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Therapeutics 2 - Fall 2017 > Weber - AntiCoag > Flashcards

Weber - AntiCoag Flashcards

1
Q

which NOACs are used for post-op prophylaxis

A

DRA

dabigatran; Rivaroxaban; apixaban

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2
Q

which NOACs are used for Non-Valvular A.Fib

A

DRAE

dabigatran; rivaroxaban; apixaban; edoxaban

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3
Q

which NOACs are used for Secondary prevention of DVT/PE

A

RA

Rivaroxaban; Apixaban

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4
Q

which NOACs are used for VTE prophylaxis

A

Betrixaban

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5
Q

which NOAC for post-op prophylaxis is used for ONLY hip replacement

A

Dabigatran

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6
Q

which NOAC for post-op prophylaxis is used for hip AND knee replacement

A

Rivaroxaban; Apixaban

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7
Q

which NOACs for DVT/PE treatment are for MAINTENANCE only

A

Edoxaban and Dabigitran (aka need parenteral anticoag for 5 - 10 days)

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8
Q

which NOACs are for DVT/PE treatment for maintenance and acute?

A

Rivaroxaban; Apixaban

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9
Q

is it an inhibitor or an activator (of the coag system?)

Von Willebrand Factor

A

activator

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10
Q

is it an inhibitor or an activator (of the coag system?)

Tissue Factor

A

activator

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11
Q

is it an inhibitor or an activator (of the coag system?)

Factor VIIa

A

activator

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12
Q

is it an inhibitor or an activator (of the coag system?)

Heparin

A

inhibitor

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13
Q

is it an inhibitor or an activator (of the coag system?)

Thrombomodulin

A

inhbiitor

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14
Q

is it an inhibitor or an activator (of the coag system?)

Factor Xa

A

activator

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15
Q

is it an inhibitor or an activator (of the coag system?)

Thrombin

A

activator

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16
Q

is it an inhibitor or an activator (of the coag system?)

Tissue Plasminogen Activator

A

activator

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17
Q

is it an inhibitor or an activator (of the coag system?)

Antithrombin

A

inhibitor

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18
Q

is it an inhibitor or an activator (of the coag system?)

Protein C

A

inhibitor

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19
Q

is it an inhibitor or an activator (of the coag system?)

Protein S

A

inhibitor

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20
Q

is it an inhibitor or an activator (of the coag system?)

plasminogen activator inhibitor 1

A

inhibitor

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21
Q

which NOACs are used for DVT/PE treatment

A

DRAE

dabigatran; rivaroxaban; apixaban; edoxaban

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22
Q

what 3 things make up Virchows triad

A

Hypercoaguable state
Circulatory stasis
Endothelial injury

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23
Q

UFH:

is it specific or non specific binding

A

non specific

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24
Q

UFH: what is its MOA?
It interacts with ______ which catalyzes formation of thrombin/antithrombin complexes
it also binds to _______ and ______

A

ATIII; heparin; platelets

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25
Dosing for UFH:
80 units/kg (BOLUS) | 18 units/kg/hr (INFUSION)
26
Labeled Uses for UFH
- prophylaxis and tx of thromboembolic disorders | - Anticoag for extracorpeal (outside of body) and dialysis procedures
27
UFH: Pregnancy Category ______
B
28
aPTT stands for?
activated partial thromboplastin test
29
what is the therapeutic range for aPTT
1.5 - 2 times the normal
30
Monitoring for UFH:
@ baseline Check @ 6 hrs (after first dose/each dose change) Check DAILY for 1st day unless out of range)
31
ADEs of UFH
- bleeding - HIT - Osteoporsis - hypersensitivity
32
HAT or HIT? | aka HIT Type 1
HAT
33
HAT or HIT? | Non-immune mediated
HAT
34
HAT or HIT? | Immune mediated
HIT
35
HAT or HIT? | Platelets > 100,000
HAT (that is known as mild decrease)
36
HAT or HIT? | Platelets decrease by more than 50%
HIT
37
HAT or HIT? | Platelets < 100,00
HIT
38
HAT or HIT? | occurs b/w 7 - 14 days
HIT
39
HAT or HIT? | occurs b/w 48 - 72 hours
HAT
40
HAT or HIT? | Need to discontinue Heparin
HIT
41
HAT or HIT? | Do NOT need to discontinue Heparin
HAT
42
how to manage HIT?
- stop all heparin products - give alternate anticoags - Do NOT give platelet infusions - Do NOT give warfarin unless platelet is >150,000 - Evaluate for thrombosis
43
ADEs of Protamine
- Hypotension - Bradycardia - Anaphylaxis
44
Protamine Dosing
MAX 50 mg over 10 minutes Protamine Dose per 100 units of UFH: - immediate: 1 - 1.5 - 30 mins - 120 mins: 0.5 - 0.75 - > 120 mins: 0.25 - 0.375
45
LWMH: inhibits ____ more than _____
Xa; thrombin (II)
46
Monitoring for Enoxaparin
CBC w/ platelet fecal occult blood SCr Anti-Xa levels
47
Max weight for enoxaparin
144 kg
48
Blackbox warning for LWMH:
neural anesthesia or spinal puncture can lead to increased risk of spinal hematoma leading to paralysis
49
what drug(s) are injectable indirect factor Xa inhibitor
Fondaparinux
50
what is fondaparinux's MOA
attaches to AT(III) and prevents factor Xa from working
51
Fondaparinux Specifications: Do not use if _________ or ______ (Can or Cannot) be used in HIT Pregnancy Category ______
do not use if renal dysfunction (CrCl < 30 mL/min) OR do not use for prophylaxis with low body weight (<50 kg) CAN be used in HIT Category B
52
what drugs are direct IV thrombin inhibitors
Lepirudin Bivalrudin Argatroban
53
Switching DOAC from Warfarin: | Can be done when INR is what for each drug?
D: < 2 R: < 3 A: < 2 E: < 2.5
54
NOAC Contraindications
- recent GI bleeding - Malignancy - Varices (slit in esophagus) - Arteriovenous malformations - Recent brain/spine/eye surgery - Concurrent use of other anticoags
55
Steps for bleeding management:
``` 1 - d/c med 2 - apply manual compression 3 - maintain BP 4 - surgical or radiological intervention 5 - blood products +/- PCC ```
56
Monitoring for Idarucizumab
baseline aPTT --> repeat in 2 hours --> q12h until normal
57
Other Considerations that could be utilized for bleeding management:
- activated charcoal < 2 hours of bleeding - Hemodialysis - for dabigatran ONLY - Tranexamic Acid
58
Genetic Variances and Warfarin: | CYP2C9 - what are the alleles that are affected
*1,*2,*3
59
Genetic Variances and Warfarin: CYP2C9 - what variety occurs in 1/3 white patients
*2/*3
60
Genetic Variances and Warfarin: CYP2C9 - which Genetic variance needs about a 80% warfarin dose lowering
*3/*3
61
Genetic Variances and Warfarin: CYP2C9 - which Genetic variance needs about a 35% warfarin dose lowering
*2/*3 or *1/*3
62
Genetic Variances and Warfarin: CYP2C9 - which Genetic variance needs about a 20% warfarin dose lowering
*1/*2
63
Genetic Variances and Warfarin: VKORC1 what are the genetic variances for VKORC1
1639:A/G
64
which race is likely to have 1639AA
asian
65
which race is likely to have 1639GG
african americans
66
a 1639GG mutation leads to (decreased or increase warfarin resistance) and leads to patients needing a (lower or higher) warfarin
INcreased resistance; Higher warfarin dose
67
a 1639AA mutation leads to (decreased or increase warfarin sensitivity) and leads to patients needing a (lower or higher) warfarin
increased sensitivity; lower warfarin dose
68
what are the requirements to be genetic tested for warfarin allele mutations?
1) pt is warfarin naive AND 2) genetic test results are available before the 6th dose AND 3) pt is at high risk of bleeding if INR is elevated (if ALL 3 - can do genetic warfarin testing)
69
How to calculate INR
(patients PT/mean normal PT)^ISI | ISI = international sensitivity index
70
Recommended INR Goals
For Mechanical Heart Valve (mitrial) - 2.5 - 3.5 | For Everything else (2 - 3)
71
How to bridge UFH/LMWH/Xa to warfarin (what are the requirements)
OVERLAP for at LEAST 5 days AND wait until INR is in therapeutic range
72
Most patients will start at ____ mg per day | but what patients may need less than the regular starting dose
start at 5 mg; Exceptions: > 60 years old; debilitated; Malnourished; CHF; liver disease; Concomitant Medications; High bleeding risk; Genetic Factors
73
Dose Alteration for Warfarin: (Goal: 2 - 3) | if INR < 2
increase by 5 - 15%
74
Dose Alteration for Warfarin: (Goal: 2 - 3) | if INR 3.1 - 3.5
decrease 5 - 15%
75
Dose Alteration for Warfarin: (Goal: 2 - 3) | if INR 3.5 - 4.0
hold 0 - 1 doses | then decrease by 10 - 15%
76
Dose Alteration for Warfarin: (Goal: 2 - 3) | if INR > 4.0
hold 0 - 2 doses | decrease by 10 - 15%

Therapeutics 2 - Fall 2017 (22 decks)

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