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Heme/Onc Exam 3 > Antiplatelet, Anticoagulation and Hemostatic agents > Flashcards

Antiplatelet, Anticoagulation and Hemostatic agents Flashcards

1
Q

Warfarin MOA

A

○ Molecule is structurally related to Vitamin K
○ Binds Vitamin K Oxide Reductase, inhibiting it
■ Inhibits ability to activate Vitamin K (factors II, VII, IX, X, Protein S, & C)

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2
Q

Warfarin indications

A

○ VTE (DVT/PE) prophylaxis
○ VTE treatment
○ Stroke prevention with A-Fib
○ Prevention of mechanical heart valve
thrombosis

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3
Q

Warfarin Contraindications

A

○ Pregnancy (teratogenic and risk of fetal bleeding)
○ Active bleed or high risk for bleed (like Thrombocytopenia)
○ Blood dyscrasia
○ Recent major surgery
○ Eclampsia or Preeclampsia
○ Frequent falls or high risk for falls
○ Dozens of Drug-Drug interactions! (Use Interaction Checker!)

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4
Q

Warfarin Side effects

A

○ Easy bruising
○ Bleeding gums
○ Nausea/vomiting/diarrhea
○ Fatigue and malaise
○ Headaches
○ Dizziness
○ Taste changes

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5
Q

Warfarin Major adverse reactions

A

○ Intracranial hemorrhage (often
fatal)
○ Skin necrosis
○ GI hemorrhage
○ GU hemorrhage

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6
Q

Warfarin BBW

A

○ Major or fatal bleeding may occur. Monitor high risk patients closely.
INR > 4.0 is very high risk for bleed

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7
Q

Warfarin (Coumadin) administration and surgery

A

If surgery planned, D/C warfarin 5 days before procedure. Restart 12-24 hours after
procedure. Bridge w/ a Heparin in high VTE risk.

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8
Q

Warfarin follow up/monitoring

A

○ Considered contraindicated in pregnancy unless Pt has mechanical heart valve, then need
to weigh risks/benefits. Probably safe with lactation.
○ Adjust doses based on PT/INR. Target INR is 2-3 for most; Some high-risk patients may
require target INR 2.5-3.5.
○ Local “coumadin clinics” are extremely helpful with monitoring.

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9
Q

Indirect Thrombin Inhibitors - Heparin

A

○ AKA - Unfractionated Heparin (UFH)
■ Mixture of proteins with a wide range of
molecular weights

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10
Q

Low Molecular Weight Heparins
(LMWHs)

A

○ Enzymatically or chemically broken down UFH, about 1⁄3 the size of UFH
■ Enoxaparin (Lovenox)**
■ Dalteparin (Fragmin)
■ Fondaparinux (Arixtra)

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11
Q

Indirect Thrombin Inhibitors MOA

A

○ Antithrombin III inhibits Factor
X and Thrombin

○ Heparin binds to Antithrombin
III and accelerate its rate of action by about 1000 fold

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12
Q

○ UFH: Thrombin ___ Factor X
○ LMWH: Factor X ___ Thrombin

A

> ; >

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13
Q

Indications (SC, IV) of UFH and LMWH

A

■ Prevention of thrombosis with Atrial
Fibrillation and PCI
■ VTE Prophylaxis in high risk patients
■ Treatment of acute VTE
■ Treatment of Acute Myocardial Infarction
and unstable angina in combo with
antiplatelet Rx

○ Enoxaparin (Lovenox) is the drug of choice during pregnancy

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14
Q

Indirect Thrombin Inhibitors contraindications

A

○ Thrombocytopenia
○ Personal history of Heparin-Induced Thrombocytopenia
○ Hemorrhage or active bleed
○ Not to be given as an IM administration
○ Hypersensitivity to Pork or Corn

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15
Q

Indirect Thrombin Inhibitors Minor Side Effects

A

○ Urticaria
○ Fever
○ Minor elevation in ALT, AST

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16
Q

Indirect Thrombin Inhibitors Major Adverse Reactions

A

○ Osteoporosis with long-term use
○ Hemorrhage (reversed by Protamine Sulfate)
○ Heparin-Induced Thrombocytopenia
○ Anaphylaxis
○ Hepatotoxicity

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17
Q

BBW Indirect Thrombin Inhibitors

A

High risk for Epidural/Spinal hematoma from acute hemorrhage during lumbar puncture or spinal injection. Can cause acute spinal cord or spinal nerve compression

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18
Q

Follow up and monitoring - UFH

A

○ UFH can be given IV or SC
■ Usually IV bolus for immediate anticoagulation, then continued until PO anticoagulant takes over
– Anticoagulant effect within minutes of IV administration
■ Monitor closely using PTT or Heparin Anti-Xa
Monitor platelets daily if on IV UFH, for at least 10 days

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19
Q

Follow Up and Monitoring - LMWHs

A

■ Peak effect is reached in 2-4 hours
■ Don’t routinely need to be monitored, but if renal insufficiency or
pregnancy, can check Heparin Anti-Xa

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20
Q

If drop in platelet count by more than ___%
from baseline, D/C medication as now
there is concern for HIT

A

50

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21
Q

Direct Thrombin Inhibitors

A

● Bivalirudin (Angiomax)
● Argatroban (Acova)
● Dabigatran (Pradaxa)**

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22
Q

Direct Thrombin Inhibitors

A

○ Just as the name implies, these
work by directly inhibiting Thrombin
○ Inhibitory effects on the Coagulation Cascade

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23
Q

Direct Thrombin Inhibitors Indications (IV, PO)

A

Bivalirudin and Argatroban are only IV
– Anticoagulation during HIT
– Prevention of thrombosis during PCI (in presence of Heparin
allergy/HIT)

Dabigatran is a PO capsule
● Stroke prevention in Atrial Fibrillation
● DVT/PE prophylaxis in high risk patients
● DVT/PE treatment

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24
Q

Direct Thrombin Inhibitors contraindications

A

○ Active bleeding
○ History of a bleeding disorder
○ Peptic ulcer disease
○ Mechanical Heart Valve Anticoagulation

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25
Q

Direct Thrombin Inhibitors BBWs

A

○ Dabigatran has earned 2 BBWs
■ Increased incidence of Thromboembolism if D/C treatment before
recommended duration
■ Large risk for epidural hematoma with spinal injections

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26
Q

Direct Thrombin Inhibitors minor side effects

A

○ Easy bruising
○ Nausea/vomiting
○ Dabigatran (PO): Gastritis
○ IV use: Hypotension, fever,
headache, IV site pain

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27
Q

Direct Thrombin Inhibitors Major adverse reactions

A

○ Severe bleeding / hemorrhage
○ Spinal hematoma w/ injection
○ Thrombocytopenia
○ Anaphylaxis
○ Thrombosis with premature D/C

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28
Q

Direct Thrombin Inhibitors Follow Up and Monitoring

A

○ Argatroban and Bivalirudin – Benefits likely outweigh risks in pregnancy
○ Dabigatran – Avoid use in pregnancy; animal studies show potential harm
○ IV meds should be monitored using PTT
○ Dabigatran does not require monitoring due to large therapeutic window and short
half-life (12-24 hours)
○ Argatroban and Bivalirudin do not have reversal agents, however…

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29
Q

Direct Thrombin Inhibitors Follow Up and Monitoring

A

○ In late 2015, the FDA announced approval for Idarucizumab (Praxbind), a reversal agent for the anticoagulant Dabigatran (Pradaxa)
○ Given as an IV dose in emergency situations (ie. head bleed)
■ Binds to Dabigatran and its metabolites,
neutralizing the drug in circulation

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30
Q

Direct Factor Xa Inhibitors

A

● Rivaroxaban (Xarelto)**
● Apixaban (Eliquis)**
● Edoxaban (Savaysa)
● Fondaparinux (Arixtra) – SQ

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31
Q

Direct Factor Xa Inhibitors MOA

A

○ These work by directly inhibiting
active Factor X, just like the name
implies
○ Fondaparinux also binds to and
accelerates Antithrombin

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32
Q

Direct Factor Xa Inhibitors Indications

A

○ All four agents
■ DVT/PE prophylaxis in high risk patients (like Ortho surgery)
■ Acute DVT/PE treatment

○ Xarelto, Eliquis, and Savaysa*
■ Thromboembolism/Stroke prevention in Atrial Fibrillation

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33
Q

Direct Factor Xa Inhibitors Contraindications

A

○ Active bleeding
○ Hepatic or Renal impairment
○ Acute PE with hemodynamic instability or requiring thrombolytics

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34
Q

Direct Factor Xa Inhibitors Side effects

A

○ Easy bruising
○ Nausea
○ Rash
○ Mild ALT/AST elevation

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35
Q

Direct Factor Xa Inhibitors Adverse effects

A

○ Severe bleeding/hemorrhage
○ Spinal hematoma with injection
○ Thrombosis with premature D/C
○ Thrombocytopenia

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36
Q

Direct Factor Xa Inhibitors BBWs

A

○ Large risk for epidural hematoma with spinal injections
○ NOACs – Increased incidence of Thromboembolism if D/C treatment before
recommended duration
○ Edoxaban – Increased risk of A-Fib related stroke if Creatinine Clearance is
greater than 95 mL/min

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37
Q

Direct Factor Xa Inhibitors follow up and monitoring

A

○ Avoid use during pregnancy and lactation safety unknown
○ Check Creatinine at baseline
■ Remember creatinine clearance BBW of Edoxaban (Savaysa)
○ Consider checking CBC periodically for thrombocytopenia
○ No routine coagulation monitoring needed because of large therapeutic
window and short half life
○ Fondaparinux is given SC and behaves similar to Heparins

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38
Q

If acute hemorrhage and the pt is on a Direct Factor Xa Inhibitor, can also provide ____

A

Fresh Frozen Plasma (FFP)

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39
Q

The Antiplatelets

A

○ Aspirin (ASA)**
○ Cilostazol (Pletal)
○ ADP Receptor Inhibitors:
■ Clopidogrel (Plavix)**
■ Ticagrelor (Brilinta)
■ Prasugrel (Effient)
○ Glycoprotein IIb/IIIa Inhibitors:
■ Abciximab (Reopro)
■ Eptifibatide (Integrilin)
■ Tirofiban (Aggrastat)

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40
Q

The Antiplatelets prolong bleeding time without affecting _____

A

PT and PTT

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41
Q

The Antiplatelets of antiplatelets

A

○ Prevention of occlusive coronary disease
○ Long term treatment of acute coronary syndrome
○ Maintenance of vascular grafts and arterial patency

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42
Q

Aspirin MOA

A

○ Thromboxane (TXA2) is a substance Platelets make and secrete which enhance platelet aggregation
○ Aspirin irreversibly inhibits
COX1-mediated TXA2 synthesis
■ This is irreversible, so stays in
effect through the life of that
platelet (7 days)

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43
Q

Aspirin indications

A

○ Mild pain
○ Fever
○ Acute Coronary Syndrome
○ MI prevention (primary or secondary)
○ TIA/CVA prevention (primary or
secondary)

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44
Q

Aspiring contraindications

A

○ ASA-induced asthma or urticaria
○ Aspirin triad (nasal polyps, asthma, aspirin intolerance)
■ Can develop rash and/or life threatening asthma attack
○ GI bleeding
○ Coagulation disorder
○ G6PD deficiency
○ Uncontrolled hypertension
○ Febrile illness in children under 2 YOA

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45
Q

Aspirin Side effects

A

○ Dyspepsia
○ Nausea
○ Dizziness
○ Rash
○ Tinnitus
○ Abdominal pain
○ Constipation
○ Ecchymosis
○ Bleeding

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46
Q

Aspirin Adverse Reactions (Major)

A

○ Anaphylaxis
○ Angioedema
○ Bronchospasm
○ Bleeding
*○ GI perforation or ulcer
*○ DIC (rarely)
○ Pancytopenia
○ Thrombocytopenia
○ G6PD Deficiency Anemia
○ Aplastic anemia
○ Nephrotoxicity
○ Hepatotoxicity
○ Salicylism
*○ Reye Syndrome

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47
Q

Aspirin follow up

A

○ May use low dose ASA in pregnancy. Avoid high dose ASA in 3rd Tri as this can trigger premature closure of patent ductus arteriosus
○ Possibly unsafe during lactation
○ Check creatinine at baseline as excreted renally
○ Aspirin can displace coumadin from plasma proteins (as well as other medications like Phenytoin)
■ Run interaction check

48
Q

Cilostazol (Pletal) MOA

A

○ Phosphodiesterase III (PDE3) is an enzyme
involved in the intracellular regulation of
platelet factor synthesis
○ Cilostazol inhibits PDE3, leading to a complex reaction that ultimately results in decreased Platelet Aggregation
○ Also causes vasodilation

49
Q

Cilostazol (Pletal) Indications

A

○ Intermittent Claudication of Peripheral
Arterial Disease (PAD)

50
Q

Cilostazol (Pletal) Contraindications

A

○ Congestive Heart Failure
○ Hemostatic bleeding disorders
○ Active bleeding
○ Caution if chronic renal disease

51
Q

Cilostazol (Pletal) BBW

A

Do not use in CHF as it has been shown to decrease survival

52
Q

Cilostazol (Pletal) Side effects

A

○ Headache
○ Dizziness
○ Abdominal pain
○ Diarrhea

53
Q

Cilostazol Major adverse reactions

A

○ Hemorrhage
○ Angina/Myocardial infarction
○ Agranulocytosis
○ Thrombocytopenia

54
Q

Follow Up and Monitoring for Cilostazol (Pletal)

A

○ Caution advised in pregnancy as some animal studies suggest fetal harm. Safety during lactation unknown
○ Check CBC prior to starting and recheck CBC periodically if taking long-term

55
Q

Antiplatelets – ADP Receptor Inhibitors

A

● Clopidogrel (Plavix)**
● Ticagrelor (Brilinta)
● Prasugrel (Effient)

56
Q

ADP Receptor Inhibitors MOA

A

○ Inhibit the binding of ADP to its
receptor on platelets, which inhibits
GP IIb/IIIa receptor activation,
thereby preventing Platelet
Aggregation

57
Q

ADP Receptor Inhibitors Indications (PO)

A

○ Treatment of Acute Coronary Syndrome (all 3 drugs)
■ Along with an indirect thrombin inhibitor (ie. Heparin)
○ Clopidogrel (Plavix) and Ticagrelor (Brilinta)
■ Prevention of thrombotic events in Coronary Artery Disease
○ Clopidogrel (Plavix) only:
■ Prevention of thrombotic events in Peripheral Arterial Disease and
Cerebrovascular Disease (Stroke/TIA)

58
Q

Contraindications of ADP Receptor Inhibitors

A

○ Active bleed
○ High risk for ischemic stroke hemorrhaging

59
Q

ADP Receptor Inhibitors side effects

A

○ Easy bruising
○ Rash and pruritus
○ Nausea/vomiting/diarrhea

60
Q

ADP Receptor Inhibitors BBWs

A

○ Clopidogrel (Plavix): Efficacy is
dependent on conversion to active metabolite by Cyp2C19. Poor Cyp2C19 metabolism results in poor efficacy
○ Ticagrelor and Prasugrel: Severe
bleeding, possibly fatal
○ Ticagrelor: Taking ASA with this
drug may reduce the effectiveness of Ticagrelor for unknown reasons

61
Q

ADP Receptor Inhibitors Major adverse reactions

A

○ Severe hemorrhage/bleeding
○ Agranulocytosis
○ In very rare instances, Ticagrelor
(Brilinta) and Prasugrel (Effient) has
been associated with TTP

62
Q

ADP Receptor Inhibitors Follow up

A

○ Benefits likely outweigh risks during pregnancy; Risk of fetal harm
not expected based on limited human data.
○ Lactation safety is mostly unknown
○ Despite some potentially life
threatening adverse reactions that can
occur with these medications, there are
no current recommendations for
routine monitoring.

63
Q

Antiplatelets - Glycoprotein IIb/IIIa Inhibitors

A

● Abciximab (Reopro)
● Eptifibatide (Integrilin)
● Tirofiban (Aggrastat)
All 3 are IV medications

64
Q

Glycoprotein IIb/IIIa Inhibitors MOA

A

Blocks the Glycoprotein IIb/IIIa receptor proteins on the
membranes of activated platelets, preventing Platelet Aggregation
Source: Epocrates

65
Q

Glycoprotein IIb/IIIa Inhibitors Indications

A

○ Acute Coronary Syndrome – Adjunct
○ Percutaneous Coronary Intervention – Adjunct

66
Q

Glycoprotein IIb/IIIa Inhibitors contraindications

A

– Recent major surgery
– Recent stroke
– Recent GI bleed
– Thrombocytopenia

67
Q

Glycoprotein IIb/IIIa Inhibitors Minor side effects

A

○ Easy bruising
○ Dizziness
○ Nausea/vomiting
○ Mild hypotension

68
Q

Glycoprotein IIb/IIIa Inhibitors Major adverse ractions

A

○ Significant hemorrhage
○ Severe thrombocytopenia
○ Coronary artery dissection
○ Anaphylaxis

69
Q

Glycoprotein IIb/IIIa Inhibitors follow up

A

○ Benefits likely outweigh risks during pregnancy; Risk of fetal harm not
expected based on limited human data
○ Check creatinine at baseline
○ Check CBC, PT, and PTT at baseline; recheck CBC daily if prolonged
treatment (which is not common)

70
Q

Thrombolytics

A

○ Alteplase (tPA)**
○ Reteplase (Retavase)
○ Tenecteplase
(TNKase)

71
Q

Thrombolytics MOA

A

These bind to fibrin and convert Plasminogen to Plasmin, promoting
Fibrinolysis (clot buster)

72
Q

Thrombolytics indications

A

○ Acute ST-Elevation Myocardial Infarction (STEMI)
■ Only if PCI is impossible within 120 minutes of arrival
■ Fibrinolytics ideally within 12 hours of symptom onset
○ Alteplase (tPA) only
■ Massive Pulmonary Embolism with shock
■ Acute Thromboembolic Stroke

73
Q

Thrombolytics Absolute contraindications

A

○ History of intracranial hemorrhage
○ Known structural cerebral vascular lesion (such as AVM)
○ Known malignant intracranial neoplasm
○ Ischemic stroke within 3 months (EXCEPT acute ischemic stroke within 3-4 1⁄2
hours)
○ Suspected aortic dissection
○ Active bleeding or unusual susceptibility to bleeding
○ Significant closed head trauma or facial trauma within 3 months
○ Intracranial or intraspinal surgery within 2 months
○ Severe uncontrolled hypertension (unresponsive to emergency therapy)

74
Q

Thrombolytics relative contraindications

A

○ Trauma or major surgery within past 3 weeks
○ Recent internal bleeding within past month
○ Pregnancy
○ Active Peptic Ulcer Disease
○ Current use of anticoagulation with an INR > 1.7

75
Q

Thrombolytics minor side effects

A

Bleeding at IV sites

76
Q

Thrombolytics Major adverse reactions

A

○ Severe bleeding, often fatal
○ Intracranial hemorrhage
○ Stroke
○ Arrhythmias
○ Anaphylaxis

77
Q

Follow Up and Monitoring

A

○ Benefits likely outweigh risks during pregnancy; Risk of fetal harm not expected based on limited human data
○ Monitor BP and EKG closely
throughout
○ PT and PTT at baseline and then
frequently

78
Q

Hemostatic Promoting Agents - plasma derivatives

A

■ Factor VIII concentrate (Advate)
■ Factor IX concentrate (Rixubis)

79
Q

Hemostatic Promoting Agents - Hemostasis promoting agents

A

■ Protamine sulfate
■ Vitamin K (Phytonadione)
■ Idarucizumab (Praxbind)
■ Coagulation Factor Xa (Andexxa)
■ Desmopressin acetate (DDAVP)
■ Thrombin, topical

80
Q

Plasma Derivatives MOA

A

○ Specific Coagulation Factor replacement
○ Given via IV infusion

81
Q

Plasma Derivatives indications

A

○ Advate – Hemophilia A
○ Rixubis – Hemophilia B

82
Q

Plasma Derivatives contraindications

A

Plasma Derivatives

83
Q

Plasma Derivatives minor side effects

A

○ Headaches
○ Fever
○ Flushing
○ Nausea/Vomiting

84
Q

Plasma Derivatives Major adverse reactions

A

○ Anaphylaxis
○ Thromboembolism Factor IX
(Rixubis)

85
Q

Plasma Derivatives Follow up

A

○ Caution advised in pregnancy, limited
data available
○ Safety unknown with lactation
○ No routine tests recommended

86
Q

Hemostatic Promoting Agents - Protamine sulfate MOA

A

Binds to Heparin molecule, forming a stable
molecule and rendering Heparin useless,
effectively reversing Heparin

87
Q

Protamine Sulfate Indications

A

○ Acute bleed while on Heparin
■ Unfractionated Heparin reversal
■ LMWH reversal
■ Does not work for Fondaparinux

88
Q

Protamine Sulfate contraindications

A

Caution in cardiac or pulmonary failure

89
Q

Protamine Sulfate BBW

A

Can cause severe hypotension,
cardiovascular collapse,
pulmonary edema, catastrophic
pulmonary constriction, and
pulmonary HTN. Be ready for
ACLS protocol

90
Q

Protamine Sulfate major adverse reactions

A

In addition to BBW…
■ Paradoxical hemorrhage
with “Heparin Rebound”
■ Thrombocytopenia

91
Q

Protamine Sulfate minor side effects

A

○ Hypotension
○ Bradycardia
○ Flushing
○ Nausea/vomiting
○ Hives

92
Q

Protamine Sulfate follow up and monitoring

A

○ Benefits outweigh risks during pregnancy; limited data
○ Safety unknown during lactation
○ Monitor EKG and BP during infusion

93
Q

Vitamin K (Phytonadione) MOA

A

Acts as vital cofactor in the hepatic production
of coagulation factors II, VII, IX, and X

94
Q

Vitamin K (Phytonadione) indications

A

○ Warfarin stabilization
○ Warfarin reversal in an active bleed situation
○ Vitamin K deficiency

95
Q

Vitamin K (Phytonadione) Contraindications

A

○ Heparin anticoagulation

96
Q

Vitamin K (Phytonadione) BBW

A

Severe reactions including death have occurred during and
immediately after IV injection. Resembles anaphylactic reaction with shock. Only applicable for IV

97
Q

Vitamin K (Phytonadione) Major adverse reactions

A

○ Anaphylaxis
○ Anticoagulant resistance (warfarin mostly)

98
Q

Vitamin K (Phytonadione) Minor side effects

A

○ Injection site hematoma
○ Flushing (if IM or IV)
○ Bad taste in mouth (lasts a few days)

99
Q

Vitamin K (Phytonadione) Follow up

A

○ May used during pregnancy; risk of fetal harm is
not expected based on limited human data
○ Safe during lactation (based on lots of data)
○ No routine tests recommended for monitoring

100
Q

Idarucizumab (Praxbind) MOA

A

A monoclonal antibody that binds
to Dabigatran (Pradaxa) and its metabolites, neutralizing the drug’s anticoagulant effect

101
Q

Idarucizumab (Praxbind) Indications (IV)

A

○ Reversal of Dabigatran (Pradaxa)
○ Used to reverse anticoagulant during acute hemorrhages or need for emergent surgery

102
Q

Idarucizumab (Praxbind) adverse reactions

A

○ Thrombosis / Thromboembolism
○ Hypersensitivity reaction

103
Q

Idarucizumab (Praxbind) Follow up

A

The medication is given as a single IV
push (one time)

104
Q

The medication is given as a single IV
push (one time) MOA

A

Binds and sequesters Factor
Xa Inhibitors and restores
thrombin generation

105
Q

Factor Xa (AndexXa) Indications

A

Reversal of Apixaban (Eliquis) and
Rivaroxaban (Xarelto)
■ Used to reverse anticoagulant
during acute hemorrhages or
need for emergent surgery

106
Q

Factor Xa (AndexXa) BBWs

A

Serious and life-threatening arterial and venous thromboembolic
events (including MI, stroke, cardiac arrest, and sudden death) may
occur with use

107
Q

Factor Xa (AndexXa) Adverse reactions

A

○ Thrombosis / Thromboembolism
○ Ischemic stroke, Myocardial infarction

108
Q

Factor Xa (AndexXa) Follow up

A

○ The medication is given as an IV push with continued infusion

109
Q

Desmopressin (DDAVP)

A

A synthetic version of ADH (Vasopressin)

110
Q

Desmopressin (DDAVP) MOA

A

○ At very low doses, activation of V2
receptors on collecting ducts of the
nephron, triggering water reabsorption
(Antidiuretic)
○ At higher doses, can activate V1 receptors
on endovascular epithelium, triggering
release of Coagulation Factor VIII and vWF

111
Q

Desmopressin (DDAVP) Indications (PO, SL, IN, SC, IV)

A

○ Surgical preparation for those with Hemophilia A or von Willebrand
disease (give 30 min before surgery)
○ Central Diabetes Insipidus (was discussed in Endo)
○ Nocturnal Enuresis (works for bedwetting)

112
Q

Desmopressin (DDAVP) contraindications

A

○ Hemophilia A or vWD patients under 3 months of age
○ Kidney disease with poor creatinine clearance
○ Hyponatremia
○ Psychogenic polydipsia

113
Q

Desmopressin (DDAVP) adverse reactions

A

○ Dilutional Hyponatremia
○ Hypotension or Hypertension with IV administration
○ Thrombosis
○ Seizures

114
Q

Desmopressin (DDAVP) follow up

A

○ Caution advised during pregnancy. Probably safe with lactation
○ Check Creatinine at baseline; periodically if chronic use
○ Watch serum sodium throughout treatment
○ If administering by IV, watch BP and HR closely

115
Q

Topical Thrombin MOA

A

○ Recombinant thrombin applied directly to a
site with mild active bleeding will trigger
Fibrin production as well as ignite the
coagulation cascade and activate platelets.

116
Q

Topical Thrombin Indications

A

○ Surgical application
○ Most commonly neurosurgery, liver surgery, and vascular surgery
○ Applied topically when suture ligation or cautery is not a safe
option

Heme/Onc Exam 3 (6 decks)

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