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Advanced Pharm Final > Blood/Hemostasis > Flashcards

Blood/Hemostasis Flashcards

ch 27, 28, 29, 30 10 questions

1
Q

What are the 3 main steps of coagulation?

A
  1. vascular spasm
  2. platelet plug formation
  3. blood clot formation/coagulation
    (4. then permanent fibrous tissue eventually closes the hole in the vessel)
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2
Q

How do platelets know to go to site of injury?

A

they release chemical mediators that attract them

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3
Q

What occurs in the tissue injury phase of hemostasis?

A
  1. vascular spasm
  2. platelet plug
  3. fibrin cross linked
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4
Q

What occurs in the tissue repair phase of coagulation?

A

Fibrinolysis of the fibrin clot to restore normal state of blood flow

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5
Q

What is the purpose of vascular constriction after vessel injury?

A

Prevents blood loss and allows procoagulants to remain locally and work in injured vessels

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6
Q

What mediators encourage platelets to release vWF?

A

GP1a, GP2a, GP5

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7
Q

What substance binds platelets to subendothelium?

A

vWF

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8
Q

What activates platelets?

A

negatively charged surfaces such as collagen secreted from the endothelium in response to injury

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9
Q

What substance recruits other platelets to assist in plug formation?

A

ADP and Thromboxane A2

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10
Q

What do activated platelets secrete and what is the purpose of these subastances?

A

Fibrinogen, vWF, and platelet growth factor. They increase efficiency of aggregation and adherence

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11
Q

Excessive clotting would occur without:

A

Nitric oxide, ADPase, prostacyclins, thrombomodulin, CD-39

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12
Q

What 3 things things encourage vessel constriction?

A
  1. Nervous reflex (smoothm.)
  2. Local myogenic spasms
  3. Local humoral factors released from traumatized tissue/platelets (thromboxane A2 vasoconstrictor)
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13
Q

What does Von Willebrand disease affect in the clotting cascade?

A

Platelet adherence to the subendothelium

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14
Q

How long does it take for blood clot formation to occur?

A

mild trauma: 1-2 minutes
severe trauma: 15-20 seconds to 6 minutes depending on severity of the trauma

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15
Q

What occurs 20min-1 hour after blood clot formation?

A

clot retracts, aiding in vessel closure

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16
Q

What cause the clot to becomes fibrous connective tissue?

A

clot is invaded by fibroblasts that form connective tissue and then allows the clot to be dissolved by plasmin

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17
Q

What is prothrombin and how does it aid in coagulation?

A

Prothrombin is a substance produced in the liver that is converted to thrombin via Ca+2 and prothrombin activator which transforms fibrinogen into fibrin monomers while also activating fibrin stabilizing factors. this assists in clot formation

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18
Q

What substance is needed to produce prothrombin and where does this occur?

A

liver, vitamin K

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19
Q

In the thrombin pathway, what are the two places calcium is needed?

A
  1. prothrombin to thrombin
  2. fibrin monomers to fibrin fibers
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20
Q

What factor covalently bonds to fibrin?

A

Factor VIII (eight): antihemophilic factor, that assists in stabilizing the clot
also works as a cofactor for factor IXa which, in the presence of Ca+2 and phospholipids, converts factor X to the activated form Xa.

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21
Q

Hemophilia A is a deficiency of:

A

Factor VIII (eight)

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22
Q

What are the two pathways of prothrombin activator formation?

A

Extrinsic: trauma to vessel/exposure to tissue factor at site of injury
Intrinsic: occurs in blood

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23
Q

Mnemonic for clotting factors:

A
  1. Fibrinogen- foolish
  2. Prothrombin- people
  3. Tissue factor- try
  4. Calcium ions- climbing
  5. Labile factors (proaccelerin)- long
  6. Stable factors (proconvertin)- slopes
  7. Antihemophilic factor- after
  8. Christmas factor- Christmas
  9. Stuart-Prower factor- some
  10. Plasma thromboplastin antecedent- people
  11. Hageman factor- have
  12. Fibrin stabilizing factor- fallen
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24
Q

By exception, where are the clotting factors synthesized?

A

all liver EXCEPT: calcium (diet), tissue factor/thromboplastin (vascular wall), vWF (endothelial cells and platelets)

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25
Q

What lab test is best used for each coagulation pathway?

A

intrinsic: aPTT/ACT
extrinsic: PT/INR

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26
Q

When do the two clotting pathways come together to form the common pathway?

A

at factor X

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27
Q

What factors are used in the extrinsic pathway?

A

Factor 7 (VII) and factor III (3)

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28
Q

What factors are used in the intrinsic pathway?

A

Factor 12 (XII), 11 (XI), 9, (IX), and 8 (VIII)

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29
Q

What three things are needed for factor X to move forward in coagulation?

A

Factor V, lipids, and calcium

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30
Q

What factors are vitamin K dependant and are not?

A

are: 2, 7, 9, 10
aren’t: 1, 5, 8, 11, 12, 13

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31
Q

Explain: for 37 cents you can buy the extrinsic pathway

A
  1. tissue factor released activates
  2. factor X activation: tf activates 7, then 7 activates 10 in the presences of 4 (ca+2)
  3. prothrombin activator: prothrombin activator and platelet phospholipids activate 2 (thrombin), 5 is a positive feedback mechanism that accelerates production of prothrombin activator to continue
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32
Q

What activates the extrinsic pathway?

A

the release of tissue factor from the subendothelium

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33
Q

What occurs after the extrinsic pathway is activated?

A

TF activates 7 > 7 and ca activates 10 > 10a, prothrombin activator and phospholipids activate 2 (thrombin) > thrombin feeds factor 5 to continue production of prothrombin

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34
Q

What causes the intrinsic pathway to begin?

A

blood trauma/collagen exposure

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35
Q

What is the process of the intrinsic pathway?

A

blood trauma/collagen exposure > activates XII > XIIa activates XI (requires HMW, accelerated by prekallikrein> XIa and calcium activate IX > thrombin activates VIII > VIIIa, X, ca+2, phospholipids, platelets, and IXa activate X > thrombin, Xa, platelets, phospholipids, ca+2 release prothrombin activator to convert prothrombin into thrombin

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36
Q

What is the mnemonic for the intrinsic pathway?

A

If you cant buy the intrinsic pathway for $12, you can buy it for $11.98

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37
Q

What step is identical in the intrinsic and extrinsic pathways?

A

Prothrombin activator/last step

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38
Q

What drug inhibits that extrinsic pathway?

A

Coumadin/warfarin

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39
Q

What drug inhibits the intrinsic and final common pathway?

A

Heparin

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40
Q

What is the mnemonic for the final common pathway?

A

“can be purchased at the five (V), and dime (X) for 1 (I) or 2 (II) dollars on the 13th (XIII) of the month”
factor 5, 10, 1, 2, 13

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41
Q

What steps in the coagulation cascade do not use calcium?

A

first two steps

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42
Q

What endogenous substances are procoagulants?

A

Coagulation factors
Collagen
wVF
Fibronectin

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43
Q

What are endogenous anticoagulants?

A

Protein C
Protein S
Antithrombin
Tissue pathway factor inhibitor
Thrombomodulin

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44
Q

What endogenous substances are fibrinolytics?

A

Plasminogen
tPA
Urokinase

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45
Q

What endogenous substances are antifibrinolytics?

A

Alpha-antiplasmin
Plasminogen activator inhibitor

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46
Q

What is things are inside a platelet?

A

actin, myosin, thrombosthenin, ADP, ca+2 (4), fibrin stabilizing factor (13), serotonin, growth factor

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47
Q

What things are on the external membrane of platelets?

A

glycoproteins and phospholipids

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48
Q

What three things must occur to make a platelet plug?

A

adhesion, activation, agregation

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49
Q

Hageman factor is used in which pathway?

A

Intrinsic

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50
Q

Which coagulation pathway is faster?

A

Extrinsic, occurs in about 15 seconds

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51
Q

What factor is depleted first in a patient vitamin K deficiency?

A

Factor VII (7)

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52
Q

What three factors are specific to the classical intrinsic pathway?

A

Factors 11, 9, 8 (12 is in both)

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53
Q

What type of surgery significantly increases risk of DVT?

A

Hip surgery

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54
Q

How does heparin work?

A

binding to antithrombin III which prevents conversion of fibrinogen to fibrin. inhibits X and thrombin. AT3 bind increases anticoag effects. Neutralizes thrombin (IIa), factors 9a, 10a, 11a, 12a

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55
Q

What is the dosing for heparin?

A

cardiac surgery: 300-400u/kg
DVT prophylaxis: 5,000u sq bid/tid
Unstable angina/acute MI: 5000u iv then 1,000u/hr infusion

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56
Q

What is the onset of action of heparin?

A

SC: 1-2 hours
IV: instant

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57
Q

What are the two major side effects of heparin?

A

HIT, Hemorrage

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58
Q

T/F heparin is safe to use with neurological procedures, HIT, and regional anesthesia

A

FALSE

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59
Q

What is the dosage for heparin reversal via protamine sulfate?

A

1mg for every 100 units of heparin less than 30 min after admin
0.75mg for every 100 units if 30-60min since admin

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60
Q

What is the goal ptt for heparin anticoagulation?

A

normal: 30-35 x 1.5-2.5 patients baseline

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61
Q

What two things can cause a falsely high PTT?

A

patients temperature and hemodilution

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62
Q

What individuals are at a high risk of anaphylactic reaction to protamine?

A

taking NPH insulin, fish allergy, vasectomy, previous exposure

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63
Q

What is the goal ACT for an individual being anticoagulated with heparin?

A

> 250

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64
Q

Where is endogenous heparin produced?

A

liver, basophils, mast cells

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65
Q

How does protamine work and how long does it take?

A

covalently/irreversibly binds to heparin, about 5 minutes for circulation time, short half life of 10 minutes

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66
Q

Does protamine work for LMWH?

A

not fully, difficult to differentiate

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67
Q

What are side effects of protamine?

A

anaphylaxis, pulm htn (give peripheral), hypotension, bradycardia
*treat with antihistamines, H1 blockers, H2 blockers, steroids, albuterol

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68
Q

What is HIT and what causes it?

A

Heparin induced thrombocytopenia is excessive clotting which causes a 50% drop in platelets 4-5 days post heparin dose. caused by heparin antibodies to platelet factor IV, triggers aggregation

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69
Q

Why does heparin to cause an adverse reaction of Pulmonary hypertension?

A

Due to the release of thromboxane A2

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70
Q

How should HIT be managed when diagnosed?

A

stop heparin, start non heparin such as bivalirudin to bridge to warfarin long term or a direct factor Xa inhibitor such as xarelto

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71
Q

What are the pros and cons of LMWH?

A

pros: less protein bound (high bioava), most consistent dose, potentially better at VTE proph, good for pregnancy
cons: renal dose, no reversal, spontaneous hematoma w spinal and epidural catheters

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72
Q

What is the choice anticoagulant for a pregnant woman?

A

LMWH

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73
Q

What is the onset time of LMWH?

A

20-30 minutes

74
Q

T/F parental direct thrombin inhibitors have a reversal agent:

A

FALSE

75
Q

What are some examples of parenteral direct thrombin inhibitors and how do they work?

A

bivalirudin, argatroban, lepirudin/desirudin- work by irreversibly binding to thrombin (IIa inhibitors)

76
Q

What patients would benefit from a parenteral direct thrombin inhibitor?

A

HIT, renal dysfunction, heparin induced skin reactions

77
Q

What patients frequently receive bivalirudin and what is its half life?

A

unstable angina/PCI, off label for cardiac surgery, and HIT. Half life is 25 minutes

78
Q

What drugs are frequently given with bivalirudin?

A

aspirin and plavix

79
Q

How is argatroban eliminated and what is its half life?

A

Hepatically, fine for renal failure, half life 40 minutes

80
Q

How long does argatroban need to be stopped for coagulation to return to baseline?

A

4 hours

81
Q

What are the not preferred effects of lepirudin and desirudin?

A

L: direct antibodies produced, major renal clearance
D: anaphylaxis

82
Q

What are the half lives of Lepirudin and Desirudin?

A

L: 80 min
D: 60 min IV, 120 min subq

83
Q

Whats a major difference between lepirudin and desirudin?

A

Lepirudin requires lab monitoring while desirudin doesnt

84
Q

How does warfarin work and what is it’s half life?

A

it is a vitamin K antagonist so it inhibits activation of vitamin K dependant factors (II, VII, IX, X) and protein S and C
Half life is 24-36 hours, onset 8-12 hours

85
Q

Is warfarin safe in pregnancy and patients with renal failure?

A

NO: highly protein bound, crosses placenta and can have dramatic effects on fetus

86
Q

What are the perks of warfarin?

A

predictable in onset, duration, and great bioavailability.
can be affected by leafy greens rich in vitamin K

87
Q

What are common warfarin dosages and lab test?

A

2-10mg, INR test want 2-3 times control

88
Q

How should warfarin be reversed?

A

Quickly: Kcentra (first line), FFP
Slowly: Vitamin K

89
Q

Surgical considerations for warfarin:

A

Check inr
minor surgerys ok
dc 1-3 days prior to major surgery pt/inr should be within 20% baseline
compression neuropathy in brachial artery puncture

90
Q

What are some considerations and dose for Vitamin K (phytonadione) administration?

A

must be given slow 1mg/min due to anaphylaxis risk. takes a couple hours to take effect.
Dose: 10-20mg po, IM, IV

91
Q

What are some examples of Xa inhibitors?

A

Rivaroxaban (Xarelto), Apixaban

92
Q

What is the mechanism of action of direct factor Xa inhibitors?

A

inhibits all forms of Xa which prevents the conversion of II into active form

93
Q

What is xarelto good at preventing?

A

stroke and systemic embolism in patients with non valvular atrial fibrillation (as does apixaban)

94
Q

What anticoagulant is suitable for patients undergoing knee and hip replacement?

A

rivaroxaban or apixaban

95
Q

epidural catheter management with rivaroxaban should follow:

A

catheter should be removed no earlier than 18 hours after last dose and next dose should not be given earlier than 6 hours after removal

96
Q

What reverse rivaroxaban and what test can measure the level?

A

prothrombin complex concentrates (PCC), reverse effects in healthy patients. anti-Xa is the lab test

97
Q

What are the concerns with the use of new oral anticoagulants?

A

can increase surgical bleeding, no antagonists, no monitoring labs, not predictable

98
Q

When should new oral anticoagulants be stopped and restarted in relation to surgery?

A

low risk: stop 24 hrs prior, restart 24 hrs post op
medium/high risk: stop 5 days prior, resume when all bleeding stops

99
Q

How should patients taking new oral anticoagulants be managed for surgery?

A

postpone procedure for at least for a minimum of 1-2 half lives.

100
Q

What is the mechanism of action of aspirin?

A

as an antiplatelet, it works by irreversibly acetylates cyclooxygenase which prevents the formation of thromboxane A2

101
Q

How is aspirin cleared, and when should it be stopped and resumed after surgery?

A

rapidly cleared but has effects 7-10 days, for the entire lift of the platelet. should be stopped 7-10 days before surgery and resumes 24 hours after surgery

102
Q

What are thienopyridines used for?

A

treats PVA, stent thrombosis prevention, stroke

103
Q

What are examples of thienopryidines?

A

clopidogrel (plavix), prasugrel (errient), and ticagrelor

104
Q

How is the MOA of thienopryidines?

A

P2Y12 receptor antagonist inhibits ADP mediated platelet activation antithrombotic

105
Q

What is dual antiplatelet therapy and why is it recommended?

A

use of a thienopyridine and aspirin for patients with ACS and PCI

106
Q

When should thienopyridines be discontinued prior to surgery?

A

seven days

107
Q

What are some examples of Platelet Glycoprotein IIb/IIIa Antagonists and their uses?

A

abciximab (reopro)- PCI
tirofiban (aggrastat)- ACS
eptifibatide (intrgrelin)- PCI and ACS

108
Q

What is the antidote for Platelet Glycoprotein IIb/IIIa Antagonists?

A

Dialysis

109
Q

What is the common side effect of Platelet Glycoprotein IIb/IIIa Antagonists?

A

thrombocytopenia

110
Q

What anticoagulant can be used with an indwelling epidural?

A

heparin

111
Q

What is the min time between last dose of heparin, epidural placement, and next dose?

A

4-6 hours prior, and 4-6 hours after placement for next dose

112
Q

How should you manage a heparin drip for a patient needing an epidural?

A

stop 4-6 hours for an aPTT <40

113
Q

minimum time between LMWH dose and epidural placement/removal?

A

place 24 hours after dose, next dose 4 hours

114
Q

What are the two antifibrinolytic agents?

A

Epsilon aminocaproic acid (amicar)
Tranexamic acid (TXA)

115
Q

What is the MOA of antifibrinolytic agents?

A

competitively inhibit activation of plasminogen to plasmin at high doses inhibiting plasmin

116
Q

What surgery is Amicar most commonly indicated for? What is the dose?

A

cardiac surgery; 15g total, 5g induction, 5g on pump, 5g post protamine OR simple IVP 5mg and gtt at 50ml/hr MAX 30g/day

117
Q

What surgeries are TXA most commonly used in?

A

OB (PPHem), total joints/ortho/spine, sepsis, heavy menstrual bleeding

118
Q

what are the adverse effects of amicar and a MAJOR thing to remember?

A

hypotension, bradycardia, arrhythmia, DONT give in same line as blood

119
Q

How can TXA be useful in surgery?

A

prevent the need of blood transfusion

120
Q

TXA dosages:

A

ortho: 20mg/kg IV, 2g joint
hemorrhage: adult 0.5-1g
peds: 10mg/kg and 1mg/kg/hr

121
Q

TXA distribution, elimination, contraindications:

A

D: widely distributed, crosses placenta, breast milk
E: 2hr half time
C: vascular disease, kidney disease, clotting issues, past stroke, MI

122
Q

What can TXA NOT be administered with and why?

A

Factor IX (9) complex concentrate/anti-inhibitor coag concentrate (major increase in thrombosis risk)

122
Q

What is a major complication with TXA?

A

Blocks GABA in frontal cortex which can result in seizure and increased need of prop/sedation
minor: bleeding, mltiorg failure, vascular occlusion

123
Q

What are some examples of antifibrinolytic agents?

A

Protamine, DDAVP, fibrinogen, recombinant activated factor 7a (novoseven), cryo

124
Q

What are the indications for protamine, MOA, and dosages? What can occur if too much protamine is given?

A

heparin reversal, neutralizes heparin, inhibits platelets. 1-1.3 mg for every 100u of circulating heparin- over 5-15min

125
Q

T/F: protamine only reverses UFH and should be given peripherally to minimize risk of PH?

A

TRUE

126
Q

If 10,000u of heparin was given 30 minutes ago how much remains and how much protamine should be given for reversal?

A

30min half life; so 5,000u would remain 5000/100 = 50mg of protamine should be given over 5-15 minutes

127
Q

What is heparin rebound and how should it be managed?

A

unbound heparin is in plasma after protamine clears, generally occurs 2-3hr after first dose and should be treated with more protamine

128
Q

What does desmopressin (DDAVP) treat? MOA?

A

hemophilia A and B, vWF disease, DI, and bed wetting
Stimulates release of vWF and factor VIII (8)

129
Q

DDAVP: dose, onset, 1/2 life, adverse effects, OD

A

d: hem A: 4 mcg/kg when factor VIII coagulant activity levels are <5%
Hemo B: 30min before surgery 0.1-0.4 mcg/kg over 10mins
DI: 4mcg/kg
peds: not used if less than 3 months old, for children less than 12 has not been est
Onset: 30 minutes
Half-life: 30 mins
AE: hypotension, HA, nausea, cramp, h2O intox, low na
OD: confus, HA, urinary/fluid retention
TX: decrease dose or stop

130
Q

What is the indication, MOA, and dosage for fibrinogen?

A

Trauma, surgery, prolonged CPB run. to restore normal clotting function. vial 900-1300mg/90-130% vial.
bleeding increases with every 100mg/dL decrease. may not work in hypothermia, acidosis

131
Q

Is fibrinogen considered a blood product and what are side effects associated?

A

yes, increased inflammation

132
Q

What Neuro-Psych medication class can interfere with platelet aggregation, Why? What is the mechanism:

A

SSRIs increase serum serotonin which increases platelet aggregation, thus leading to a higher risk of clotting…. can increase both risk for clotting AND risk for bleeding???

133
Q

What are the indications for Factor VII (7) and the adverse effects?

A

I: Hemo A&B, cardiac pts, uncontrolled head bleed
AEs: MI, stroke, DVT, PE

134
Q

Factor VII MOA and dosing:

A

works in common pathway by binding to active platelets and activates factor X which improves thrombin production
Dose: Hem A&B- 90mcg/kg q2h achieve hemostasis or preop prophylaxis

135
Q

What is cryoprecipitate and what are it’s indications and side effects?

A

prepared by thawing FFP: concentrated clotting factors (FVIII, vWF, FXIII, fibrinogen and fibronectin) 150-250mg fibrinogen
SE: donor exposure, thrombosis
dose: 6-10 units

136
Q

what three things are indicated for hypofibrinogenemia?

A
  1. Fibrinogen: not discussed as much
  2. Cryoprecipitate: only when fibrinogen is <100-150 w no clotting def/last line
  3. FFP: mostly used for warfarin reversal when kcentra is unavailable
137
Q

How much does cryo increase fibrinogen?

A

100mg/dL/5kg

138
Q

What are indications for prothrombin complex concentrates(REIBA & Bebulin) and what are they?

A

I: Warfarin reversal, increased INR with urgent reversal
contains: F II, VII, IX, X
other warfarin reversal agent: FFP

139
Q

What should be given (1st line) for vWFD or hemophilia prior to giving cryo, fibrinogen, or FFP?

A

DDAVP (stimulates release of vWF and factor VIII)

140
Q

Side effects and dosage of bebulin:

A

D: 30-50iu/kg for active blood w/ anticoag, low dose: 20-25iu/kg soft tissue (doses based on pt/inr)
SE: thrombosis

141
Q

What condition is Bebulin contraindicated in?

A

DIC

142
Q

What is in FFP?

A

Procoag and anticoag factors, albumin, and immunoglobulins

143
Q

What type of coagulation promotion is frequently used in cholecystectomy?

A

topical hemostatic agent such as
surgicel (oxidized cellulose): good for local hemostasis
tisseel (fibrin sealant): good for venous oozing
gel foam (gelatin sealant): small capillary bleeds

144
Q

Failure of what organ should be considered in the setting of hemorrhage?

A

Liver

145
Q

What things should be given to prevent need of blood transfusion in JWs?

A

iron, erythropoietin, DDAVP, antifibrinolytics, F XII
consider synthetics and human derivatives

146
Q

What is the most important Thrombolytic and what are considerations?

A

tPA
Increased bleeding risk (no sticks)

147
Q

What two drugs shouldnt be given with tPA?

A

nitro decreases effectiveness
aspirin increases toxic effects

148
Q

What two substances should be associated with platelet activation and aggregation?

A

ADP and Thromboxane A2

149
Q

How many half-lives should pass before considered back to normal coagulation function?

A

5 half lives

150
Q

How long does the intrinsic pathway take to form a clot?

A

up to 6 minutes

151
Q

What is the primary goal of both extrinsic and intrinsic coagulation pathways?

A

produce prothrombin activator

152
Q

What is the role of Thrombin and what substance is needed to convert them into fibrin fibers?

A

Converts fibrinogen to fibrinogen monomer (active form), calcium

153
Q

What is Plasminogen?

A

Proenzyme synthesized in the liver that is incorporated into the clot during formation- activated by plasmin activator becomes plasmin that breaks down clot

154
Q

What is plasmin?

A

plasminogen activated by tPA and Urokinase to make plasmin which is a Proteolytic enzyme that degraded fibrin into fibrin degradation products

155
Q

What two enzyme inhibitors turn off the fibrinolytic process?

A

tPA inhibitor and Alpha-2 antiplasmin

156
Q

What is the dose for DDAVP?

A

0.3mcg/kg IV

157
Q

What role does calcium play in the coagulation cascade?

A

activates platelets and F 2, 7, 9, 10, prothrombin
speeds coagulation and synthesizes protein C

158
Q

What is in Kcentra?

A

VIIa, XIII, PCC (4 Factor), II, VII, IX, X

159
Q

When should warfarin be stopped prior to surgery?

A

2-4 days

160
Q

Patients with ____ need renal dosing for LMWH

A

Renal disease

161
Q

Calcium is required for all blood clotting with the exclusion of the first ___ steps in the ________ pathway

A

2, intrinsic

162
Q

What treatment could potentially cause calcium to become low enough to alter coagulation?

A

CVVHDF (CRRT) and HD

163
Q

What type of feedback system is blood coagulation considered?

A

Negative feedback

164
Q

What 2 actions are the goals achieved in the common pathway?

A
  1. prothrombin -> thrombin (CP acts as check/balance)
  2. fibrin fibers formed/activated
165
Q

How long does it take heparin to work?

A

virtually instantly but 5 mins required for circulation

166
Q

when should we check an ACT to assess heparinization?

A

surgeon request or 1 hour post dose

167
Q

What factor does LMHW act on?

A

Xa

168
Q

What are s/s of HIT?

A

signs of DVT/PE
limb necrosis
MI/Stroke
venous gangrene
HTN, tachy, CP, SOB

169
Q

T/F both HIT-1 and HIT-2 require treatment

A

False, HIT-1 does not require any treatment

170
Q

Which medication should be used with caution in patients with renal failure: heparin or LMWH?

A

LMWH

171
Q

Why is the use of LMWH more concerning that heparin in the use of epidurals/spinals?

A

lack of reversal and long DOA

172
Q

What anticoagulant is hepatically metabolized (and can be given to patients with renal failure?

A

argatroban

173
Q

What is the anticoagulant of choice in a patient with a HIT induced AKI?

A

argatroban

174
Q

What is warfarins half time and how is it excreted?

A

24-36hr, excreted in bile

175
Q

T/F apixaban can easily be reversed with FFP

A

FALSE, difficult to reverse… FFP doesnt even reverse it

176
Q

What the MOA of TXA?

A

allows formation of stronger fibrin mesh, prevents breakdown of clots, completely inhibits breakdown of fibrin clots by blocking activation of plasminogen

177
Q

What is an anesthesia consideration for giving DDAVP?

A

give dose 30-60 secs to work prior to procedure

178
Q

What should be given to a pt with hemophilia A or B prophylactically prior to surgery?

A

F VIII and IX

179
Q

What are indications to give cryoprecipitate?

A

tx vWF, hemophilia when direct concentr. not available. rapid transfusion protocol, active OB bleed, hypofibrinogenemia

180
Q

What are anesthesia considerations regarding PCC?

A

primarily used for warfarin reversal, esp in pts experiencing life threatening bleed w/ high INR

181
Q

What is the treatment of coagulopathies such as vWF and hemophilia?

A
  1. missing factor
  2. Kcentra
  3. FFP
  4. Cryo

Advanced Pharm Final (5 decks)

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