ANTICOAGULATION/VENOUS LATEST
THROMBOEMBOLISM NAPLEX
JT is a 62-year-old woman with a history of atrial fibrillation, coronary
heart disease, hypertension, and diabetes mellitus. Her current
medications include warfarin 5 mg daily, amlodipine 5 mg daily,
clopidogrel 75 mg daily, lisinopril 10 mg daily, metformin XR 1000 mg
daily, and ibuprofen 600 mg three times daily.
JT presents to her PCP with polyuria and pain on urination and is
diagnosed with a urinary tract infection. Which antibiotic would be
expected to have the least effect on her warfarin therapy? - ANSWERS-
Nitrofurantoin
Rationale: Nitrofurantoin can be used safely in patient's receiving
warfarin therapy without interaction.
TS is a 46-year-old man who was admitted to your hospital with an
acute DVT. The patient has no other significant medical history and this
is the first episode of DVT in this patient. Warfarin was initiated 2 days
ago and a therapeutic INR has not yet been achieved. The patient is
being discharged today with discharge prescriptions for warfarin and
Lovenox.
Which agent would be the best pain management option for TS to utilize
while on chronic warfarin therapy? - ANSWERS-Acetaminophen
END OF
PAGE
1
, ANTICOAGULATION/VENOUS LATEST
THROMBOEMBOLISM NAPLEX
Rationale: Although use of high doses of acetaminophen over several
days can cause an interaction with warfarin therapy, as needed, doses
less than 1500 mg daily is a safe option. Acetaminophen is the
recommended over-the-counter agent for the management of mild-
moderate pain with chronic warfarin therapy.
Which drug can be used safely in a Heparin-induced thrombocytopenia
(HIT) patient with a creatinine clearance of 25 mL/min? - ANSWERS-
Argatroban
Rationale: Argatroban, a direct thrombin inhibitor, should be used to
prevent and treat thrombosis associated with HIT. It is metabolized in
the liver and therefore, safe to use in patients with renal insufficiency.
KP is 72-year-old woman who presents to the emergency department
and reports hematuria for the past 2 days. The patient's INR is 7.2 and
KP reports she may have accidentally taken old 10 mg warfarin tablets
instead of her currently prescribed 5 mg tablets for the past week. Which
agent is the most appropriate reversal agent to be used in the case of
warfarin overdose? - ANSWERS-Vitamin K
Rationale: Vitamin K reverses the anticoagulant effects of vitamin K
antagonists (VKAs) such as warfarin. VKAs reduce thrombus formation
END OF
PAGE
2
, ANTICOAGULATION/VENOUS LATEST
THROMBOEMBOLISM NAPLEX
by inhibiting the activation of the vitamin K-dependent clotting factors
II, VII, IX, and X. The anticoagulant effect of VKAs is a fine balance
between the amount of vitamin K available to activate the clotting
factors and ultimately produce thrombin. Ingestion of additional Vitamin
K upsets this equilibrium and reverses the anticoagulant effects.
A 57-year-old woman (65 kg, BMI 28) was just admitted to the hospital
for treatment of a pulmonary embolism. An order was written for
heparin IV bolus 80 units/kg followed by a continuous infusion of 18
units/kg/h. What are respective heparin bolus dose and continuous
infusion rate for this patient? - ANSWERS-5000 units IV bolus; 1200
units/h infusion
Rationale: Heparin is dosed based on actual body weight. For the initial
bolus dose, 65 kg × 80 units/kg = 5200 units. The dose is rounded to
5000 units for ease of administration. Heparin is prepared as a 5000
units syringe. Alternatively, it would be difficult to draw up a dose to the
nearest 100 units dose. For the continuous infusion, 65 kg × 18
units/kg/h = 1170 units/kg/h. In this case, the dose is rounded to the
nearest 100 units because most IV pumps could not be programmed to
the nearest 50 units dose.
In which procedure should enoxaparin use be avoided? - ANSWERS-
Epidural anesthesia
END OF
PAGE
3
THROMBOEMBOLISM NAPLEX
JT is a 62-year-old woman with a history of atrial fibrillation, coronary
heart disease, hypertension, and diabetes mellitus. Her current
medications include warfarin 5 mg daily, amlodipine 5 mg daily,
clopidogrel 75 mg daily, lisinopril 10 mg daily, metformin XR 1000 mg
daily, and ibuprofen 600 mg three times daily.
JT presents to her PCP with polyuria and pain on urination and is
diagnosed with a urinary tract infection. Which antibiotic would be
expected to have the least effect on her warfarin therapy? - ANSWERS-
Nitrofurantoin
Rationale: Nitrofurantoin can be used safely in patient's receiving
warfarin therapy without interaction.
TS is a 46-year-old man who was admitted to your hospital with an
acute DVT. The patient has no other significant medical history and this
is the first episode of DVT in this patient. Warfarin was initiated 2 days
ago and a therapeutic INR has not yet been achieved. The patient is
being discharged today with discharge prescriptions for warfarin and
Lovenox.
Which agent would be the best pain management option for TS to utilize
while on chronic warfarin therapy? - ANSWERS-Acetaminophen
END OF
PAGE
1
, ANTICOAGULATION/VENOUS LATEST
THROMBOEMBOLISM NAPLEX
Rationale: Although use of high doses of acetaminophen over several
days can cause an interaction with warfarin therapy, as needed, doses
less than 1500 mg daily is a safe option. Acetaminophen is the
recommended over-the-counter agent for the management of mild-
moderate pain with chronic warfarin therapy.
Which drug can be used safely in a Heparin-induced thrombocytopenia
(HIT) patient with a creatinine clearance of 25 mL/min? - ANSWERS-
Argatroban
Rationale: Argatroban, a direct thrombin inhibitor, should be used to
prevent and treat thrombosis associated with HIT. It is metabolized in
the liver and therefore, safe to use in patients with renal insufficiency.
KP is 72-year-old woman who presents to the emergency department
and reports hematuria for the past 2 days. The patient's INR is 7.2 and
KP reports she may have accidentally taken old 10 mg warfarin tablets
instead of her currently prescribed 5 mg tablets for the past week. Which
agent is the most appropriate reversal agent to be used in the case of
warfarin overdose? - ANSWERS-Vitamin K
Rationale: Vitamin K reverses the anticoagulant effects of vitamin K
antagonists (VKAs) such as warfarin. VKAs reduce thrombus formation
END OF
PAGE
2
, ANTICOAGULATION/VENOUS LATEST
THROMBOEMBOLISM NAPLEX
by inhibiting the activation of the vitamin K-dependent clotting factors
II, VII, IX, and X. The anticoagulant effect of VKAs is a fine balance
between the amount of vitamin K available to activate the clotting
factors and ultimately produce thrombin. Ingestion of additional Vitamin
K upsets this equilibrium and reverses the anticoagulant effects.
A 57-year-old woman (65 kg, BMI 28) was just admitted to the hospital
for treatment of a pulmonary embolism. An order was written for
heparin IV bolus 80 units/kg followed by a continuous infusion of 18
units/kg/h. What are respective heparin bolus dose and continuous
infusion rate for this patient? - ANSWERS-5000 units IV bolus; 1200
units/h infusion
Rationale: Heparin is dosed based on actual body weight. For the initial
bolus dose, 65 kg × 80 units/kg = 5200 units. The dose is rounded to
5000 units for ease of administration. Heparin is prepared as a 5000
units syringe. Alternatively, it would be difficult to draw up a dose to the
nearest 100 units dose. For the continuous infusion, 65 kg × 18
units/kg/h = 1170 units/kg/h. In this case, the dose is rounded to the
nearest 100 units because most IV pumps could not be programmed to
the nearest 50 units dose.
In which procedure should enoxaparin use be avoided? - ANSWERS-
Epidural anesthesia
END OF
PAGE
3
