only for initial and bridge therapy
71
heparin can be used as bridge therapy with warfarin to take the heparin off and continue just the warfarin, what criteria MUST be met
must be given for both: 5 or more days INR must be 2 or more
72
when giving heparin for TREATING vte, the dose must be titrated to meet....... what is route of administration in this case
the goal aPTT given as bolus dose IV and then by continuous infusionbased on WEIGHT use the nomogram!!! simplified titrating and dosing instructions to minimize errors
73
name 5 AE of heparin when given at therapeutic, weight based dosing
HIT hemorrhage osteoporosis (only with long term use - 6 or more months - rare - chronic effect) hyperkalemia hypersensitivty rxns
74
prolonged aPTT
blood is taking too long to clot - can be a side effect of heparin - risk of bleeding
75
pt is on heparin and aPTT is prolonged. what to do if: -no suspicion of bleeding -evidence of bleeding
no suspicion - discontinue the heparin and monitor bleeding - discontinue and give volume replacement as needed --- fluid, blood, plasma, clotting factor concentrates can also use protamine!
76
protamine is used as the reversal agent for heparin it can be administered if heparin caused bleeding 1mg of protamine neutralizes ______ of heparin BUT
100 units it has a half life of 7 minutes
77
using heparin to TREAT VTE: -bolus dose -continuous infusion dose
bolus - 80 units/kg (round to nearest 500 units) 18 uinits/kg/hr (round to nearest 100 units)
78

Cardio-Renal I Midterm (14 decks)

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