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N929 Pharmacology II > Emergent reversal of anticoagulants > Flashcards

Emergent reversal of anticoagulants Flashcards

1
Q

Antiplatelet agent reversal agent

A

platelet transfusion

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2
Q

Heparins reversal agent

A

protamine

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3
Q

Direct thrombin inhibitors reversal agents

A 
idarucizumab (reverses dabigatran)
andexanet alfa (reverses apixaban or rivaroxaban)
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4
Q

Vitamin K antagonists (warfarin) reversal agent

A

vitamin K

3 & 4 factor PCCs

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5
Q

Drug that reverses unfractionated heparin, low molecular weight heparin, fondaparinux, dabigatran, and FXa:

A

ciraparangtag

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6
Q

Cryoprecipitate contains

A

fibrinogen, FVIII, vWF, and factor FXIII

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7
Q

Factor concentrates include

A

plasma derived and recombinant

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8
Q

FFP contains

A

near normal levels of coagulation factors, coagulation inhibitors, albumin, and immunoglobulins

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9
Q

Large volumes of plasma transfusion are not well tolerated in patients with

A

limited cardiopulmonary reserve and can be associated with transfusion-associated circulatory overload and acute lung injury

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10
Q

The efficacy of transfusion is commonly assessed by

A

PT/INR, PTT, fibrinogen level, platelet count, and visoeleastic tests which average a turn around time of 60 minutes

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11
Q

Plasma derived fibrinogen

A

contains the most fibrinogen content per vial or unit as compared to FFP and cryo

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12
Q

These blood products go through the filter and the warmer

A

RBCs, FFP, and cryoprecipitate

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13
Q

These blood products go through the filter only (NO warmer)

A

platelets

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14
Q

Factor concentrates of recombinant include

A

Factor VIIa, Factor IX

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15
Q

Plasma derived factor concentrates include

A

factor VIII, vWF, Factor IX, Factor XIII

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16
Q

Kcentra contains factors

A

II, VII, IX, and X

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17
Q

Profilnine contains factors

A

II, IX, and X

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18
Q

FEIBA is

A

factor eight inhibitor bypassing activity and mainly contains non-activated II, IX, and X and mainly activated VII

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19
Q

Riastap contains

A

fibrinogen concentrate (Factor I)

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20
Q

Riastap is convenient because

A

it can be stored at room temperature for up to 30 months
can be quickly reconstituted and administered IV with no thawing or blood-type matching required
fibrinogen concentrate is standardized in each vial

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21
Q

Factor complex concentrates are

A

a biological product of pooled human plasma with therapeutic concentrations of factors II, VII, IX, and X
includes 4 factor: Kcentra & 3 factor: Profilnine

22
Q

Clinical uses of factor complex concentrates include

A

reverses the effects of significant vitamin K-antagonism coagulopathy
emergent or urgent surgery for someone on coumadin
clotting deficiency

23
Q

Factor complex concentrates are contraindicated in

A

DIC & HIT

24
Q

Profilnine is a

A

3 factor complex concentrate which was originally approved for treatment of patients with hemophilia B (factor IX deficency)

25
Q

Profilnine is reserved mainly for

A

cardiac cases

NOT indicated for warfarin or factor Xa reversal

26
Q

Kcentria is a

A

4 factor complex concentrate which is approved for reversal of vitamin K antagonists

27
Q

Factor IX complex is also known as

A

Profilnine

28
Q

Profilnine contains

A

concentrated factors of IX, II, X and low levels of factor VII
does not contain heparin and contains no preservatives

29
Q

Profilnine dosing is

A

based on temporarily increasing the plasma level of factor IX
10-15 units/IBW kg; max dose of 1,000 units

30
Q

KCentra contains

A

antithrombotic proteins C & S and heparin 8-40 units in 500-unit vials in addition to factors II, VII, IX, and X

31
Q

KCentra is FDA approved for the treatment of

A

adult patients treated with vitamin K antagonists (i.e. warfarin) with an INR >1.5 and experiencing acute major bleeding

32
Q

KCentra can help reverse

A

factor Xa inhibitors like Xarelto and Eliquis at higher doses

33
Q

Recombinant activated factor VII is also known as

A

NovoSeven

34
Q

Recombinant activated factor VII is a

A

form of blood factor VII

35
Q

Recombinant activated factor VII is used for

A 
hemophilia A (deficiency of VIII) or B (deficiency of IX), congenital factor VII deficiency 
mostly used for "off-label" use for the prevention and treatment of coagulopathy and major blood loss
36
Q

Specific uses of recombinant activated factor VII include

A

postpartum hemorrhage, trauma, reversal of various anticoagulants, and high-risk cardiothoracic, spinal, transplant, or vascular surgery

37
Q

rFVIIa can be associated with an increased risk of

A

thrombosis particularly in patients who do not have hemophilia

38
Q

Recombinant activated factor VIi is

A

the activated form of factor VII, bypasses factors VIII and IX and causes coagulation without the need for factors VIII and IX

39
Q

Novoseven promotes hemostasis by

A

activating the extrinsic pathway of the coagulation cascade
forms a complex with tissue factor at the site of injury and activates coagulation factors IX and X which leads to the formation of a hemostatic plug

40
Q

Theoretically, the mechanism of recombinant activated factor VII

A

localizes the action of factor VIIa to the site of injury and avoids the complications of thrombosis occurring in other vascular beds

41
Q

Factor VIIa got its start during

A

the Iraq war to treat wounded troups

42
Q

Factor VIIa works on

A

2 pathways

at the site of tissue injury to combine with tissue factor to directly activate factor X and on the platelet surface

43
Q

Factor VIIa dosing includes:

A

20 mcg/kg to over 200 mcg/kg

re-dose can be every 2 hours as clinically indicated

44
Q

Risks associated with factor VII include:

A

risk of thrombotic adverse events- DIC, advanced atherosclerotic disease, crush injury, septicemia, or concomitant tx prothrombin complex concentrates increase risk

45
Q

Factor VII will not stop

A

surgical hemorrhage; it is a temporizing agent

46
Q

Factor VII should not be given instead of

A

other blood products; need adequate FFP, Cryo, and platelets to be present for full effect (the mechanism of action depends on platelet and fibrinogen function

47
Q

Factor Complex concentrates provide faster correction of

A

coagulopathy as compared to FFP and Vitamin K

48
Q

The factors in plasma are relatively

A

dilute and a large volume is required for clinical reversal of oral anticoagulants

49
Q

There is less risk of _____ with factor complex concentrates

A

infection and noninfectious transfusion reactions

50
Q

The action of factor complex concentrates still require

A

adequate concentrations of platelets and fibrinogen

N929 Pharmacology II (16 decks)

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