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NAPLEX THINGS TO REMEMBER QUESTIONS AND ANSWERS 2024
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NAPLEX THINGS TO REMEMBER QUESTIONS AND ANSWERS 2024
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NAPLEX THINGS TO REMEMBERWarfarin: Dosing & Monitoring - ANSWERS-Healthy outpatients= 10 mg daily for
first 2 days, then adjust per INR
Elderly, malnourished, taking drugs which can increase warfarin levels, liver
disease, heart failure, or high bleeding risk = Lower doses ≤5mg
Missed dose = Do not double the dose
In pts with acute DVT/PE - start warfarin on same day as the parenteral
anticoagulant. Continue both for a minimum of 5 days and until the INR ≥ 2 for at
least 24 hours.
For patients with consistently stable INR, testing can be done every 12 weeks.
warfarin tablet colors - ANSWERS-***Please Let Greg Brown Bring Peaches To
Your Wedding***
Pink - 1mg
Lavender - 2mg
Green - 2.5 mg
Brown - 3 mg
Blue - 4mg
Peach - 5 mg
Teal - 6 mg
,Yellow - 7.5 mg
White - 10 mg
anticoagulant antidotes - ANSWERS-UFH/LMWH = protamine
- UFH -- 1 mg protamine per 100 units hep (MAX DOSE = 50 mg)
- LMWH -- 1 mg protamine per 1 mg enoxaprin
Dabigitran (Pradaxa) = Idarucizumab (Praxbind)
Apixiban & Rivaroxiban = Andexanet alfa (Andexxa)
Warfarin = Vitamin K or phytonadione (Mephyton)
Use of Vit K with warfarin reversal - ANSWERS-< 4.5 without bleeding = Reduce or
skip dose. Monitor INR
INR or 4.5-10, without bleeding = Hold 1-2 doses of warfarin (Vit K not
recommended with no evidence of bleeding)
INR >10 without bleeding = Oral Vitamin K
Major bleeding = Slow IV injection Vit K and four factor prothromin complex
concentrate
VTE Treatment - ANSWERS-Provoked = TREAT FOR 3 MONTHS!
,Unprovoked = longer than 3 mo is recommended (at least 3 months)
Estrogen containing medications and SERMs are CI in patients with history of or
current VTE and should be d/c
WITHOUT CANCER: dabigitran or oral Xa inhibitors (DOACS) are preferred over
warfarin for the first three months
WITH CANCER: LMWH is preferred over all other anticoagulants (including
warfarin)
CHA2DS2VASC - ANSWERS-CHF
HTN
Age ≥ 75 (2)
Diabetes
Prior stroke/TIA (2)
Vascular disease (prior MI, PAD, aortic plaque)
Age 65-74
Sex - female
SCORE ≥ 2 MALES OR ≥ 3 FEMALES = anticoag with DOAC (> warfarin)
ANTICOAG IN PREGNANCY - ANSWERS-LMWH preferred over UFH
, Warfarin is teratogenic
DOACs and direct thrombin inhibitors - not studied in pregnancy = not
recommended
Elemental iron in products - ANSWERS-GLUCONATE = 12%
SULFATE = 20%
SULFATE, DRIED = 30%
FUMARATE = 33%
Iron defiency anemia (Mircocytic) - ANSWERS-Lab findings:
↓ Hbg, MCV <80, ↓ rBC (low ritculcye count)
↓ serum iron, ferritin and TSAT
↑ TIBC
Treatment:
Recc dose: 100-200 mg elemental iron QD
Take iron on empty stomach
Avoid H2RAs and PPIs - separate from antacids
SR or EC formulations cause less GI irritation but are not recc for initial therapy
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