ch 34/40 highlights

Question 1

EPO/hgb levels

Answer 1

kidneys, 12 g/dl, 10 for cancer pt, if doesnt go up then monitor….

Question 2

GCSF

Answer 2

reg prod of neutrs in bone marrow (neuopogen)
myelosupp/cancer/bone marrow transplant/progenitor cells/chronic severe neutropenia
primary se: mild/mod bone pain, nonopioid analgesia

Question 3

heparin

Answer 3

natural substance in liver, blocks clots, first used in blood transf for clots
is rapid anticoag for thrombosis of dvt, pe, evolving stroke, Open heart surg, DIC for ccp
combines w/antithrom III , accelerates anticoag cascade, prevents thrombus form., fibrinogen does not convert to fibrin, no clot.
NOT PO poorly absorbed, heparinase
PTT/APTT
protamine sulfate
ffp, rbc, plts
serial monitoring aptt q 6-8h. should be 1.5-2x control
hep from pigs, irreg

Question 4

DIC

Answer 4

fibrin clots form in vascular system, clots consume proteins and platelets, deplete clotting factors, excess bleeding. tx heparin

Question 5

bridge tx

Answer 5

pt starts oral anticoags (warfarin) with long term heparin until INR is therapeutic

Question 6

LMWH

Answer 6

extracted from standard hep, anticoag eff with dec bleeding.
inactivates xa, less able to inactivate thrombin.
labs not necessary, only plt

Question 7

selective factor xa

Answer 7

arixtra, xarelto, eliquis

arixtra: synthetic engineered antithrom, designed to be eff as once/day injection, closely r/t structure in hep/lmwh

Question 8

oral anticoags

Answer 8

blocks synth of vit k, affects clotting II, VII, Ix, X. bleeds occur in 10% of pts on this

Question 9

anticoag antagonists

Answer 9

choice: vit k. antagonist to warfarin, uncontrolled bleeds.
1-10mg at once, if fails, then ffp/plt/whole blood.
24-48 hrs for efectiveness.
blocks warf. 1-2 wk
give vit k vs ffp or both depending on inr, clinical status of pt

Question 10

antiplt drugs

Answer 10

prevent thrombus in arteries by supporting plt agg.
mainly prophylactic for MI, stroke w fam hx, repeat mi/cva, stroke in pt with tia
ASA also

Question 11

thrombolytics

Answer 11

increase fibrinolytic mechanism, destroy fibrin in clot, thrombus/blood clot disintegrates if thrombolytic is admin within 3 hrs of stroke, 4 hrs of AMI.
norm takes 1-2 wkss to dissolve naturally

Question 12

epogen ci

Answer 12

anemia, adequate rbc, no transf.
ci: uncontrolled htn, hypersens to mammalian/albumin
seizure, hyperkalemia. life thrt: mi, tia, cva
hgb.
pt take iron supp hs.
teach subq inj, safe disposal