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Therapeutics 2 - Exam 4 > weber pre-lecture pt 3 > Flashcards

weber pre-lecture pt 3 Flashcards

pages 43-66

1
Q

what is the targeted reversal of UFH/LMWH?

A

protamine sulfate

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2
Q

what is the targeted reversal of dabigatran?

A

idarucizumab (praxbind)

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3
Q

what is the targeted reversal of factor Xa inhibitors?

A

andexanet alfa

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4
Q

what are some considerations of bleeding management?

A

activated charcoal within 2 hours of bleeding
in patients on hemodialysis, use dabigatran only
tranexamic acid

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5
Q

what are the steps of bleeding management?

A

d/c medication
apply manual compression
maintain BP
surgical or radiological intervention
blood productions + prothrombin complex concentration + targeted antidotes

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6
Q

what are some AE of protamine sulfate?

A

hypotension
bradycardia
fix through slow IV infusion rate with a max of 50 mg over 10 minutes

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7
Q

what is the MOA of idarucizumab?

A

direct binder to dabigatran

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8
Q

what are some AE of idarucizumab?

A

delirium
HA
hypokalemia
constipation
pneumonia
fever

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9
Q

what is the monitoring schedule of idarucizumab?

A

baseline aPTT
repeat in 2 hours
every 12 hours until normal

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10
Q

what is the MOA of andexant alfa?

A

binds and sequesters FXa inhibitors (rivaroxaban and apixaban)

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11
Q

what is considered a low dose of andexant alfa?

A

400 mg IV bolus
4mg/min IV infusion

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12
Q

what is considered a high dose of andexant alfa?

A

800 mg IV bolus
8 mg/minute IV infusion

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13
Q

what are some AEs of andexant alfa?

A

local site infusion rxn
DVT
ischemic stroke
AMI
PE UTI
pneumonia

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14
Q

how should bleeding be managed while on warfarin?

A

Vit K
Fresh Frozen Plasma (FFP)
Prothrombin complex concentrate (PCC)

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15
Q

what is the Vit K dosing for warfarin bleeding management?

A

oral 5 mg tablets (preferred route)
parenteral 1mg/min max (do not go over due to anaphylaxis)

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16
Q

how should PCC be monitored?

A

check INR before and 30-60 minutes after

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17
Q

what should be done if the INR is between 4.5-10 while on warfarin?

A

if no evidence of bleeding –> avoid Vit K

18
Q

what should be done if the INR is over 10 while on warfarin?

A

if no evidence of bleeding –> oral vit K

19
Q

what should be done if there is major bleeding while on warfarin?

A

use PCC over FFP
may add vit K oral as well

20
Q

in warfarin reversal, what is rapid?

A

PCC (immediate replacement of Vit K-dependent clotting factors)

21
Q

in warfarin reversal, what is fast?

A

FFP (correction of coagulopathy is partial)

22
Q

in warfarin reversal, what is prompt?

A

IV vit K

23
Q

in warfarin reversal, what is slow?

A

oral vit K

24
Q

in warfarin reversal, what is very slow?

A

omit warfarin with no vit K

25
Q

what is the chance of VTE in medical patients w/o prophylaxis?

A

5-15%

26
Q

what is the chance of VTE in surgical pts w/o prophylaxis?

A

40-80%

27
Q

what are the options for VTE prophylaxis?

A

UFH
LMWH
Factor Xa inhibitors
Vit K antagonists

28
Q

what is considered tx of patients with low risk?

A

no specific pharmacologic therapy recommended
early and aggressive ambulation

29
Q

who is considered a moderate VTE risk?

A

general surgery pts
acutely ill medication pts

30
Q

how should general surgery pts be treated for prophylaxis?

A

UFH, LMWH, and fondaparinux recommended
continue 28 days after discharge

31
Q

how should acutely ill medical patients be treated for prophylaxis?

A

UFH, LMWH, fondaparinux –> all appropriate, no recommendation for duration
Rivaroxaban –> 31-39 days total treatment
Betrixaban –> 35-42 days total treatment

32
Q

who is considered high VTE risk?

A

orthopedic surgery (TKA or THA)

33
Q

how should orthopedic surgery pts be treated for prophylaxis?

A

UFH, LMWH, fondaparinux, rivaroxaban, apixaban, dabigatran (hip only), or vit K antagonists
continue over 10-14 days post op (up to 35 days)

34
Q

how would you treat a high bleeding risk?

A

mechanical prophylaxis preferred so intermittent pneumatic compression devices, venous foot pumps, graduation compression socks

35
Q

what is a CHA2DS2-VASc score?

A

used only in AFib
risk factors for stroke or systemic VTE

36
Q

what is the HAS-BLED score?

A

used only in AFib
risk factors for bleeding

37
Q

why is Afib important in relation to VTE?

A

increases risk of stroke or systemic VTE by 5 fold
anticoag therapy can reduce this risk and all-cause mortality

38
Q

what are factors of CHA2DS2-VASc?

A

congestive HF - 1
HTN - 1
over 75 yrs - 2
between 65-74 - 1
diabetes - 1
stroke/tia - 2
vascular disease - 1
female - 1

39
Q

what is recommended with a CHA2DS2-VASc score of 2?

A

oral anticoagulation

40
Q

what is the recommendation of a CHA2DS2-VASc score of 1?

A

no antithrombotic therapy OR
oral anticoagulant OR
antiplatelet (ASA)

41
Q

what is a prominent score of HAS-BLED?

A

equal to or greater than 3
high risk of bleeding –> caution and regular of the patient are recommended

Therapeutics 2 - Exam 4 (9 decks)

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