Blood Transfusion/Antiviral Drugs Flashcards
blood transfusion therapy
the TRANSFUSING of WHOLE BLOOD or BLOOD COMPONENTS through IV
why do we utilize BT THERAPY?
many different reasons;
- in general – want to REPLACE LOST COMPONENTS OF THE BLOOD
ex. trama/serious injury
ex. surgical procedures
ex. illnesses - anemia, leukemia, kidney dx
what are some BLOOD TRANSFUSION PRODUCTS?
- WHOLE BLOOD
- RBC/WBC/PLATELETS
- PLASMA
- ALBUMIN
- GAMMA GLOBULIN
standard transfusion
transfusion with a compatible blood donor
autologous transfusions
where BLOOD IS COLLECTED for ANTICIPATION of FUTURE TRANSFUSIONS
- designated use only for the sole client
- can donate up to 6 WEEKS PRIOR to surgery
intraoperative blood salvage
saving of LOST STERILE BLOOD during a procedure by a filter machine - able to transfuse during operation or post-op
what are the TWO BIOMARKERS that are used to ensure safety during a BLOOD TRANSFUSION?
- ABO FACTOR
- RhD FACTOR
*we can CROSSMATCH for ABO COMPATIBILITY, but NOT for ANTIGENS
Rh Factor
- can be either PRESENT or ABSENT
- if Rh-NEG; means patient is BORN WITHOUT the Rh ANTIGEN
- can only develop ANTIBODIES once SENSITIZIED
- if in contact with RH+ BLOOD; can cause RXN.
what are the BLOOD TYPES?
A+/A-
B+/B-
AB+/AB-
O+/O-
abo factor
classification of BLOOD TYPES that are classifed by the types of ANTIGENS within the RBC and ANTIBODIES within the plasma
antigens - triggers an IMMUNE response when FOREIGN
group A
- has the A antigen
- plasma; anti-B antibody
will attack B antigen
group B
- has the B antigen
- plasma; anti-A antibody
will attack A antigen
group AB
- has both A & B antigen
- plasma; DOES NOT have any anti-A or B antibodies
will not attack anyone!
is considered the UNIVERSAL RECIPIENT (AB+)
group O
- does NOT have any A or B antigens
- but DOES HAVE both ANTI-A and ANTI-B ANTIBODIES
considered the UNIVERSAL DONOR due to not having any ANTIGENS, however, can only receive O type BLOOD due to having both antibodies
what must be done BEFORE administering BLOOD?
- always make sure YOU HAVE THE CORRECT PATIENT, BLOOD, and ORDER
- recording BASELINE VITAL SIGNS; assessing needle GAUGE (around 18-19) **checking if the patient is afebrile
- need to only use NS with BLOOD / proper Y-TUBING
how long do you have to START THE BLOOD TRANSFUSION?
- must give blood within 30 MINUTES OF RECEIVING
- must have a 2-RN check ready to proceed
what is the TYPICAL STARTING RATE of a BLOOD TRANSFUSION?
- around 2 mL/min (120 mL/hr) for the FIRST 15 MINUTES - must STAY BY BEDSIDE
- rate is increased after
- blood bag; around 250-300 cc
- can only TRANSFUSE NO MORE THAN 4 HOURS
when do we check ROUTINE VITAL SIGNS during BLOOD TRANSFUSIONS?
- 5 minutes from start
- 15 min mark
- 30 min mark
- 1 hour until end
- 1 hour AFTER
what do we NEVER administer with BLOOD?
- dextrose **hemolysis
- medications
- in general do not want to mix anything with blood; only allowed NS for priming etc…
allergic reaction
- flushing, SOB, hives, pruritus
- sensitivity to the plasma protein antibody
febrile or non-hemolyic reaction
causes sudden chills, fever, headache, anxiety
- greater hypersensitivity to donor white cells or platelets
- often onset within 2 hours of starting
hemolytic reaction
the INFUSION OF INCOMPATIBLE BLOOD PRODUCTS
- chills, tachycardia, hypotension, flushing, hematuria
- can be LIFE-THREATENING , can cause DIC (disseminated intravascular coagulation)
what happens if there is a BLOOD TRANSFUSION REACTION?
- Always STOP THE TRANSFUSION FIRST!!
- administer IV LINE - NS
- observe S & S; can place in fowlers/O2 therapy is SOB
- emergency drugs - antihistamines, fluids, steroids
- MUST SAVE EVERYTHING! - contact provider ASAP
describe VIRUSES
- there are particles that work by INFECTING and REPLICATING INSIDE OF THE CELLS
- they can only do so when INSIDE OF THE CELL
virion
type of a MATURE VIRUS that has a GENOME + CAPSID + ENVELOPE
the CAPSID - protects and transports viral genetic information; RNA
what are the FOUR MAIN ENTRY ROUTES for viruses?
- INHALATION - RESP
- INGESTION - GI
- TRANSPLACENTALLY - MOM - INFANT
- INOCULATION - SKIN/MM
inoculation route - viruses
- SEXUAL CONTACT
- BLOOD
- NEEDLE SHARING
- ORGAN TRANSPLANTS
- BITES
describe ANTIVIRAL DRUGS
work by either KILLING or SUPPRESSING VIRUSES by destroying VIRIONS or INHIBITING their skill of replicating
- most of these drugs are SYNTHETIC COMPOUNDS - mostly INHIBIT VIRAL REPLICATION vs. direct destruction
- can interfere with VIRAL NUCLEIC ACID SYNTHESIS
- why? - similar to viruses, they only work by ENTERING INTO A HOST CELL (must enter by FUSION)
antiviral (NON-HIV) drugs; MOA, indications etc…?
MOA;
work by BLOCKING POLYMERASE ENZYME
- enzyme is important for the SYNTHESIS OF VIRAL GENOMES; causes IMPAIRED VIRAL REPLICATION
indications;
treatment for HSV, VARICELLA-ZOSTER, cytomegalovirus CMV, HEP B & C
contraindications;
severe allergies
HIV
virus affecting the body’s IMMUNE SYSTEM; destroys WBC (CD4/T cells)
- can develop AIDS; risk for serious infections or cancer **known as END-STAGE HIV INFECTION
what are the STAGES OF HIV
STAGE I - acute HIV INFECTION
- chills, fevers, muscle aches
STAGE II - CHRONIC HIV INFECTION
- treatment/drug therapy, blood exams
STAGE III - AIDS
increase of opportunistic infections; continued decrease of WBC cells
what are our ANTIVIRAL (NON-HIV) DRUGS? (8)
- AMANTADINE*
- RIMANTADINE
- ACYCLOVIR*
- ENTECAVIR
- GANCICLOVIR
- OSELTAMIVIR/ZANAMIVIR
- RIBAVIRIN
- SOFOSBUVIR
amantadine
- only used against INFLUENZA A VIRUSES
; also used for PARKINSONS - can be used in CHILDREN
- only used ORALLY
- can cause DRY MOUTH, URINARY RETENTION, or CONSTIPATION
rimantadine
- has a LONGER HALF-LIFE vs. amantadine
- has LESS ADVERSE EFFECTS
- similar to AMANTADINE in indications
- only used ORALLY
acyclovir
- used to SUPPRESS REPLICATION of HSV 1 & 2 & VSV
- can be used orally, topically, or through injection (want to infuse slowly through IV–over 1 hour)
- IS SAFE DURING PREGNANCY**
- delays synthesis of VIRAL DNA
adverse effects;
can cause NEUROLOGIC TOXICITY–want to lower doses for pt. in dialysis
entecavir
- treats HEP B INFECTIONS
- is given ORALLY; doses 0.5 - 1 mg/day for min. of 12 months
- does have BLACK BOX WARNINGS;
can cause SEVERE EXACERBATIONS - HEP B, LACTIC ACIDOSIS, HEPATOMEGALY, HIV RESISTANCE
adverse effects;
- INCREASED LIVER FUNCTION TESTS
- headaches, rashes, hematuria, increased creatinine
ganciclovir
- treats CMV INFECTIONS and PREVENTION of CMV disease in high-risk pts. (who are getting organ transplants)
- given IV or ORAL
- must assess for BONE MARROW SUPPRESSION - dose-limiting toxicity
oseltamivir/zanamivir
- are NEURAMINIDASE INHIBITORS - enables VIRIONS to ESCAPE from the infected cells/spread throughout body
indications
- INFLUENZA VIRUS TYPE A and B
adverse effects;
- N/V, diarrhea, nausea, sinusitis
*oral form (oselt) / *powder form (zanamivir)
ribavirin
MOA;
interferes with RNA & DNA SYNTHESIS
indications;
used to treat HEP C or SMV
**is a CATEGORY X DRUG - TETATOGENIC
sofosbuvir
- is the FIRST-IN-CLASS RNA POLYMERASE INHIBITOR
- helps to treat CHRONIC HEP C **often combined with RIBAVIRIN
interactions
- STRONG CYP3A4 INDUCERS
- RIFAMPIN
- ST. JOHN’s WORT
**PREGNANCY CATEGORY X DRUG
describe HIV TRANSMISSION
- needs OPEN SURFACE CONTACT and is spread through BODY FLUIDS that contain the VIRUS
- ex. BLOOD, SEMEN, VAGINAL FLUID, BREAST MILK
SUBTYPES;
- HIV-1**more common
- HIV-2
ANTI-VIRAL (HIV) DRUGS; MOA, indications etc…
MOA;
work by SUPPRESSING the VIRAL REPLICATION PROCESS
indications;
active HIV INFECTION or some to treat HEP B
adverse effects;
- bone demineralization
- osteoporosis (reduced calcium)
what are our HIV DRUGS? (10)
- ENFUVIRTIDE
- INDINAVIR
- NEVIRAPINE
- RALTEGRAVIR
- TENOFOVIR
- ZIDOVUDINE
- MARAVIROC (SELZENTRY)
- RALTEGRAVIR
- TENOFOVIR ALAFENAMIDE (VEMLIDY)
- ZIDOVUDINE (RETROVIR)
enfuvirtide
- type of FUSION INHIBITOR; suppresses fusion process & replication
- is quite expensive/inconvenient dosing
indinavir
- type of PROTEASE INHIBITOR
- can cause KIDNEY STONES in around 4% of PATIENTS
- recommendation; increased LIQUIDS
nevirapine
- type of NON-NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITOR **important enzyme that allows viral rna to change to DNA
- often is WELL TOLERATED
- only taken ORALLY
raltegravir
- stops HIV REPLICATION; prevents insertion of VIRAL DNA into the human cell – type of INTEGRASE INHIBITOR
indications;
- patients with MULTIDRUG RESISTANCE/ACTIVE REPLICATION
adverse effects;
- myopathy
- immune reconstitution syndrome
contraindications;
- LACTATION, PRE-TERM NEONATES etc…
tenofovir
indicated for HIV and HEP B–allows to SLOW ITS PROGRESSION by preventing INSERTION OF VIRAL DNA
- is a NRTI (NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITOR)
- has been having INCREASED RESISTANCE
adv. effects;
- LIVER/KIDNEY FXN, LACTIC ACIDOSIS, TACHYC. DARK URINE
zidovudine
the first anti-viral drug for HIV
- not typically used now; can cause severe adverse reactions
- was often given to INFECTED PREGNANT WOMEN/NEWBORN BABIES
- adverse effect; BONE MARROW SUPPRESSION
