Hat Hit And Reversal Agents 1 Jeopardy Template

Definition and Pathophysiology	Scoring	Treatment	Mechanism, Side effects, Precautions	Cases!
100 Within 2-3 days of heparin exposure How soon after heparin exposure does type 1 HIT tend to occur?	100 Platelet serotonin-release assay (SRA) What is the gold standard diagnostic test for HIT?	100 Discontinue heparin and replace with continuous IV argatroban or bivalirudin How do you treat isolated type II HIT or HITT?	100 Chest pain, flushing, hypotension, tachycardia, as well as its black box warning for anaphylaxis What are the adverse effects of Mephyton?	100 Protamine sulfate at 0.5 mg for every 1 mg of enoxaparin administered Patient SK is actively bleeding. He received enoxaparin 9 hours ago and the attending physician wishes to give SK a reversal agent but cannot recall the name of the medication or its dosing. As the pharmacist on duty, what do you recommend?
200 Within 5-10 days of heparin exposure and lasts up to several weeks How soon after heparin exposure does type II HIT tend to occur?	200 To determine the probability of type II HIT What is the 4 T’s criteria used for?	200 Angiomax (bivalirudin) Which treatment option is preferred in patients with HIT that require urgent cardiac surgery?	200 Factors II, VII, IX and X as well as proteins C and S Which clotting factors are contained in Kcentra?	200 Type I HIT A patient presents to the ED with bruising over their legs and arms. Upon interviewing the patient and reviewing their med reconciliation was found that the patient received heparin therapy for the last 3 days. What are they most likely presenting with?
300 Patients who have undergone cardiac or orthopedic surgery as well as women Which patient populations are at a higher risk for Type 2 HIT?	300 Thrombocytopenia, timing of platelet count fall, thrombosis, other causes of thrombocytopenia What are the 4 T’s?	300 150,000 per microliter to prevent venous limb gangrene What must platelet count be to transition to warfarin and why?	300 Rivaroxaban and apixaban; it binds and sequesters rivaroxaban and apixaban and inhibits the activity of Tissue Factor Pathway Inhibitor Andexxa is an approved reversal agent for which medication(s) and what is its mechanism?	300 Argatroban falsely elevate the INR, therefore you must hold the argatroban while on warfarin therapy and measure the INR to see if you are therapeutic. A patient being bridged from argatroban to warfarin needs to be discharged and switched to their therapeutic warfarin dose. However what must you do prior transitioning off the argatroban and why?
400 Count of < 100,000 per microliter or a 50% decrease within 5-10 days of heparin exposure What changes in platelet count are indicative of Type II HIT?	400 Intermediate probability of HIT What does a score of 4-5 in the 4T’s criteria indicate?	400 At least 5 days and until INR reaches target range (stop argatrobran when INR >4 then recheck INR after 4-6 hours to determine warfarin’s effect on INR) How long must you overlap warfarin with argatroban for?	400 INR baseline, during treatment and 30 minutes after treatment How long do you monitor INR after administering K-centra?	400 SubQ Vitamin K (Mephyton) 5-10 mg and k-centra 50 units/kg at max dose of 5,000 units. Patient with a history of alcohol abuse for 15 years and has been on warfarin therapy for 6 years for his underlying atrial fibrillation. Patient has been coughing up blood and has blood in his stool x 1 day. Labs reveal INR: 7.5, Hgb: 8.1. What would you do to treat his elevated INR and what route, dose of therapy would you choose?
500 Heparin forms a complex with platelet factor 4 and once IgG recognizes and binds to these complexes, platelets are activated and thrombin is formed In type II HIT, what does heparin form a complex with and what is generated from this complex?	500 50% By which percentage must platelet count fall to account for 2 points under the thrombocytopenia 4T category?	500 Rivaroxaban and apixaban Which additional agents are being explored for use in HIT but are not yet supported by the CHEST guidelines?	500 5 mL vials that contain 2.5 g each; appropriate dose for dabigatran is 5 g IV What dosage form is Praxbind available in and what is the appropriate dose and route for reversal of dabigatran?	500 Treat HIT as if it were confirmed. Conduct continuous doppler sonographies on patients to ensure they have not developed any DVT’s. 5. Patient is being treated for HIT, however his SRA has been sent out and will take several days to come back with results, in the meantime what should you be doing for your patient?

HAT, HIT, and Reversal Agents

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