Question

15. A patient comes into the emergency department with typical signs and symptoms of ST-segment elevation myocardial infarction (STEMI). The team decides to anticoagulant the patient with unfractionated heparin (UFH) in the setting of fibrinolytic use. Which regimen is correct?

a. 1 mg/kg every 12 hours

b. 80 units/kg bolus plus 18 units/kg/hr infusion

c. 60 units/kg bolus plus 12 units/kg/hr infusion

d. 2.5 mg subcutaneously once daily

16. Dosage adjustment of enoxaparin is required in patients with renal dysfunction whose creatinine clearance is less than

a. 15 ml/min.

b. 20 ml/min.

c. 30 ml/min.

d. 40 ml/min.

17. Which drug is contraindicated for use in patients weighing less than 50 kg when given for venous thromboembolism (VTE) prophylaxis?

a. Unfractionated heparin (UFH)

b. Enoxaparin

c. Dalteparin

d. Fondaparinux

18. In a patient who weighs 78 kg and has concurrent liver dysfunction, what is the proper starting dose of argatroban for heparin-induced thrombocytopenia (HIT)?

a. A bolus of 100 mcg plus an infusion of 156 mcg/hr

b. No bolus; just an infusion of 156 mcg/hr

c. A bolus of 50 mcg plus an infusion of 78 mcg/hr

d. No bolus; just an infusion of 39 mcg/min

19. Monitoring of chromogenic factor X levels is suggested for

a. unfractionated heparin (UFH).

b. dalteparin.

c. fondaparinux.

d. argatroban.

Answer 1

15. The regimen of dose of anticoagulant (Unfractionated Heparin) for patient with STEMI in the setting of fibrinolytic use 60 units/kg bolus plus 12 units/kg/hr infusion

16.Dosage adjustment of enoxparine is required when the creatinine clearance level is <30 ml/hr.because it will prolong the drug excretion time from the blood.

17.As enoxaparin, dalteparin and fondaparinux are belongs to low molecular weight Heparin group there is a increased chance of bleeding in underweight patients.unfractionated Heparin is recommended for this for patients weights less than 50 kg for venous thromboembolism prophylaxis.

18.For patient (case of Heparin induced thrombocytopenia) weights 78 kg with concurrent liver dysfunction the dosage of argatroban is no bolus, just an infusion of 39 mcg/min.(for hepatic failure patients initial dose is 0.5mcg/kg/min for 1-3 hrs)

19.Monitoring of chromogenic factor X level is suggested for patients taking Argatroban as it will prolong the prothrombin time it will show inaccurate International normalized ratio value to alter the drug dosage.