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31 Cards in this Set
- Front
- Back
which meds work by binding antithrombin III
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unfractionated heparin, low molecular weight heparins, and fondaparinux
leading to a decrease in factor Xa |
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which meds specifically inactivate factor Xa
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LMW> Unfractionated heparin
fondaprinux is selective factor Xa inhibitor-still requires AT binding to work |
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why are IV direct thrombin inhibitor so important
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they do NOT cross react with heparin-induced thrombocytopenia (HIT) antibodies
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what is the PO direct thrombin inhibitor DOC
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Dabigatrin
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how does rivaroxaban work
whats the brand name |
inhibits factor Xa
Xarelto |
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how does UFH work
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binds AT3, inactivating factors IIa (thrombin) and Xa
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what is the prophylaxis dose of VTE for UFH
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5,000 units SC Q8-12 H
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UFH
dosed based on. (weight) antidote: SE how to monitor |
dosed based on actual body weight
protamine 1mg reverses 100 units of heparin (max 50 mg ) SE-bleeding and HIT monitor- via aPTT (therapeutic range of 1.5-2.5 |
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LMWH MOA
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like UFH, but more specific Xa inhibition
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Enoxaparin
brand? prophylaxis dose of VTE Tx dose of VTE and NSTEMI |
VTE prophyl- 30 mg SC Q 12 H/ 40 mg SC daily
Tx of VTE/NSTEMI- 1mg/kg SC Q 12 H (CRCL <30) or 1.5 mg/kg SC Daily |
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enoxaparin
tx dose of STEMI |
<75 IV bolus of 30mg then 1mg/kg q 12 H
>75 NO BOLUS, just .75mg/kg q 12 H if <30ml/min do 1mg/kg DAILY |
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IF pt is to undergo PCI (balloon) and received enoxaparin 8 H ago, what should be done
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give 0.3 mg/kg IV bolus
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dalteparin
brand |
fragmin
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what category is warfarin
UFH? LMWH? |
warfarin + UFH = Cat x + C
LMWH= cat B!! |
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fondaparinux
brand prophylaxis VTE dose tx of VTE dose CI |
arixtra
Prophyx- 2.5 mg SC daily tx: <50 kg = 5mg daily 50-100 kg = 7.5 mg daily >100 kg = 10 mg daily CI- CrCl <30 ml/min |
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direct thrombin inhibitors
meds |
lepirudin
argatroban bivalirudin (angiomax) desirudin dabigatrin |
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dabigatrin
dosing directions SE PREG CAT |
med must be used within 4 months of opening bottle, keep in original container
SE- gastiritis, bleeding Cat C |
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per CHEST guidelines which is preferred, warfarin or dabigatrin
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dabigatrin, prevented more strokes - preferred for A.Fib
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rivaroxaban
indications BBW |
non valvular Afib- take with evening meals
Prophylaxis of DVT and tx of DVT/PE BBW-spinal punctures, and D/Cing in pts with non valv A. Fib (increased stroke) |
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warfarin
MOA |
reduces vit K via inhibiting VKORC1 enzyme
depleting factors II, VII, IX, X and protein C + S |
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warfarin
is a racemic mixture of... which is more potent |
R and S enanitomers
S- is 3-4 X more potent |
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warfarin colors
pink= yellow= tan= green= white= teal= peach= blue= lavender= |
p1nk= 1
lavender = 2 (e's) =2 mg green= 2e's and 5 letters total = 2.5 mg tan= 3 letters= 3 mg blue= 4 letters = 4mg peach = 5 letters = 5 mg teal= think Steal, S = 6mg yellow= steelers touchdown = 7.5 mg white= white ppl are 10's, 10 mg |
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meds like aspirin used with warfarin may cause
what to happen to bleeding? what to happen to INR |
increase Bleeding, but INR may remain unchanged
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Vitamin K
what form is preferred infused slow, why? |
PO is preferred, but IV is used in a serious bleeding pt
infuse slowly, reports of anaphylaxis |
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when should vitamin K be used
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when INR >10 and no bleeding, HOLD warfarin and start oral vitamin K 2.5 mg or 5 mg
if bleeding-give IV vitamin K 5-10mg slowly and prothrombin complex concentrate |
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CHADS scoring system
what is it |
C-CHF
H-HTN A-Age >75 D-dabetes S-Stroke/TIA all = 1 pt, except stroke/TIA = 2 pts |
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Chest guidelines
pt with Afib >48H attempting cardioversion |
warfarin for 3 wks prior to and 4 weeks after cardioversion
<48 H, start anticoag tx, attempt cardioversion, and tx for 4 weeks after cardioversion |
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CHADS score of 0
what to use |
aspirin 75mg - 325 mg daily
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CHADS score of 1
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use oral anticoag over ASA (favors dabigatrin)
if unable to take anticoag- use ASA + clopidogrel |
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CHADS score of > or = 2
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oral anticoag- favors dabigatrin over warfarin
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specific enoxaparin dosing directions
airbubbles |
do not expel the air bubble unless the dr has told you to do so
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