Therapeutics: Dosing

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Author:
kyleannkelsey
ID:
261130
Filename:
Therapeutics: Dosing
Updated:
2014-05-06 15:58:40
Tags:
Dosing
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Dosing
Description:
Therapeutics: Dosing
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  1. Heparin DVT Prevention
    • Dose 5000 IU SQ Q8-12H
    • Q8H High risk
  2. Heparin DVT/ PE Tx
    • Bolus 80 U/kg (max 10K)
    • Infusion 18 U/kg/hr (2.3k U/hr)
  3. Heparin Protamine Dosing
    1mg = 100 units
  4. Enoxaparin (lovenox) Prevention DVT - Med pt
    • 40mg SQ QD
    • < 30 ml/min
    • 30mg SQ QD
  5. Enoxaparin (lovenox) Prevention DVT - Hip
    • 30mg SQ Q12 or 40mg SQ QD
    • < 30 ml/min
    • 30mg SQ QD
  6. Enoxaparin (lovenox) Prevention DVT - Knee Replacement
    • 30mg SQ Q12
    • < 30 ml/min
    • 30mg SQ QD
  7. Enoxaparin (lovenox) Prevention DVT - abdominal Surgery
    • 40mg SQ QD
    • < 30 ml/min
    • 30mg SQ QD
  8. Dalterparin (fragmin) Prevention DVT - Abdominal surgery
    • 2.5K IU SQ QD
    • 1-2 hours post surgery
  9. Dalterparin (fragmin) Prevention DVT - abdominal Surgery High VTE
    • 5K IU SQ QD
    • Q12H post surgery
  10. Dalterparin (fragmin) Prevention DVT - Med Pt
    5k IU SQ QD
  11. Dalterparin (fragmin) Prevention DVT - Hip
    • 5K IU SQ
    • Q12H post/ pre op QD
  12. Enoxaparin VTE Tx
    • 1mg/kg SQ Q12H or
    • 1.5mg/kg SQ QD
    • < 30ml/min
    • 1mg/kg SQ QD
  13. Tinzaparin (Innohep) VTE Tx
    • VTE 175 IU/kg SQ QD
    • CI under <30ml/min
  14. Fonadparinux (arixtra) - Surgery Prophylaxis
    • 2.5 mg Q6-8 before
    • CI < 30ml/min, BW < 50kg
  15. Fonadparinux (arixtra) Tx < 50 kg
    • 5 mg SQ QD
    • CI Renal < 30ml/min
  16. Fonadparinux (arixtra) Tx 50 - 100 kg
    • 7.5 mg SQ QD
    • CI Renal < 30ml/min
  17. Fonadparinux (arixtra) Tx 100 + kg
    • 10 mg SQ QD
    • CI Renal < 30ml/min
  18. Warfarin Tx
    • 5-10 mg PO Young
    • 2.5 - 5 mg Old, Surgery Pt
    • CI Pregnant
  19. Rivaroxaban (Xarelto) Post Op VTE Prophylaxis
    • 10mg PO
    • CI < 30ml/min
  20. Rivaroxaban (Xarelto) Tx and 2nd Prophylaxis
    • 15mg BID w/food x21D
    • 20 mg QD w/food Duration therapy
    • CI < 30ml/min
  21. Rivaroxaban (Xarelto) Tx Afib
    • 20mg PO Qpm
    • 15-30 ml/min 15mg PO Qpm
  22. Rivaroxaban (Xarelto) Tx Knee
    10mg QD x 12D
  23. Rivaroxaban (Xarelto) Tx Hip
    10mg QD x 35D
  24. Rivaroxaban (Xarelto) Liver Dosing
    CI B and C
  25. Rivaroxaban (Xarelto) Food dosing
    • 10mg w/o food
    • 10+ mg w/food
  26. Argatroban Infusion
    2 mcg/kg/min
  27. Argatroban Infusion > 6 Liver dosing
    0.5 mcg/kg/min
  28. Argatroban Infusion HF
    0.5 - 1.2 mcg/kg/min
  29. Apixaban (Eliquis) - Stroke prophylaxis
    5mg BID
  30. Apixaban (Eliquis) reduced dose
    • 2.5 mg PO BID
    • Strong CYP3A4 inhibitor, 80+ y/o, BW < 60kg, SCr > 1.5
  31. Dabigatran (Pradaxa) CrCl > 30 ml/min
    150 mg BID
  32. Dabigatran (Pradaxa) CrCl 15 - 30ml/min
    75 mg BID
  33. Dabigatran (Pradaxa) < 15 ml/min
    No use

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