VTE (17 questions) – Study Guide and Practice Calculations

VTE (17 questions) - Study Guide and Practice Calculations Study Guide: Recognize signs and sx's of VTE, etiology, and risk factors for VTE Identify treatment goals for VTE Formulate a treatment regimen for a patient with VTE (case-based), similar to the main VTE case in class Be able to determine appropriate treatment duration for VTE Formulate VTE prophylaxis regimen given a specific patient case considering thrombosis risk and bleeding risk o Padua risk score and bleeding risk items will be provided; however, know the first three bleeding risk factors on the slide Active gastroduodenal ulcer Bleeding in 3 months before admission Platelet count less than 50 x 109/L (this means 50,000 cells per cubic mm; don't need to know how to convert unit for Pit count, units will be in cells per cubic mm) Know the red dosing for VTE treatment and prophylaxis (including renal function dosing and medication choice for special populations) o For cases on exam, don't forget to check if you need to renally adjust the anticoagulant dose and/or if the medication can be used based on patient's renal function • If CrCl is needed for a case, it will be given o As a note, special populations we went over in more detail include cancer- associated thrombosis, massive PE, pregnancy, renal impairment, orthopedic surgeries. Again, make sure you know the preferred anticoagulant option(s) for these patients. Slides on patients with extreme weights will be FYI for the exam at this time. Please read through them so you know that there are recommendations for this patient population. Know all DDI inside out for VTE medications Know major patient counseling points for VTE medications, drug class, monitoring parameters, bridging, conversion from one anticoagulant to the other (emphasized in class) Identify INR goals for different conditions Know how to dose/adjust UFH and Coumadin if given a case (similar to cases in class) • Adjustment protocol(s) will be given if needed on exam Discuss about antidote/reversal strategies for different anticoagulants including: • Warfarin (there is a table for reversing warfarin which is emphasized in class) o Unfractionated heparin and LMWH DOACS Don't have to know all indications for each medication, but know which one can only be used for treatment Know brand and generic for the medications discussed Practice Calculations: Final answers are included on the last page of this file; check them after you work on the questions 1. MD orders heparin pharmacy to dose for patient AA who is 35 years old and weighs 50 kg. Diagnosis: DVT; PMH: none; NKDA Baseline pertinent labs: aPTT: 30; H/H: 12/40; Pit: 220,000 a. Calculate the initial unfractionated heparin (UFH) bolus dose (in units) and infusion rate (in mL/hr). Premixed heparin bags contain 25000 units in 250 mL D5W. Round to the nearest 100 units for all calculations. b. When should the next aPTT be checked? 2. a. For the same patient AA above, the next aPTT value comes back at 37. Utilizing the protocol below, decide the unfractionated heparin regimen for the patient. Round to the nearest 100 units for all calculations. Unfractionated Heparin Titration Protocol aPTT less than 35; Bolus 80 units/kg (max 5000 units); Infusion Rate Increase by 4 units/kg/hr aPTT = 35-42: Bolus = 40 units/kg (max 5000 units); Infusion Rate Increase by 2 units/kg/hr aPTT = 43-49; Bolus 20 units/kg (max 3000 units); Infusion Rate Increase by 2 units/kg/hr aPTT = 50-70; Bolus 0; Infusion Rate Continue same rate aPTT = 71-90; Bolus = 0; Infusion Rate Reduce by 2 units/kg/hr aPTT = 90-140; Bolus 0; Infusion Rate Hold heparin for 1 hour, then reduce by 3 units/kg/hr aPTT = greater than 140; Bolus = 0; Infusion Rate = Hold heparin for 2 hours, then reduce by 3 units/kg/hr b. When should the next aPTT be checked?