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Thrombosis Chapter 16

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Thrombosis Chapter 16 John Noviasky, PharmD Question 1 What are common signs of DVT? Question 2 What are risk factors for DVT? Question 3 What tests should be done to ... – PowerPoint PPT presentation

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Title: Thrombosis Chapter 16


1
ThrombosisChapter 16
  • John Noviasky, PharmD

2
Question 1
  • What are common signs of DVT?

3
Question 2
  • What are risk factors for DVT?

4
Question 3
  • What tests should be done to confirm DVT?

5
Question 4
  • What baseline data is needed prior to
    anticoagulation?

6
Question 5
  • What should be used to treat DVT?

7
Question 6
  • Why is heparin loading dose required?
  • What is purpose of this treatment?

8
Question 7
  • What can alter response to heparin therapy?

9
Question 8
  • How should heparin therapy be monitored?

10
Question 9
  • How long should heparin therapy be monitored?

11
Question 10
  • Describe HIT I HIT II
  • How should we treat HIT II?
  • Can LMWH be used in HIT?

12
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?

13
Question 12
  • When does osteoporosis become an issue with
    heparin therapy?
  • What electrolyte disturbance can occur with
    heparin?

14
Question 13
  • What are options for patient without venous
    access?

15
Question 14
  • When should protamine be used?
  • What is onset of protamine?
  • How is protamine dosed?
  • What are adverse effects of protamine?

16
Question 15
  • What are contraindications to outpatient use of
    LMWH?
  • Doesing of LMWH?

17
Question 16
  • Requirements of Home LMWH?

18
Question 17
  • What are risk factors for development of DVT?
  • How does recommended prevention differ by risk
    group?

19
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?

20
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?

21
Question 20 continued
  • What happens when protein C or protein S is
    depleted?
  • Can heparin affect INR?
  • Can warfarin affect PTT?

22
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.?

23
Question 22
  • How long does endothelization take?
  • When a pt. Has a CVT and these risk factors,
    warfarin should be continued indefinitely.

24
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?

25
Question 23 continued
  • Is the increased chance of bleed in the elderly
    related to warfarin management?

26
Question 24
  • When does warfarin skin-necrosis present?

27
Question 25
  • Is warfarin contraindicated in protein
    (deficiency)?
  • When does purple-toe occur?
  • Why should warfarin be stopped in purple-toe?

28
Question 27
  • Table 16-11, Key elements of patient education.

29
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?

30
Question 28 continued
  • How does heart failure, hepatic congestion and
    liver disease affect INR?
  • How does thyroid affect INR?

31
Question 29
  • Important steps in managing warfarin (fig. 16-5)

32
Question 30
  • Adjusting warfarin (fig. 16-6)

33
Question 31
  • When should INR be rechecked?

34
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?

35
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?

36
Question 34
  • What effects does warfarin have on fetus?
  • What other anticoagulant can be used?
  • Can warfarin be used by nursing mother?

37
Question 35
  • Describe warfarin therapy peri-cardioversion.
  • What diagnostic test es used to rule out a left
    atrial and left atrial appendage trhrombi?

38
Question 36
  • Why should warfarin be continued for at least 4
    weeks post cardioversion?

39
Question 38
  • Which mechanical valve has most thromboembolic
    potential?
  • What INR range for mechanical valve?

40
Question 39
  • What INR and what duration for bioprosthetic?

41
Question 40
  • When should ASA be added to warfarin?

42
Question 41
  • When should warfarin be used in patients with
    dilated cardiomyopathy?

43
Question 42
  • What are reasons for TE after MI?
  • How long should warfarin be used after MI?

44
Question 43
  • What is Bridge Therapy
  • What factors determine the type of anticoagulant
    used in bridge-therapy?
  • Table 16-14

45
Question 44
  • Is it necessary to hold warfarin for all dental
    procedures?
  • Table 16-15

46
Question 45
  • Table 16-16

47
Question 46
  • How does amiodarone influence INR?

48
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?

49
Question 47 continued
  • Which NSAID is usually suggested with warfarin?
  • What is analgesic DOC with warfarin?

50
Question 48
  • Table 16-17
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