Pharmacotherapy Test: Venous Thromboembolism (VTE)

Venography is an expensive, invasive test that carries the risk of anaphylaxis and nephrotoxicity.

• True

• False

Arixtra is contraindicated if severe renal impairment.

• True

• False

SERMs are a risk factor for VTE.

• True

• False

Which lab test tests for a fibrin degradation product?

• Doppler

• ESR

• D-dimer

• WBC

Cranberry juice raises the INR.

• True

• False

LMWH has a longer half-life than UFH.

• True

• False

Guidelines recommend UFH if CrCl < 30 mL/min.

• True

• False

A D-dimer can be used as a sole diagnostic test. A doppler is not necessary for diagnosis if the d-dimer is positive.

• True

• False

You can use an LMWH if a patient has a history of HIT.

• True

• False

Protamine neutralizes 60% of LMWH activity. We should give a _____ protamine dose if the LMWH was given greater than 8 hours ago.

• Larger

• Smaller

Arixtra (a factor Xa inhibitor) does not affect platelet function or aggregation.

• True

• False

If you suspect that a patient is excessively anticoagulated, what would your next step be?

• Monitor Hgb, Hct, and BP. Lower the dose of UFH. Administer IV protamine sulfate.

• Monitor Hgb, Hct, and BP. Discontinue UFH. Administer IV protamine sulfate.

• Monitor Hgb, Hct, and BP. Lower the dose of UFH. Administer IV Vitamin K and fresh frozen plasma.

• Monitor Hgb, Hct, and BP. Discontinue UFH. Administer IV Vitamin K and fresh frozen plasma.

There is no known antidote for DTIs.

• True

• False

A patient got a DVT from being in bed all week and not moving.  She is healthy otherwise.  How long should she be on warfarin?

• 3 months

• 6 months

• 12 months

What is the gold standard used to diagnose DVT?

• Ultrasonography

• D-dimer

• Venography

Heparin dissolves clots.

• True

• False

We can consider using an anti-thrombolytic in DVT if there is risk for limb grangrene, the patient has shock or ________.

• Hypertension

• Hypotension

Hypercoagulation disorders can be hereditary or acquired. Genetic may be deficiencies in anticoagulant proteins and acquired may be things such as pregnancy or _____.

If monitoring anti-Xa activity when a patient is on an LMWH, get sample __ hours after SC dose was given (peak concentration).

Arixtra is probably preferable to Lovenox for the prevention of venous thromboembolism.

• True

• False

The severity of pain correlates with the size of the thrombus.

• True

• False

If a patient has a non-life threatening bleed from Arixtra therapy, the patient should receive...

• Factor VIIa

• Fresh frozen plasma

• Protamine

A patient presents with an INR of 5.5 and no risk of bleeding.  What would be the preferred next step?

• Hold 1 to 2 doses and give PO vitamin K and resume at a lower dose

• Hold 1 to 2 doses and resume at a lower dose

VTE risk factors include:  (Check all that apply.)

• HRT meds

• Acute medical illness

• Immobility

• Trauma

• Pregnancy

• Cancer

The doctor decides to give the woman an LMWH. What should we monitor?

• APTT

• Anti-factor Xa

• Factor IIa

• INR

If a patient's assessment indicates DVT but a doppler does not show DVT, what is your next step?

• Check for Homan's sign.

• Check lab tests.

• Do an invasive test (such as angiography or venography).

• Nothing, if the doppler is negative there is no need to go further.

Warfarin inhibits the practical synthesis of biologically active forms of the vitamin K-dependent clotting factors: __, __, __, and __, as well as the regulatory factors proteins C and S. (Check all that apply.)

• II

• IV

• V

• VII

• VIII

• IX

• X

• XI

• XII

Bivalirudin is not indicated for DVT.

• True

• False

We can use a thrombolytic in PE (ASAP, effective up to 14 days after sx onset) if the patient is hemodynamically unstable.  Hemodynamically unstable means a systolic blood pressure less than ___.

Arixtra is indicated for:  (Select all that apply)

• Prophylaxis of DVT

• Treatment of acute DVT when given with warfarin

• Treatment of PE when given with warfarin and therapy initiated in the hospital

Both UFH and LMWH have IIa inhibitor activity. Arixtra has...

• A little thrombin IIa inhibition

• A lot of thrombin IIa inhibition

• No thrombin IIa inhibition

Measure INR daily when both Argatroban and Warfarin are given together and discontinue the _________ when the INR > 4.

• Argatroban

• Warfarin

Which of the following is true regarding ultrasonography? Select all that apply.

• Non-invasive

• Commonly used for DVT diagnosis

• Not commonly used for DVT diagnosis

• Cannot detect small blood clots in distal veins

• Can detect small blood clots in distal veins

• Invasive

Patients should take warfarin in the morning.

• True

• False

If a patient has had two VTEs how long should she be on warfarin?

• 3 months

• 6 months

• 12 months

• 18 months

• 24 months

If a 38 year old patient with no risk factors has major surgery, this patient is in what risk classification.

• Low

• Moderate

• High

• Highest

This drug is approved for patients with HIT and 40% of patients develop antibodies to it (leading to anaphylaxis).  You also need to adjust the dose in renal failure.

• Fondaparinux

• UFH

• Lepirudin

• Hirudin

Long term use of UFH can cause? (Check all that apply.)

• Alopecia

• Hyperkalemia

• Osteoporosis

General contraindications to anticoagulant therapy includes...

• Active bleeding

• Hemorrhagic tendencies (hemophilia)

• Severe liver dx

• Severe thrombocytopenia

• Malignant HTN

• Inability to supervise or monitor therapy

Lovenox and Arixtra prophylactic dosing is weight-based.

• True

• False

If a patient has his first episode of idiopathic DVT, how long should we treat him with warfarin?

• 3 months

• 6 months

• 12 months

• 24 months

Thrombolytics have been shown to improve morbidity and mortality.

• True

• False

Incidence of VTE almost doubles each decade after age __.

If platelets decrease, 50% from baseline or fall below 240,000, then suspect HIT.

• True

• False

If a patient has a hip fracture, the patient's risk classification for VTE prophylaxis is in what category?

• Low

• Moderate

• High

• Highest

Prior to LMWH therapy, we should monitor? Select all that apply.

• Serum creatinine

• Baseline PT/INR

• APTT

• CBC with platelet

If a patient 42 year old patient has no risk factors and minor surgery, this patient is in what risk classification.

• Low

• Moderate

• High

• Severe

A woman has just given birth and is breastfeeding. The doctor wants to know if you can provide her UFH or LMWH? You tell the doctor. (Select all that apply.)

• Not UFH, because it is not safe during breastfeeding.

• Not UFH, because there is a risk of maternal hemorrhage.

• LMWH is a better alternative because it does not cross the placenta.

• These drugs cross the placenta.