Therapeutics - VTE Part 2 Flashcards
LMWH can be used for VTE treatment for initial AND long term therapy
however, long term use is reserved for who?
pts who can’t take warfarin or have cancer
which is more predictable and why - heparin or LMWH
LMWH
less protein binding so better PK profile
it’s better clinically - less deaths and hemorrhages and recurrent VTE
true or false
clearance of LMWH is dependent on kidney function
TRUE
where is LMWH like enoxaparin injected
available as prefilled syringes or multi dose vials
injected into abdominal area aorund the belly button or the outer upper thigh
rotate injection sites!
how does the dose of enoxaparin change for kidney function
normal - 1mg/kg subq q 12 or 1,,5mg/kg subq qd
BUT if crcl less than 30 - do 1mg/kg qd
true or false
there is no kidney concern with dalteparin and tinzeparin
FALS
they are LMWH —- if cr cl less than 30, need to be cautious and consider reducing dose
how are dalteparin and tinzeparin administered
subq
true or false
it is not routine to monitor efficacy when treating VTE with LMWH
true
may check anti xa activity only in renal disease or pregnancy
BBW enoxaparin and LMWH
same as fondaparinux –spinal hematoma after lumbar puncture, epidural, etc
the AE of LMWH is similar to….
heparin
true or false
LMWH has a lower risk of developing osteoporosis than heparin
true
true or false
protamine can be used to reverse LMWH
FALSE
**cost of heparin vs LMWH
the drug itself — enoxaparin is more expensive BUT if getting heparin you need to stay in hospital - potential cost more – requires tubing and infusion pump and a nurse
whereas LMWH given once or twice a day by YOURSELF in prefilled syringes
**differentiate between the monitoring of LMWH vs heparin for treating VTE
heparin - have to monitor the aPTT frequently until reaches therapeutic range, and then monitor daily
LMWH - no monitoring necessary, only rare occassions
**differentiate between the reversal agent for heparin vs LMWH
heparin has protamine, LMWH does not have one
*differentiate between the half lives of LMWH vs heparin and is this is advantage/disadvantage
heparin has shorter half life. this is good bc we can turn it off if procedure or bleed is suspected, however it does need continuous drip
LMWH has longer half life which is bad bc we can’t quickly stop it, however, it can be administered once or twice at home
***true or false
LMWH has lower HIT and osteoporosis than heparin
true
can fondaparinux be reversed
no
checking for target aPTT for heparin is every….
6 hours! - thats a lott use nomogram to help!
differentiate between HIT type 1 and HIT type 2:
-immune mediated?
reversible?
occurs quickly or over 5-14 days?
platelet count?
symptoms?
MANAGEMENT?
HIT typ1 is non immune, reversible, platelets below 100k, occurs quick, and is asymptomatic. NO management needed
HIT typ 2 is immune mediated and has long onset, platelets decrease below 50% and there is high risk of clot. management is to stop the heparin, start a direct thrombin inhibitor, and document the allergy
there is higher risk of HIT type 2 when it is administered what route?
IV is higher risk than subq
also, heparin has higher risk than UFH
name 3 intravenous direct thrombin inhibitors
they are used as alternative anticoagulants in _____
argatroban, lepirudin, bivalirudin
HIT
bridging to warfarin with an IV direct thrombin inhibitor
it’s hard bc they all increase the INR
for which IV direct thrombin inhibitor do we reduce the dose for hepatic dysfuncion? what about renal?
renal - lepirudin and bivalirudin
hepatic - argatroban
