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Pharmacology ATI > Hemotology > Flashcards

Hemotology Flashcards

1
Q

Factor VIII and Factor IX
Classification

A

Antihemophilic Factor

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2
Q

Factor VIII and Factor IX
Indication

A

Factor VIII = Hemophilia A
Factor IX = Hemophilia B

-replaces missing coagulation factor, which reduces bleeding and joint damage

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3
Q

Factor VIII and Factor IX
MOA

A

Clotting factor replacements and cofactors for factor Xa

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4
Q

Factor VIII and Factor IX
Prototypes

A

plasma derived factor VIII concentrate (Hemofil-M)

recombinant factor VIII (Advate)

plasma-derived factor IX concentrate (Alpha-Nine S-D)

recombinant factor IX concentrate (BeneFix)

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5
Q

Factor VIII and Factor IX
Adverse effects

A

Hypersensitivity
Prion diseases

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6
Q

Factor VIII and Factor IX
Nursing interventions

A

Monitor for allergies - rash, itching, anaphylaxis
-diphenydramine, epinephrine

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7
Q

Factor VIII and Factor IX
Administration

A

Reconstitute
IV bolus over 5-10 min
Treatment for bleeding or prophylaxis (1-3X per week)

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8
Q

Desmopressin
Class

A

Antidiuretic

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9
Q

Desmopressin
Indication

A

Short term control of bleeding for Hemophilia A (injury or prep for surgery)

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10
Q

Desmopressin
Prototype

A

desmopressin (DDAVP, Stimate)

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11
Q

Desmopressin
MOA

A

Stimulates release of stored factor VIII (must be able to create factor VIII and does not work for Hemophilia B)

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12
Q

Desmopressin
Adverse effects

A

Dilutional hyponatremia
Fluid retention
Seizures
Drowsiness
Headache
Nausea
GI discomfort

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13
Q

Desmopressin
Interventions

A

Monitor serum sodium and I&Os
Restrict fluids and salt with overload, possible diuretic therapy
Monitor for diabetes insipidus

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14
Q

Desmopressin
Admin

A

IV or intranasal
IV: Dilute in 0.9% NaCl and administer over 15-30 min
Intranasal: Stimate, be careful to spray the exact number of times for the dose otherwise overdose can occur

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15
Q

Desmopressin
Teaching

A

Weigh daily and report sudden changes
Report uncontrolled bleeding, dyspnea, headache
Avoid alcohol

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16
Q

Desmopressin
Contraindications

A

Renal failure
Nephrogenic diabetes insipidus
Type IIB von Willebrand’s disease
Heart failure (precaution)

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17
Q

Factor Xa/Thrombin Inhibitors
Prototype

A

heparin - thrombin inhibitor
Enoxaparin (Levenox) - factor Xa in hibitor

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18
Q

Factor Xa/Thrombin Inhibitors
Classification

A

Anticoagulants

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19
Q

Factor Xa/Thrombin Inhibitors
Indication

A

Prevent blood clots from forming or worsening:
-CVA treatment
-DVT and pulmonary emboli prevention
-Surgery, hemodialysis, blood transfusions
-DIC treatment
-post MI

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20
Q

Factor Xa/Thrombin Inhibitors
MOA

A

Binds with antithrombin and inactivates factor Xa and thrombin
Prevents fibrin development

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21
Q

Factor Xa/Thrombin Inhibitors
Adverse effects

A

Bleeding/Hemorrhage
Thrombocytopenia due to autoimmune reaction to protein in heparin
Hypersensitivity

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22
Q

Factor Xa/Thrombin Inhibitors
Interventions

A

Monitor for hypotension/tachy indicating bleeding
Monitor activated partial thromboplastin time (aPTT) - should be no longer than twice the baseline
Administer protamine for long aPTT or bleeding

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23
Q

Factor Xa/Thrombin Inhibitors
Admin

A

Subq or IV
Get baseline aPTT, CBC, platelet, and hct
Monitor aPTT for heparin q 4-6 h
(Enoxaparin dose is based on weight and does not need aPTT monitoring)

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24
Q

Factor Xa/Thrombin Inhibitors
Instructions

A

Report bleeding, bruising, petechiae, black stools, hematomas
Report calf pain, swelling, redness or warmth, dyspnea
Do not take NSAIDS
Use soft toothbrush
Avoid razors

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25
Factor Xa/Thrombin Inhibitors Contraindications
Thrombocytopenia Uncontrollable bleeding Lumbar puncture, epidural, regional anesthesia, or any surgery involving brain, spinal cord, or eyes Pregnancy (miscarriage risk)
26
Vitamin K Antagonists Prototype
Warfarin (Coumadin)
27
Vitamin K Antagonists Indication
Prevents DVT with pulmonary emboli, CVAs secondary to a fib, thromboemboli with prosthetic valves, and reoccurring MI Treats TIAs
28
Vitamin K Antagonists Class
Anticoagulant
29
Vitamin K Antagonists MOA
Block action of vitamin K, which is needed in synthesis of clotting factors VIII, IX, and X and prothrombin
30
Vitamin K Antagonists Adverse effects
Bleeding
31
Vitamin K Antagonists Interventions
Monitor for signs of bleeding Administer vitamin K slowly via IV if hemorrhage occurs Administer blood products if vitamin K doesn't work
32
Vitamin K Antagonists Admin
PO Monitor PT/INR daily until correct dosage then every 2-4 weeks (INR result needed to determine daily dose) Takes 8-12 hours for onset of anticoagulation
33
Vitamin K Antagonists Contraindications
Pregnancy Vitamin K deficiency Thrombocytopenia Liver disease Alcoholism Uncontrolled bleeding Regional anesthesia, lumbar puncture, or surgery involving CNS and eyes
34
Thrombolytics Prototype
alteplase (Activase) streptokinase (Streptase) reteplase (Retevase) tenecteplase (TNKase)
35
Thrombolytics Indication
Breaks down blood clots that have already formed -treats PE, MI, CVA, DVT -re-establish patency of occluded IV
36
Thrombolytics MOA
Selectively convert plasminogen into plasmin, which is an enzyme that breaks down fibrin (breaks down clot) and clotting factors (prevents new clots from forming)
37
Thrombolytics Adverse Effects
Bleeding
38
Thrombolytics Interventions
Monitor intracranial bleed: consciousness, orientation, headache, Monitor GI bleed: abdominal pain, dark stool, VS Limit venipuncture/injections Apply pressure to puncture sites Administer aminocaproic acid (Amicar) for bleeding to facilitate clotting
39
Thrombolytics Admin
IV post MI, CVA etc. Obtain INR, PT, aPTT, hct, etc. Ensure patent secondary IV for emergency Monitor neuro status q 30 min for 8 hours after admin
40
Thrombolytics Contraindications
Prior intracranial hemorrhage Hemorrhagic CVA Aortic dissection Aneurysm Acute pericarditis Brain tumor Recent head trauma
41
Erythropoietic Growth Factors Prototype
epoetin alfa (Epogen, Procrit) darbepoetin alfa (Aranesp): long-acting
42
Erythropoietic Growth Factors Indication
Increases erythrocyte production in renal failure, preop anemia, chemotherapy, or taking Retrovir for HIV
43
Erythropoietic Growth Factors Class
Erythropoiesis stimulating agents
44
Erythropoietic Growth Factors Adverse effects
HTN due to increased hct CVA, MI, cardiac arrest due to increased hgb Seizures Progression of cancer
45
Erythropoietic Growth Factors MOA
mimics natural erythropoieten secreted by the adrenal glands by stimulating RBC production in bone marrow
46
Erythropoietic Growth Factors Admin
IV or subq 3x per week Do not shake or mix Monitor hgb 2x per week until optimal dose obtained and report hgb over 12 Monitor iron level
47
Erythropoietic Growth Factors Contraindications
Uncontrolled HTN Cancer w/o chemo or radiation Hypersensitivity Iron deficiency anemia (not effective)
48
Leukopoietic Growth Factor Prototype
fligrastim (Neupogen)
49
Leukopoietic Growth Factor Class
Colony-Stimulating Factors
50
Leukopoietic Growth Factor Indication
Increase WBCs - used to prevent infection with bone marrow transplant, myelosuppresive chemo, or chronic neutropenia
51
Leukopoietic Growth Factor MOA
Stimulates bone marrow to increase stem cell production of leukocyte precursors
52
Leukopoietic Growth Factor Adverse effects
Leukocytosis Bone pain Fever Splenomegaly (gets clogged with cells with long-term use) Hypersensitivity and acute respiratory distress
53
Leukopoietic Growth Factor Admin
Baseline CBC Monitor CBC 2x per week IV or subq Avoid administering within 24 hours of chemotherapy
54
Leukopoietic Growth Factor Interventions
Monitor CBC - report to provider if WBC is over 10,000 Administer acetaminophen for mild bone pain and fever
55
Leukopoietic Growth Factor Contraindications
Sensitivity to E. coli derived proteins ARDS Currently undergoing chemo or radiation
56
Thrombopoietic Growth Factor Prototype
oprelvelkin (Interleukin-11 and Neumega)
57
Thrombopoietic Growth Factor Indication
Treats thrombocytopenia from myelosuppresive chemo for non-myeloid cancers (decreases need for platelet transfusions)
58
Thrombopoietic Growth Factor MOA
Stimulates synthesis of megakaryocytes (precursor of platelets) in bone marrow
59
Thrombopoietic Growth Factor Adverse effects
Fluid retention and dilutional anemia Dysrhythmias secondary to fluid retention Hypersensitivity Conjunctival infection is common
60
Thrombopoietic Growth Factor Admin
Baseline CBC, electrolyte panel Subq QD 4-6 hours after chemo and do not administer more than 21 days
61
Thrombopoietic Growth Factor Interventions
Monitor for dysrhythmias Monitor fluid intake and output and signs of retention Monitor for allergic reaction
62
Thrombopoietic Growth Factor Contraindication
Use with caution with HF or pleural effusion Use with caution with myeloid cancer

Pharmacology ATI (19 decks)

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