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A physician needs your help to calculate the protamine dose on a patient who started hemorrhaging while on heparin. Patient has been receiving heparin at a dose of 13mls/hr for 2 hrs when the physician decides to use protamine to reverse the heparin. Heparin bag says concentration of 50 units/ml. The half-life of heparin is 60 minutes. 1 mg of protamine reverses 100 units of heparin.
How much protamine should be given to this patient?
Answer : E
1st hour: 13mL/hr 1 hr = 13mL 50U/mL = XU/13mL 650U Heparin given in hours since the half-life of protamine is 60 min 2nd hour 650/2 =325 units 650 units + 325 units = 975 units needs to be reversed.
**1mg of protamine reverses 100U of Heparin (1mg protamine/100U Heparin) = (x mg protamine/975U Heparin given) = x = 9.7mg protamine
In a study where Rivaroxaban was compared to Enoxaparin to find total VTE following HIP replacement surgery, there were 17 total VTE out of 1513 patients in the Rivaraoaban group and 57 total VTE out of 1473 patient in the enoxaparin group.
What is the absolute risk reduction of using Rivaroxaban over Enoxaparin?
Answer : D
Absolute risk reduction: 0.027 = 2.7% (Event rate in enoxaparin group) -- (Event rate in rivaroxaban group) = (57/1473) -- (17/1513) = 0.02746
According to the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, which of the following medications and dosing regimens is considered moderate-intensity statin therapy?
Answer : E
Moderate-Intensity Statin Therapy: Atorvastatin 10 (20) mg, Rosuvastatin (5) 10 mg, Simvastatin 20--40 mg,
Pravastatin 40 (80) mg, Lovastatin 40 mg, Fluvastatin XL 80 mg, Fluvastatin 40 mg bid, Pitavastatin 2--4 mg
JT is a 58-year-old women who is on vancomycin empirically for pyomyositis confirmed by MRI. Surgical debridement has successfully removed infected tissue and pus. C&S of the infected tissue comes back MSSA sensitive to everything on the panel. JT is allergic to PCN (rash), she has had cephalosporin for her UTI in the past with no problem.
What would be the most appropriate antibiotics to switch to while JT is still in the hospital?
Answer : E
Cefazolin or an antistaphylococcal penicillin (oxacillin or nafcillin) is recommended for this patient because the C&S results indicate MSSA. Since the patient develops a rash to penicillins, it would be acceptable to use cefazolin in this case.
https://academic.oup.com/cid/article/59/2/e10/2895845/Practice-Guidelines-for-the-Diagnosis-and
Calculate the Osmolarity of 3% hypertonic saline?
Answer : A
Osmolarity = mOsmol/L = (wt of substance (g/mL))/(MW(g/mol)) (# of particles) 1000 Weight of substance: 3% = (3g/100mL) = (xg/1000mL), x = 30g/L. # of particles NaCL: Na+ + Cl- (2 particles). mOsmol/L = (30g/L)/ (58.5g/mol) 2 1000 = 1,025.6. The answer is 1026 mOsmol/L.
