Thrombosis Chapter 16

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ThrombosisChapter 16

• John Noviasky, PharmD

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Question 1

• What are common signs of DVT?

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Question 2

• What are risk factors for DVT?

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Question 3

• What tests should be done to confirm DVT?

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Question 4

• What baseline data is needed prior to
  anticoagulation?

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Question 5

• What should be used to treat DVT?

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Question 6

• Why is heparin loading dose required?
• What is purpose of this treatment?

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Question 7

• What can alter response to heparin therapy?

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Question 8

• How should heparin therapy be monitored?

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Question 9

• How long should heparin therapy be monitored?

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Question 10

• Describe HIT I HIT II
• How should we treat HIT II?
• Can LMWH be used in HIT?

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Question 11

• What is most common adverse event wit heparin?
• What is bleeding risk with heparin?
• Most common sites of bleeding?
• What factors increase risk of bleeding?
• What are signs of bleeding?

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Question 12

• When does osteoporosis become an issue with
  heparin therapy?
• What electrolyte disturbance can occur with
  heparin?

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Question 13

• What are options for patient without venous
  access?

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Question 14

• When should protamine be used?
• What is onset of protamine?
• How is protamine dosed?
• What are adverse effects of protamine?

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Question 15

• What are contraindications to outpatient use of
  LMWH?
• Doesing of LMWH?

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Question 16

• Requirements of Home LMWH?

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Question 17

• What are risk factors for development of DVT?
• How does recommended prevention differ by risk
  group?

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Question 18

• Common signs and symptoms of PE?
• What is most specific diagnostic test for PE?
• What is a V/Q mismatch?
• When should anticoagulation be started when PE is
  suspected?

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Question 20

• When should warfarin begin in relation to heparin
  therapy?
• What is half-life of warfarin?
• What is half-life of factor KII, Factor VII,
  protein C?
• What factor depletion is required for full
  anticoagulation?

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Question 20 continued

• What happens when protein C or protein S is
  depleted?
• Can heparin affect INR?
• Can warfarin affect PTT?

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Question 21

• What is usual dose of warfarin?
• What are factors that increase warfarin
  sensitivity? (table 16-9)
• What warfarin dose should be started in these
  pts.?

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Question 22

• How long does endothelization take?
• When a pt. Has a CVT and these risk factors,
  warfarin should be continued indefinitely.

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Question 23

• Annual frequency of bleeding with warfarin?
• Most common bleeding sites?
• How common are ICH with warfarin?
• What risk factors increase chance of warfarin
  bleed?

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Question 23 continued

• Is the increased chance of bleed in the elderly
  related to warfarin management?

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Question 24

• When does warfarin skin-necrosis present?

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Question 25

• Is warfarin contraindicated in protein
  (deficiency)?
• When does purple-toe occur?
• Why should warfarin be stopped in purple-toe?

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Question 27

• Table 16-11, Key elements of patient education.

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Question 28

• What factors influence INR?
• How much vitamin K should be allowed for a
  patient on warfarin?
• How does alcohol affect INR?
• How does diarrhea affect INR?

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Question 28 continued

• How does heart failure, hepatic congestion and
  liver disease affect INR?
• How does thyroid affect INR?

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Question 29

• Important steps in managing warfarin (fig. 16-5)

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Question 30

• Adjusting warfarin (fig. 16-6)

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Question 31

• When should INR be rechecked?

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Question 32

• If a pt. Is not bleeding and has elevated INR,
  what should be done?
• How long does it take for INR to return to
  normal?
• How long does it take for vit. K 2.5mg po to work?

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Question 32 continued

• Which is preferred, po, SQ, or IM vit K?
• How should vit K IV be administered?
• How should major bleed be corrected?

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Question 34

• What effects does warfarin have on fetus?
• What other anticoagulant can be used?
• Can warfarin be used by nursing mother?

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Question 35

• Describe warfarin therapy peri-cardioversion.
• What diagnostic test es used to rule out a left
  atrial and left atrial appendage trhrombi?

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Question 36

• Why should warfarin be continued for at least 4
  weeks post cardioversion?

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Question 38

• Which mechanical valve has most thromboembolic
  potential?
• What INR range for mechanical valve?

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Question 39

• What INR and what duration for bioprosthetic?

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Question 40

• When should ASA be added to warfarin?

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Question 41

• When should warfarin be used in patients with
  dilated cardiomyopathy?

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Question 42

• What are reasons for TE after MI?
• How long should warfarin be used after MI?

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Question 43

• What is Bridge Therapy
• What factors determine the type of anticoagulant
  used in bridge-therapy?
• Table 16-14

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Question 44

• Is it necessary to hold warfarin for all dental
  procedures?
• Table 16-15

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Question 45

• Table 16-16

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Question 46

• How does amiodarone influence INR?

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Question 47

• How do concurrent warfarin and NSAIDS increase
  risk of bleed?
• Are NSAIDS safe in warfarin therapy?
• How much increased risk of bleed with warfarin
  and NSAIDS?

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Question 47 continued

• Which NSAID is usually suggested with warfarin?
• What is analgesic DOC with warfarin?

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Question 48

• Table 16-17