Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
IS-4 Exam 4
Coagulation
| Question | Answer |
|---|---|
| What are the 3 basic risk factors for Virchow's Triad? | venous stasis, vascular damage, hypercoaguable state |
| Which part of the triad does smoking affect? | vascular damage |
| Which part of the triad does obesity and old age affect? | venous stasis |
| Which part of the triad does cancer and estrogen use affect? | hypercoaguable states |
| What is the most common inherited hypercoaguable condition? | Factor V leiden mutation |
| T or F: Signs and symptoms of DVT are neither sensitive or specific | TRUE |
| What is a common complication of DVT? | post thrombotic syndrome |
| What is the number one diagnostic test for PE? | ventilation-perfusion radionuclide scan |
| What is a complication of PE? | pulmonary hypertension |
| T or F: IVC Filter is only indicated for DVT treatment | FALSE |
| Where is the IVC filter placed? | inferior vena cava |
| Why are IVC filters bad? | increase long term risk of VTE |
| What anticoagulant is indicated for line flushing? | UFH |
| What is the MOA of UFH? | inhibits clotting factors currently in circulation |
| What factors does UFH effect? | XII, XI, IX, Xa, IIa (thrombin) |
| What is the IV dose for DVT/PE with UFH? | 80-100 units/kg bolus followed by 17-20 units/kg/hr IV drip |
| How do you adjust the UFH dose for treatment of VTE? | aPTT or antifactor Xa levls |
| What is the SQ dose for DVT/PE with UFH? | 333 units/kg followed by 250 units/kg every 12 hours |
| Does UFH need to be renally adjusted? | NO |
| When should aPTT and antifactor Xa levels be drawn? | 6 hours after starting dose (6 hours after any dose change) |
| What is the therapeutic range of aPTT? | 1.5-2.5x control |
| What is the therapeutic range of antifactor Xa? | 0.3-0.7 units/mL |
| What does LMHW have greater activity against? | factor Xa |
| LWMH has less incidence of what compared to UFH? | osteoporosis and HIT |
| What is the SQ dose for DVT/PE with Enoxaparin? | 1 mg/kg SQ every 12 hours |
| What is the SQ inpatient dose for DVT/PE with Enoxaparin? | 1.5 mg/kg SQ every 24 hours |
| How do you renally adjust for LMWH? | ClCr < 30 mL/min: 1 mg/kg SQ every 24 hours |
| What is dalteparin? | LMWH |
| What is the SQ dose for DVT/PE with Dalteparin? | 100 units/kg SQ every 12 hours |
| Which LMWH is dosed 175 units/kg SQ every 24 hours? | Tinzaparin |
| What weight do you use for anticoagulants? | actual body weight |
| What are common SE of heparins? | low platelets, osteoporosis, HYPERkalemia |
| Thrombocytopenia | platelet count <150,000 |
| When is the onset for HAT? | 1-4 days |
| When is the onset for HIT? | 5-14 days |
| What causes HAT? | direct interaction between heparin and platelets |
| What causes HIT? | antibody mediated interaction |
| Can you continue heparin when a patient develops HAT? | YES |
| What medication should you give to patients who develop HIT? | direct thrombin inhibitors |
| What is fondaparinux? | factor Xa inhibitors? |
| What other medications are factor Xa inhibitors? | rivaroxaban and abixaban |
| Which factor Xa inhibitor is not approved for VTE? | abixaban? |
| Which factor Xa inhibitor is indicated for DVT prophylaxis? | fondaparinux? |
| Which factor Xa inhibitor is indicated for postoperative prophylaxis? | rivaroxaban |
| What is fondaparinux dosed by? | actual body weight |
| What is the fondaparinux dose for DVT/PE? | 5 mg SQ daily (<50 kg), 7.5 mg SQ daily (50-100kg), 10 mg SQ daily (>100kg) |
| What is the rivaroxaban dose for DVT/PE treatment? | 15 mg BID with food for 3 weeks, then 20 mg QD with food |
| What is the rivaroxaban dose for recurrent reduction DVT/PE? | 20 mg QD with food |
| What is the rivaroxaban dose for postoperative reduction DVT/PE? | 10 mg QD with food (up to 35 days) |
| Do factor Xa inhibitors require therapeutic monitoring? | NO |
| Can you develop HIT for Xa inhibitors? | YES |
| When are factor Xa inhibitors CI? | ClCr <30mL/min |
| Which medication has interactions with CYP3A4 (inhibitors/inducers? | rivaroxaban |
| What is the MOA of direct thrombin inhibitors? | inhibit BOTH circulating and clot-bound thrombin |
| What can DTI's never cause? | HIT |
| Which DTI requires dose reduction with liver disease? | argatroban |
| Which DTI requires dose reduction with renal disease? | bivalirudin |
| Which DTI is not approved for VTE treatment? | dabigatran |
| What do DTI agents increase? | INR levels |
| What labs should be taken every 6-12 months for all anticoagulants? | Hgb, Hct, platelets |
| What is the treatment for acute bleeding from anticoagulants? | FFP, packed RBCs |
| What is the black box warning for all anticoagulants? | neuraxial anesthesia (hematomas) |
| What is the MOA of warfarin? | inhibits production of several vitamin K dependent clotting factors |
| Which clotting factor has a half life of 4-6 hours? | VII |
| Which clotting factor has a half life of 8-10 hours? | Protein C |
| Which clotting factor has a half life of 20-30 hours? | IX |
| Which clotting factor has a half life of 24-40 hours? | X |
| Which clotting factor has a half life of 40-60 hours? | Protein S |
| Which clotting factor has a half life of 60-100 hours? | II |
| What is protime? | the time in seconds for a clot to form |
| What is the reliability of the result influenced by? | sensitivity of thromboplastin reagents |
| What is the equation for INR? | (PT patient/PT control)^ISI |
| How do you first monitor INR? | twice a week |
| How do you monitor INR after a dose change? | in 7-14 days |
| When is warfarin CI? | active or recent major bleed, alcohol/drug abuse, pregnancy, patient at risk for trauma or falls |
| When does purple toe syndrome typically occur? | 3-10 weeks after starting warfarin |
| What is the cause of warfarin induced skin necrosis? | deficiency in protein C or S |
| What should be given to patients with warfarin induced skin necrosis? | heparin |
| Which warfarin enantiomer is 4x more potent? | S (9/19) |
| If there is a transient drug interaction how do you change warfarin dose? | skip 1-2 doses |
| How does diarrhea effect INR? | increases |
| Which medication is most likely to increase a patient's INR? | metronidazole |
| Which OTC pain reliever is safest to take with warfarin? | APAP |
| How do grapefruit and cranberry juices effect INR? | increase |
| How does chronic alcohol effect INR? | decreases (binge drinking increases INR) |
| What does smoking while on warfarin do? | induce 1A2 (metabolism of R-isomer) |
Created by:
jgk25
Popular Science sets