final lecture 8

Question 1

PT reflects

Answer 1

extrinsic pathway

Question 2

aPTT reflects

Answer 2

intrinsic pathway

Question 3

INR reflects

Answer 3

factors II, VII, X

Question 4

heparin treatment dosing

Answer 4

initiation: 8units/kg bolus

followed by infusion: 18 units/kg/h

Question 5

heparin monitoring

Answer 5

aPTT 1.5-2.5

Question 6

major bleeding w/ heparin

Answer 6

when 2g decrease in Hgb

Question 7

heparin antidote

Answer 7

1 mg protamine sulfate will neutralize 100 units of heparin

Question 8

enoxaparin therapeutic dose

Answer 8

1mg/kg Q12H

Question 9

dalteparin therapeutic dose

Answer 9

200 units/kg Q24H

Question 10

LMWH monitoring

Answer 10

CBC

Question 11

fondaparinux doses

Answer 11

100kg: 10mg QD

Question 12

at what time of day should you give warfarin?

Answer 12

at bedtime

Question 13

warfarin dose

Answer 13

5-10mg if 65

Question 14

need UFH or LMWH to ____

Answer 14

bridge until patient reaches therapeutic range w/ warfarin

Question 15

time to steady state on warfarin

Answer 15

8-15 days

Question 16

warfarin monitoring

Answer 16

INR 2-3

mechanical valves 2.5-3.5

Question 17

warfarin adustment is based on

Answer 17

weekly dose

adjust by 5-10% based on INR

Question 18

ADRs for warfarin

Answer 18

skin necrosis
purple toe syndrome
teratogenic

Question 19

drug interactions w/ warfarin

Answer 19

bactrim, amiodarone, metronidazole, azoles, rifampin, barbiturates, vitamin K, EtOH,

Question 20

supratherapeutic warfarin 4.5<10

Answer 20

vitamin K generally not recommended; skip 1-2 doses

Question 21

supratherapeutic warfarin INR>10, no sig. bleeding

Answer 21

give vit K(2.5-5mg PO)

Question 22

supratherapeutic warfarin serious bleeding at any INR elecation

Answer 22

give vit K (5-10 slow IV)

Question 23

supratherapeutic warfarin life-threatening bleed

Answer 23

hold warfarin; given frozen plasma

Question 24

rivaroxaban dose

Answer 24

factor Xa inhibitor
VTE: 15mg PO BID X 3 weeks, then 20mg PO QD for 3 months
Afib: 20mg PO QD

Question 25

rivaroxaban pros

Answer 25

no monitoring, less interactions

Question 26

apixaban dose

Answer 26

factor Xa inhibitor
VTE/PE: 10mg PO BID X7 days then 5mg PO BID for 6 montsh then 2.5mg BID x 12month
Afib: 5mg BID

Question 27

dabigatran dose

Answer 27

IIa(thrombin) inhibitor (DTI)

Afib/VTE/PE: 150mg PO BID