kinetics anticoags

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coal
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251217
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kinetics anticoags
Updated:
2013-12-13 10:46:34
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kinetics anticoags
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kinetics anticoags
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  1. warfarin MOA
    • interferes with hepatic synthesis of vitamin K dependent clotting factors
    • 7,C,9,10,S,2 - shortest to longest T1/2
  2. warfarin's onset of action, full therapeutic effect and duration of action
    • 24-72 hrs
    • 5-7 days
    • 2-5 days
  3. warfarin's absorption and distribution
    • F = .9
    • Vd = 0.1-0.2
    • 90% bound to albumin
  4. warfarin's metabolism
    • S - CYP2C9
    • R - 1A1, 1A2, 2C19, 3A4
  5. drugs that can have an increase risk of bleeding but don't affect INR
    • NSAID's
    • ASA
    • clopidogrel
    • SSRI's
  6. a food that will increase INR
    cranberry
  7. risk factors that can affect INR
    • fever
    • N/V
    • diarrhea
    • hyper & hypothyroidism
    • hepatic failure
    • CHF
    • cancer
  8. 5 pt factors to consider when deciding to initiate on warfarin
    • age
    • comorbidities
    • diet
    • medications
    • nutritional status
  9. rules of thumb for starting doses
    • > 65 - start with < 5mg
    • < 65 and healthy 5-10 mg
    • AFib - 3mg
    • DVT 10mg x 2 days then check INR
  10. when do we monitor warfarin upon initiation and maintenance
    • initiation - day 3 (checking for antithrombotic effect) and day 5 (possible full therapeutic affect)
    • maintenance - 1-2 weeks after dose change
    •                       q4 week once stable
    •                       q12 wks stable & reliable
  11. Coumadin indication and INR levels not 2-3
    • pulmonary hypertension 1.5-2.2
    • mechanical mitral valve 2.5-3.5
    • multiple indication (AFib & valve) - 2.5-3.5
  12. coumadin indications with and INR goal of 2-3
    • AFib
    • DVT/PE
    • biologic mitral valve/aortic valve or mechanical aortic valve
    • post MI
    • post stroke
    • prophylaxis of DVT
    • cardioversion
    • nephrototic syndrome
  13. length of warfarin tx for AFib, DVT and PE
    • lifelong
    • 3 months 1st episode, multiple lifelong
    • 3-6 months
  14. absolute CI of warfarin
    • major bleeding
    • major surgeries
    • pregnancy
    • blood dyscrasias
  15. relative CI of warfarin
    • alcoholic
    • noncompliance
    • liver disease
    • fall risk
    • uncontrolled HTN
    • malnutrition
    • some surgeries
  16. rules for dose adjustment of warfarin
    • based on weekly doses
    • typically 10-20%
    • 5% in sensitive pts
  17. hereditary effects on warfarin
    • VKOR
    • Asians = more senstive
    • African & European = more resistant
  18. pradaxa
    dabigatran
  19. pradaxa MOA
    direct thrombin inhibitor
  20. when is the maximum effect of pradaxa and the T1/2
    • 2-3 hrs
    • 12-14 hrs
  21. pradoxa's indication and dose
    • nonvalvular AFib
    • 150 mg BID
  22. what is the dose of pradaxa if the CrCl is 30-50 ml/min
    75 mg BID
  23. what is the dose of pradaxa if the CrCl is < 30 ml/min
    avoid use
  24. xarelto
    rivaroxaban
  25. xarelto indication and dose
    • nonvalvular AFib - 20 mg QD
    • postoperative thromboprophylaxis after knee or hip surgery - 10 mg QD
  26. xarelto MOA
    factor Xa inhibitor
  27. heparin MOA
    • converts antithrombin from a slow clotting enzyme to a fast one
    • inactivates thrombin and factor Xa 1:1
    • prevents conversion of fibrinogen to fibrin
  28. heparin dosing for DVT
    80 unit/kg bolus then18 unit/kg/hr
  29. heparin dosing for STEMI & nonSTEMI
    60 unit/kg bolus then 12 unit/kg/hr
  30. aPTT time when no change in heparin is needed
    55-75
  31. LMWH's
    • lovenox - enoxaparin
    • fragmin - dalteparin
    • innohep - tinzaparin
  32. lovenox MOA
    strong inhibitor of factor Xa
  33. lovenox T1/2 and duration of action
    • 4.5-7 hrs
    • 12 hrs
  34. enoxaparin dosing
    1mg/kg BID - actual body weight
  35. therapeutic range of lovenox given BID SQ
    0.6-1 iu/mL
  36. therapeutic range of lovenox given QD SQ
    >1 iu/mL
  37. heparin Vd & T1/2
    • 0.07 L - use actual body weight
    • 1.6 hrs
  38. relationship between IV & SQ doses of heparin
    SQ should be 10% higher
  39. difference between heparin metabolisms
    • depolymerizations - saturable/rapid
    • renal - non-saturable/slower
  40. arixtra
    fondaparinux
  41. arixtra MOA
    selective Xa inhibitor
  42. arixtra contraindication
    CrCl < 30 ml/min
  43. two anticoags CI if CrCl is < 30 ml/min
    • arixtra
    • pradaxa
  44. arixtra prophylaxis dosing
    2.5 mg SQ QD
  45. arixtra tx weight based dosing
    • < 50 kg = 5 mg SQ QD
    • 50-100 kg = 7.5 mg SQ QD
    • >100kg = 10 mg SQ QD

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