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Therapeutics II > VTE quiz > Flashcards

VTE quiz Flashcards

1
Q

Unfractioned heparin

A

-anticoagulant
-dec platelets
-aPTT monitoring
-can cause HAT or HIT

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2
Q

HAT

A

-non-immune
-dont need to treat

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3
Q

HIT

A

-immune
-stop heparin
-give dif anticoagulant
-dont give warfarin is platelet count > 150k

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4
Q

LMWH

A

-better than UFH
-reduced risks
-monitor antiXa levels in children, kidney failure, obesity, pregnancy
-enoxaparin
-dalteparin

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5
Q

Fondaparinux

A

-prophylaxis after surgery
-tx DVT/PE
-do NOT use in renal function
-do NOT use w low body weight
-can use in HIT
-pregnancy category B

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6
Q

HIT tx options

A

-Fondaparinux
-Lepirudin
-Bivalirudin
-Argatroban

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7
Q

Warfarin

A

-1-6mg
-2.5, 7.5, 10mg

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8
Q

Warfarin

A

-inhibits vit K, factor II, VII, IX, X
-monitor INR
-give vit k for reversal
-consider PCC + IV vit K if major bleeding reversal
-consider FFP then
-

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9
Q

Dabigatran

A

-inhibits thrombin
-caution kidney function, age
-reversed by idarucizumab, charcoal, dialyzable

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10
Q

Rivaroxaban

A

-

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11
Q

Chadsvasc score

A

-only for afib pt

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12
Q

Virchow’s Triad

A

-hypercoaguable state
-circulatory stasis
-endothelial injury

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13
Q

DVT nonpharma tx

A

-bed rest
-elevate feet
-pain management
-compression stockings

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14
Q

PE nonpharma tx

A

-Oxygen
-mechanical ventialation

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15
Q

LMWH vs UFH

A

-reduced protein binding
-predicatble dose response
-longer half-life
-smaller molecule (absoroption)
-less HIT risk

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16
Q

Warfarin genetic cariances

A

-CYP2C9
-VKORC1

17
Q

Warfarin drug interactions

A

-inc INR: meronidazole, fluconazolem cirpo, bactrim
-dec INR: rifampin

18
Q

Warfarin and alcohol

A

-acute: inc effect
-chronic: dec effect
-chronic w liver damage: inc effect, reduce dose

19
Q

Antiplatelet use in VTE

A

-limited role
-consider aspirin in CHAD score 1
-consider dipyridamole in warfarin with prosthetic heart valves

20
Q

Bleeding management

A

-d/c med, compress, watch BP
-consider blood products + PCC + targeted reversal

21
Q

Bleeding tx

A

-activeated charcoal within 2 hours
-dabigatran for HD
-tranexamic acid

22
Q

Targeted reversals

A

-protamine sulfate for UFH or LMWH
-idarucizumab for dabigatran
-andexanet for factor Xa inhibitors

23
Q

Warfarin bleeding reversal

A

-vit K if INR over 10 w no bleeding
-PCC (rapid)
-FFP (fast)

24
Q

Moderate VTE risk prophylaxis tx

A

-UFH, LMWH, factor Xa inhibitor (fondaparimux
-continue up to 28 days after discharge

25
Q

Moderate VTE risk prophylaxis tx in acute illness

A

-UFH. LMWH, fondaparinux, rivaroxaban, betrixaban

26
Q

High VTe risk prophylaxis tx

A

-orthopedic surgery
-UFH, LMWH, fondaparinux, rivaroxaban, apixaban, dabigatran (hip), vit K antagonist
-continue 10-14 days post op

27
Q

CHAD score

A

-over 2= oral anticoagulation
-1: none or oral or aspirin
-only if afib

28
Q

Dabigatran

A

-post-op prophylaxis
-afib
-DVT/PE tx

-thrombin inhibitor

29
Q

Rivaroxaban

A

-post-op prophylaxis
-afib
-tx
-secondary prevention
-VTE prophylaxis

-not if CrCl < 30

30
Q

Apixaban

A

-post-op
-afib
-DVT/PE tx
-secondary prevention

31
Q

Edoxaban

A

-afib
-DVT tx

32
Q

Warfarin intial dose

A

-5mg PO qd
-overlap w UFA/LMWH/Xa for at least 5 days and until INR is therapeutic
-adjust weekly dose

33
Q

If goal INR 2-3

A

-less than 2: inc 5-15%
-3.1-3.5: dec 5-15%
-3.5-4: hold 0-1 dose, dec 10-15
-over 4: hold 0-2 doses, dec 10-15%

34
Q

Warfarin adj 2.5-3.5

A

-less than 2.5: inc 5-15%
-3.6-4: dec 5-10%
-4-4.5: hold 0-1, dec 10-15%
-over 4.5: hold 0-2, dec 10-15%

35
Q

Bridging

A

-stop warfarin 5 days before surgery
-give LMWH or UFH until procedure
-stop UFH 4-6 h before
-stop LMWH 24 hours before
-resume warfarin 12-24h later

Therapeutics II (55 decks)

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