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62 Cards in this Set
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|
is a ld necessary for heparin
|
yes
hep usu takes 2-3 hrs to work, but need to work right away due to life threatening clots |
|
ld of hep
|
80-100 u/kg
max: 10,000 u |
|
warfarin dose that should be given on 1st day
|
5 mg
|
|
hep dose should be calibrated to keep dose w/in tx range of
or antifactor Xa level of |
0.2-0.4 U/ml or antifactor
0.3-0.7 U/ml |
|
aPPT should be -- to ---- x the baselin
|
1.5 - 2.5
|
|
min dose of ufh
max dose of ufh |
17-20 u/kg/hr
2,300 u/hr |
|
how often should the aPTT be rechecked
|
q 6 hrs for 1st 24 hrs
then q AM unless outside tx range |
|
type of hit
occurs btw days 1-5 of tx associated w/ mild decrease in plt count that returns to normal w/ continued hep tx |
type 1
|
|
type 2 hit occurs btw -- to -- days of tx or immediately in someone preveiously exposed to hep. associate dw/ a marked decline in plt count ----- ----
|
5-14 days
>50% of baseline; < 100,000 |
|
hep should be d/ced and replaced w/ ------ for hit
|
DTI
|
|
pf- + ---- + ----- interact w/ heparin like cells and damage the endothelial calll and collagen
|
PF4
Heparin IgG collagen potent acitvator of platelet aggregation |
|
tx goals of hit
|
interrupt the immune stimulus: stop all forms of hep
inhibit thrombin generation: start an alternative anticoagulant |
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when do you hold warfarin
|
until platelets >/= 150K
|
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continue warfarin and DTI >/=
|
5 days
|
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tx inr for hit for the
|
last 2 days
|
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continue warfarin and --- until platelets count stabilizes
|
dti
|
|
what dose do you initiate warfarin w/argatroban
do you giv a loading dose |
expected daily dose
no ld |
|
measure inr w/ argatroban and warfarin
|
daily
|
|
continu warfarin and argatroban if inr
|
less than or equal to 4
|
|
if inr is > ---
stop argatroban |
4
|
|
how often do you repeat the inr after stopping the srgatroban
|
4-6 hrs later
|
|
when would u restart argatroban
|
if inr below tx range
|
|
when is it ok to give warfarin by itself when giving w/ argroban
|
when inr tx
|
|
when do you initiate warfarin dose w/ lepirudine
|
aPTT ratio of 1.5
|
|
d/c lepirudin when inr >
|
2.0
|
|
warfarin and lepirudin
begin warfarin and continue both until inr = |
2.0
|
|
how do hep and warfarin work together
|
warfain prevents activation
heparin deactivates already activated clotting factors |
|
first time dvt/pe: reversibleor time limited rfs
duration: |
>/= 3 months of tx
|
|
first time dvt/pe: unprovoked duration of tx
|
long term
|
|
first time dvt/pe
irreversible rf duration |
indefinate
|
|
recurrent vte/pe
duration |
indefinate
|
|
inr tx
|
2-3
|
|
when to give warfarin w/ afib/flutter
|
3 weeks prior
4 weeks after |
|
a fib/ flutter w/ no risk factors
|
asa 75 mg to 325 mg
|
|
when will the inr goal be 2.5-3.5
|
mitral valve mechanical heart valve
caged ball or disk mechanical heat |
|
when do you add asa to mechanical valve valves
|
additional rf:
a fib, stemi-awmi, left atrial enlargement, hypercoaguable, low ejection fraction or athersclerotic vascular disease hx of systemic embolism w/ tx inr |
|
bioprosthetic heart valve
when do you give asa |
aortic
asa 50-100mg qd |
|
give asa 75 - 100mg q day indefinately for stemi plus
|
clopdigorel 300 mg LD, 75 mg qd for </= 12 mos
warfarin does to inro for less than or equal 3 mos |
|
for nstem give asa 75-100 mg qd indefinately plus
|
clpidogrel 75 mg
|
|
bioprosthetic heart valve + past hx of systemic embolism duration of tx
|
more than or equal 3 months
|
|
bioprothetic heart valve and additional rf and/or atherosclerotic vascular disease + asa 50-100 mg qd duration of tx
|
long term
|
|
out pt dosing of warfarin
inr < 2 small increases increase weakin doses by |
5-10%
|
|
inr < 2 larger increases increase weekly dose by
|
10-20%
|
|
inr > 3 but < 5
decrease weekly dose by |
5-10%
|
|
inr > 3, < 5
larger decrease |
hold 1st dose
decrease weekly dose by 10-20% |
|
t/f
doubling dose of warfarin will double inr |
f
nonlinear |
|
if inr > 3 -3.5 to < 5 what do you do
|
decrease weekly dose
and/ or omit warfarin dose |
|
if inr >/= 5, < 9 what do you do
|
omit 1-2 warfarin doses
and decrease weekly dose or omit warfarin dose and vit k 1-2.5 mg po |
|
inr > 9 and no bleeding what do u do
|
omit 1-2 warfarin doses
and vit k 2.5-5 mg po |
|
what if sign bleeding and increased inr
|
hold warfarin
vit k 10 mg iv slowly (may repeat in 12 hrs) given slowly due to possible anaphylaxis |
|
w/ high doses (10 mg or more) vit k is. ..
|
resistant to warfarin for 2 weeks
no change in inr vit k fat soluable, so stored in fat and released slowly |
|
whatcan increase warfarin
|
thyroid
fever liver dysfunction renal dysfunction chf |
|
interactions w/ warfarin: increased inr
atb |
macrolides
septra/bactrim antifungals |
|
interactions w/ warfarin: increased inr
gi |
cimetidine
omeparazole cholestyramine |
|
di w/ warfarin: increased inr
cv |
statins
amiodarone flecainide |
|
di w/ warfarin: increaesed inr
|
ssris
etoh |
|
di w/ warfarin: increased inr
misc |
herbals
|
|
di w/ warfarin:decreased inr
atb |
dicloxacillin
nafcilllin rifampin |
|
di w/ warfarin:decreased inr
gi |
sucrafate
cholestyramine |
|
di w/ warfarin:decreased inr
misc |
herbals
|
|
di w/ warfarin:decreased inr
cv |
atorvastatin
tobacco |
|
di w/ warfarin:decreased inr
cns |
ssri
etoh tegretal phenytoin |
