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Pharm 3 (me) > CF, Trauma, Blood Disorders > Flashcards

CF, Trauma, Blood Disorders Flashcards

1
Q

6 adverse effects of surgical bleeding:

A
  1. Visual obstruction of the surgical field
  2. Reduction in core temp
  3. Thrombocytopenia
  4. Hypovolemic shock
  5. Need for blood transfusions
  6. Economic consequences
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2
Q

Normal physiologic coagulation process (4):

A
  1. Vascular constriction (limits flow of blood to the area)
  2. Platelet plug formation (adhesion, activation, aggregation)
  3. Fibrin formation (coagulation cascade: thrombin cleaves fibrinogen to fibrin)
  4. Fibrinolysis (clot dissolves to allow the normal BF after tissue repair)
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3
Q

What activates plasminogen to plasmin for fibrinolysis?

A

t-PA

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4
Q
  • Provides global information on the dynamics of clot development, stabilization, and dissolution
  • diagnosis of early trauma coagluopathies
A

Thromboelastography

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5
Q

What information does thromboelastography provide (4):

A
  1. Clotting time
  2. Max clot firmness
  3. Lysis index after 30 min
  4. Max lysis
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6
Q

What 4 diagnosis can thromboelastography provide (4):

A
  1. Hypercoagulability
  2. Hyperfibrinolysis
  3. Platelet dysfunction
  4. Hypocoagulability
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7
Q

3 mechanical methods to achieve surgical hemostasis:

A
  1. Direct pressure
  2. Fabric pad/gauze sponges/sponges
  3. Sutures/staples/ligating clips
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8
Q

3 thermal/energy-based methods to achieve surgical hemostasis:

A
  1. Electrosurgery
  2. Ultrasonic device
  3. Laser
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9
Q

2 chemical methods to achieve surgical hemostasis:

A
  1. Pharmacological agents

2. Topical hemostatic agents

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10
Q

4 indications for hemostatic agents:

A
  1. Cardiac surgery with cardiopulmonary bypass and other surgical procedures with significant blood loss
  2. Intraop significant blood loss
  3. Specific CF deficiencies, platelet dysfunction, or antithrombotics
  4. Refractory bleeding
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11
Q

2 antifibrinolytic agents

A 
E-aminocaproic acid (EACA)
Tranexamic acid (TXA)
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12
Q

Blocks the binding of plasminogen to fibrin and its activation to plasmin

A

Antifibrinolytic agents

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13
Q

2 uses for antifibrinolytic agents:

A
  1. Prophylactically to reduce surgical blood loss and transfusion
  2. Traumatic hemorrhage (TXA)
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14
Q

3 adverse effects of antifibrinolytic agents:

A
  1. Thromboembolic complications
  2. Hypotension (EACA)
  3. Seizures (TXA)
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15
Q

What is needed for patients with clinically important bleeding and low fibrinogen levels

A

Fibrinogen replacements

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16
Q

Prepared from plasma and contains fibrinogen, von willebrand factor, factor 8,13 and fibronectin

A

Cryoprecipitate

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17
Q

The need for cryoprecipitate?

A

Replacement of fibrinogen in hypofibrinogenemia

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18
Q

2 adverse effects of cryoprecipitate?

A

Infection and transfusion reactions

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19
Q

Difference between unactivated and activated prothrombin complex concentrate (PCC)?

A

Of 4 factors (2, 7, 9, 10), 7 is mostly active form

Activated does not contain heparin

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20
Q

What is used to reverse warfarin?

A

Unactivated PCC

21
Q

What is used to reverse fondaparinux, DOAC and prevent/treat bleeding in hemophilia A and B?

A

Activated PCC

22
Q

Adverse effects of PCC?

A

Thrombotic complications

23
Q

Contains all of the coagulant factors and coagulation inhibitors in normal blood except platelets; it is free of erythrocytes and leukocytes

A

Fresh frozen plasma

24
Q

1 ml of FFP is equivalent to what?

A

1 unit of blood coagulation factor activity

25
Q

What is needed for FFP to obtain a 20-30% increase in level of any CF?

A

15-20ml/kg

26
Q

4 uses for FFP?

A
  1. Surgery in presence of abnormal coagulation tests
  2. Reversal of warfarin
  3. Thrombotic thrombocytopenia purpura
  4. Congenital or acquired factor deficiency with no alternative therapy
27
Q

Adverse effects of FFP?

A

Similar to blood transfusion complications

28
Q

Hemophilia A deficiency of what CF?

A

8

29
Q

Severe, less severe and mild hemophilia A (8) activity levels:

A

Severe: <1%
Less severe: 1-5% (increased risk of hemorrhage)
Mild: 6-30% (risk for excessive bleeding)

30
Q

Who is at risk of excessive surgical bleeding?

A

Female carriers of hemophilia A

31
Q

How is hemophilia A (8) identified?

A

Prolonged aPTT, normal PT

32
Q

Moderate to severe hemophilia A need correction of coagulopathy requires what?

A

Preop dose of recombinant CF8

33
Q

Prior exposure to recombinant CF8 increase chance of what?

A

To develop inhibitor antibodies that render it ineffective

34
Q

Half life of CF8 is about what?

A

12 hours

35
Q

CF8 therapy must be continued for how long postop to avoid bleeding that could disrupt wound healing?

A

2 weeks

36
Q

Longer periods of CF8 therapy (4-6wks) may be required in pts who undergo what surgeries?

A

Bone or joint surgery

37
Q

Synthetic vasopressin analogue

A

Desmopressin

38
Q

Mechanism:

  • stimulates endothelial release of CF8 and von Willebrand factor into the plasma (increase level of CF8 3-5 fold)
  • promotes the release into plasma of tissue-type plasminogen activator, resulting in short-lived plasmin
A

Desmopressin

39
Q

2 indications for desmopressin:

A
  1. Hemophilia A and von Willebrand’s disease with CF8 >5%

2. Useful in pts with mild hemophilia or type 1 von willebrands disease undergoing surgery

40
Q

3 off label uses for desmopressin:

A
  1. Cardiac surgery
  2. Bleeding due to inherited/acquired bleeding disorders or platelet dysfunction (anti platelets)
  3. Ability to shorten bleeding time is unpredictable and must be assessed individually in each pt
41
Q

2 contraindications for desmopressin:

A
  1. SIADH

2. GFR < 50ml/min

42
Q

4 adverse effects of desmopressin:

A
  1. Potent antidiuretic (hyponatremia, water retention)
  2. Hypotension
  3. Induction of premature labor
  4. Thrombosis
43
Q

Hemophilia B deficiency of what CF?

A

9

44
Q

Prothrombin complex concentrate (PCC) has what 2 facts?

A
  1. Treat mild bleeding episodes or administered as prophylaxis for minor surgery
  2. Increased risk of thromboembolic complications (especially in ortho)
45
Q

What is recombinant factor 9 used for?

A

Several days to treat bleeding

46
Q

Activated recombinant factor 7 enhances what bypassing the need for what factors?

A

Thrombin generation

Bypassing the need of 8 and 9

47
Q

4 uses for activated recombinant factor 7?

A
  1. Prevent/treat bleeding episodes in disorders of hemostasis (hemophilia, F7 deficiency, platelet disorders, acquired von Willebrand disease, uremia and liver disease)
  2. Control life threatening bleeding
  3. Reversal of anticoagulation
  4. Only considered for uncontrollable bleeding that cannot be managed by other procoagulant interventions
48
Q

Adverse effect of activated recombinant factor 7?

A

Serious arterial and venous thrombotic events

49
Q

3 options for warfarin reversal?

A
  1. Vitamin K (phytonadione); will produce 2,7,9,10
  2. Prothrombin complex concentrates (PCC); contain Vit K dependent clotting factors
  3. Fresh frozen plasma

Pharm 3 (me) (7 decks)

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