PC707 Module 5 Cardiac Exam with 100% Verified and Updated Solutions

PC707 Module 5 Cardiac Exam with 100% Verified and Updated Solutions Warfarin inhibits what? - answerAction of Vitamin K (which decreases the synthesis of several clotting factors). Is Warfarin plasma bound? - answerYes. Warfarin inhibits the formation of? - answerProthrombin, leading to slowed clot formation. Why is Warfarin considered a high risk drug? - answerD/t its narrow therapeutic range and ability to be altered by certain foods, drugs, and even altitude. T/F. Warfarin must be taken regularly and requires monitoring? - answerTrue. With Warfarin how are doses adjusted? - answerAccording to INR. What is the desired INR when on Warfarin? - answer2.5 (2.0-30). In which population can Warfarin therapy be problematic? - answerElderly with dementia. What could be an access barrier for Warfarin monitoring? - answerFrequent lab monitoring. T/F. Warfarin is one of the most recognized medications for which genetic variation plays an influential role? - answerTrue. Is there such a thing as genetic testing before starting a patient on Warfarin therapy? - answerYes, for optimal dosing, reducing the risk of bleeding and hemorrhage from a dose that's too high, and blood clots from a dose that's too low. Which 2 medications inhibit platelet aggregation? - answerAspirin & NSAIDs. T/F. The effects of NSAIDs on platelet aggregation are reversible and last for a shorter period of time, depending on drug half-life? - answerTrue. Typically platelet function returns to normal within how many hours of discontinuation of ibuprofen. - answer24 hours. Name some of the platelet inhibitors? - answerClopidogrel (Plavix), ticagrelor (Brilinta) and prasugrel (Effient). Platelet inhibitors is added to ASA after? - answerAcute coronary syndrome. Which platelet inhibitors has been used the most and why? - answerClopidogrel (Plavix). First drug around and it has been used the most. Which platelet inhibitor is more effective? - answerTicagrelor (Brilinta). - Prevents 11 more cardiovascular deaths - Prevents 11 more MIs - Prevents 6 more thromboses after stent placement What are the newer generations of anticoagulants? - answerDabigatran, rivaroxaban and apixaban. Do the newer generation of anticoags need INR monitoring? - answerNo. Is there in increased risk of under or over dosing? - answerNo, it is decreased. Compared to Warfarin which has half-life of 40 hours, what is the half-life for newer generations? - answerShort-acting and have short half-lives of only 12 hours, which may contribute to higher rates of strokes if not adhering correctly. Initial dosage varies widely among patients. Its based on factors such as? - answerAge Race Body weight Sex Genotype Concomitant drugs Indication ACCP recommends average starting dose for Warfarin is? - answer5 mg. Warfarin dosage should be lowered for whom? - answerElderly CHF Malnourished Liver disease Recent major surgery Certain drugs After getting baseline INR, when should your next INR check be for Warfarin and then? - answerAfter two or three doses, twice weekly (until within therapeutic INR levels), weekly, q other week, finally monthly. Which herbs need to be watched when taking Warfarin? - answerGarlic, gingko, vit. E. Patient education for Warfarin include? - answerGreens can impact clotting time. Use electric razor, no ASA or NSAIDs, monitor for bleeding, wear bracelet, or keep medication card in wallet. What's the deal with Heparin? - answer- Used less often in primary care. - Has the advantage of being inexpensive, but must be given IV or subcutaneously. - Has a very short half life, allowing for rapid induction of anticoagulation and reversal. What's the deal with Lovenox? - answer- Often substituted for heparin. - Administered subcutaneously. - Administered only once or twice daily (unlike heparin which requires qid or continuous IV dosing). - It does not require monitoring. - Despite its significantly higher cost, enoxaparin can reduce overall health costs as it does not require hospitalization. Lovenox and Fragmin in pregnancy? - answerBoth are cate B (per Lexicomp). What are the risk for these two LMWH? - answerBleeding, hemorrhage and thrombocytopenia. Heparin (cate. C) is used for what in pregnancy? - answerPrevention of VTE for those at risk, treatment of emergency thrombotic events such as DVT and PE, and prophylactic treatment for history of thrombosis or certain congenital thrombophilias. Is an anesthesiologist required to be consulted for LMWH? - answerYes. D/t complications associated with low-molecular weight heparin. Is Heparin (cate. C) considered safe during pregnancy and lactation. - answerYes. Coumadin in pregnancy? - answerNo. Cate. X. Fetal Warfarin syndrome? - answerInclude facial malformations and associated airway obstruction and neonatal respiratory difficulties. T/F. If possible, both warfarin and heparin should be avoided with imminent or possible abortion or miscarriage. - answerTrue. When Warfarin is prescribed postpartum (after 6 weeks d/t hx of thrombosis) what do you need to watch for in the infant? - answerPetechiae and ecchymoses. Conditions leading to HF? - answerHypert