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A1 > Hematology > Flashcards

Hematology Flashcards

1
Q

Virchows triad

A

3 possible settings of thrombus formation
Hypercoagulable
Vascular wall injury
Circulatory stasis

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2
Q

How far in advance should heparin, aspirin, warfarin, nsaids, and plavix be stopped?

A

H 1-2 days
A 7 days
W 2-4 days
NSAIDS- 1-2 days
P 5-7 days

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3
Q

What percent of PTT is due to heparin?

A

50% or less

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4
Q

Protamine sulfate dose

A

1mg per 100u heparin
Dose drops over hours to .5 mg per, .25mg per
SLOW 3 minutes

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5
Q

When can I restart heparin after surgery?

A

24 if low risk
48 if high risk

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6
Q

What lab to monitor for heparin and LMWH

A

H- aptt and anti xa
L- aptt and anti xa

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6
Q

DOACs names

A

Rivaroxaban xarelto
Apixaban eliquis
Edoxaban

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7
Q

Andexxa high vs low dose

A

H- 800mg in 30 min, 8 mg /min 120 mins
L-400mg in 30 min, 4mg/min 120 mins

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8
Q

LKW limits for thormbolytics

A

TPA- 3-4 hours

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8
Q

Warfarininterferes with which factors

A

2
7
9
10

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9
Q

Warfarin antidote

A

Vit k but it takes 24h

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10
Q

Intracranial hemmorhage in thrombolytics risk rate

A

1%

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11
Q

Who needs bridge therap after surgery?

A

Pt on warfarin who are very high risk- mechanical valve, recent stroke 3 months, VTE 3 months

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12
Q

P2Y12 inhibitors

A

Platelet aggregation inhibitors (top of cell which starts whole process)
Clopidogrel (plavix)
Prasugrel
Ticagrelor (brilinta) (reversible)
Cangrelor (reversible)

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13
Q

COX inhibitors

A

Prevents platelet aggregation
Prevents ADP/ TXA2 activation at top of cell, prevents CA inside the cell, prevents the breakdown of AA - > TXA2
COX specifically stops AA to TXA2
Aspirin

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14
Q

GP2B/3A inhibitors

A

Platelet aggregation inhibitors (holding hands)
Abciximab
Eptifibatide
Tirofiban (aggrastat)

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15
Q

Anti platelets

A

P2Y12 inhibitors (top of cell)
COX inhibitors (AA to TXA12)
GP2B3A inhibitors (holding hands)

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16
Q

What coagulation factors does the liver make?

A

2,7,9,10- pro coagulants
C, S- anti coagulants
All are dependent on Vitamin K to make them functional

17
Q

Anti coagulants

A

Block factor 10 (and 2) in coagulation cascade
Blocks via AT3
Heparin
LMWH
Fondaparinux

17
Q

How common is heparin toxicity, and what are the signs?

A

1-10%
Bleeding
HIT (thrombocytopenia)
ABNM LFT

18
Q

HIT signs and causes

A

Platelet under 100,000 or drop from baseline
1-15% risk, 5% with heparin flush, 10x lower with LMWH
5-15 days after treatment
Caused by antibodies

19
Q

How to diagnose HIT

A

4Ts
Thrombocytopenia, timing of TCP, thrombosis, other causes of TCP
If score over 3, ELISA testing
SRA (serotonin release assays) is gold standard

20
Q

HIT treatment

A

Stop heparin
Administer other anticoagulants
Add allergy to chart
Protamine sulfate?

21
Q

DOACs

A

Direct acting anti coagulants on factor X (XA in name)
Apixiban (xarelto)
Rivoroxiban (eliquis)
Edoxaban
—
Direct thrombin inhibitors
dabigatran
argatroban
bivalruden

22
Q

Anticoagulants and anesthesia

A

DOAC- d/c doac 4-5 days, but dabigatran is 3-5 days, restart 24-72 h after procedure depending on risk level

23
Q

When can u give activated charcoal when bleeding? what med

A

Dabigatran DOAC
But the antidote is idarucizumab and ciraparantag

24
Q

VKAs

A

Warfarin 2 7 9 10

25
Q

What naturally prevents platelets

A

NO
PG
Protein C, S

26
Q

Fibrinolytics

A

Clot busting- increases plasminogen to plasmin to break down fibrin, and break down fibrinogen so they dont hold clots together
Alteplase
reteplase
tenecteplace
streptokinase
urokinase

27
Q

Thrombolytic major risk and %

A

Hemmorhage 2-4%
ICH 1%

27
Q

When are thrombolytics used

A

PE
DVT
clot on IV catheter
Acute MI

28
Q

How long do fibrinolytics last?

A

7-24h post d/c

29
Q

Who is at risk for sodium citrate toxicity?

A

hypothermia, liver/kidney pt, hypocalcemia

30
Q

Anti coags that can stop factor 10 and 2

A

Via AT3 -Heparin, LMWH, fondaparinux
DOACs- xa- Apixiban (xarelto)
Rivoroxiban (eliquis)
Edoxaban
Direct thrombin inhibitors
dabigatran
argatroban
bivalruden

31
Q

Which are good for arterio vs venous

A

Artery- anti platelet
Venous-
Both- anti coagulants

32
Q

ACS treatment

A

Aspiring COX
P2Y12 Plavix
GP2B3A tirofiban (aggrastat) maybe
Heparin anti coag

33
Q

ASA risks with use

A

PUD
Liver dmg <19yo reye syndome
Asthma exacerbation

34
Q

What can inhibit CYP450 and for what drug does it matter

A

Warfarin
PAAAM
PPI
Amio
Azoles
Acetaminophen
Macrolides

35
Q

CYP450 inducer drugs

A

Important for warfarin
C arbomazepine
P phenytoin
R ifampin

36
Q

Hematology teratogenic drug

A

Warfarin

37
Q

Minor vs major bleeding after hem drugs

A

minor- epistaxis (minimal), bleeding from wound, gingival,
major- GI bleed, massive uterine bleeding, cereberal hmg, hemothorax, hemopericardium

38
Q

Hem reversal agents

A

APA- desmopressin
Heparin- protamine sulfate
DOACs- Xa- andexxa, 4-factor PCC (2,7,9,10)
Thrombin inhibitors- idaracizumab (reverse dabigatran)

39
Q

What does andexanet alpha reverse

A

DOAC 400/4mg/min 800/8g/min

40
Q
A

A1 (124 decks)

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