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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
Q

Factor Xa/Thrombin Inhibitors
Contraindications

A

Thrombocytopenia
Uncontrollable bleeding
Lumbar puncture, epidural, regional anesthesia, or any surgery involving brain, spinal cord, or eyes
Pregnancy (miscarriage risk)

26
Q

Vitamin K Antagonists
Prototype

A

Warfarin (Coumadin)

27
Q

Vitamin K Antagonists
Indication

A

Prevents DVT with pulmonary emboli, CVAs secondary to a fib, thromboemboli with prosthetic valves, and reoccurring MI

Treats TIAs

28
Q

Vitamin K Antagonists
Class

A

Anticoagulant

29
Q

Vitamin K Antagonists
MOA

A

Block action of vitamin K, which is needed in synthesis of clotting factors VIII, IX, and X and prothrombin

30
Q

Vitamin K Antagonists
Adverse effects

A

Bleeding

31
Q

Vitamin K Antagonists
Interventions

A

Monitor for signs of bleeding
Administer vitamin K slowly via IV if hemorrhage occurs
Administer blood products if vitamin K doesn’t work

32
Q

Vitamin K Antagonists
Admin

A

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
Q

Vitamin K Antagonists
Contraindications

A

Pregnancy
Vitamin K deficiency
Thrombocytopenia
Liver disease
Alcoholism
Uncontrolled bleeding
Regional anesthesia, lumbar puncture, or surgery involving CNS and eyes

34
Q

Thrombolytics
Prototype

A

alteplase (Activase)
streptokinase (Streptase)
reteplase (Retevase)
tenecteplase (TNKase)

35
Q

Thrombolytics
Indication

A

Breaks down blood clots that have already formed
-treats PE, MI, CVA, DVT
-re-establish patency of occluded IV

36
Q

Thrombolytics
MOA

A

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
Q

Thrombolytics
Adverse Effects

A

Bleeding

38
Q

Thrombolytics
Interventions

A

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
Q

Thrombolytics
Admin

A

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
Q

Thrombolytics
Contraindications

A

Prior intracranial hemorrhage
Hemorrhagic CVA
Aortic dissection
Aneurysm
Acute pericarditis
Brain tumor
Recent head trauma

41
Q

Erythropoietic Growth Factors
Prototype

A

epoetin alfa (Epogen, Procrit)
darbepoetin alfa (Aranesp): long-acting

42
Q

Erythropoietic Growth Factors
Indication

A

Increases erythrocyte production in renal failure, preop anemia, chemotherapy, or taking Retrovir for HIV

43
Q

Erythropoietic Growth Factors
Class

A

Erythropoiesis stimulating agents

44
Q

Erythropoietic Growth Factors
Adverse effects

A

HTN due to increased hct
CVA, MI, cardiac arrest due to increased hgb
Seizures
Progression of cancer

45
Q

Erythropoietic Growth Factors
MOA

A

mimics natural erythropoieten secreted by the adrenal glands by stimulating RBC production in bone marrow

46
Q

Erythropoietic Growth Factors
Admin

A

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
Q

Erythropoietic Growth Factors
Contraindications

A

Uncontrolled HTN
Cancer w/o chemo or radiation
Hypersensitivity
Iron deficiency anemia (not effective)

48
Q

Leukopoietic Growth Factor
Prototype

A

fligrastim (Neupogen)

49
Q

Leukopoietic Growth Factor
Class

A

Colony-Stimulating Factors

50
Q

Leukopoietic Growth Factor
Indication

A

Increase WBCs - used to prevent infection with bone marrow transplant, myelosuppresive chemo, or chronic neutropenia

51
Q

Leukopoietic Growth Factor
MOA

A

Stimulates bone marrow to increase stem cell production of leukocyte precursors

52
Q

Leukopoietic Growth Factor
Adverse effects

A

Leukocytosis
Bone pain
Fever
Splenomegaly (gets clogged with cells with long-term use)
Hypersensitivity and acute respiratory distress

53
Q

Leukopoietic Growth Factor
Admin

A

Baseline CBC
Monitor CBC 2x per week
IV or subq
Avoid administering within 24 hours of chemotherapy

54
Q

Leukopoietic Growth Factor
Interventions

A

Monitor CBC - report to provider if WBC is over 10,000

Administer acetaminophen for mild bone pain and fever

55
Q

Leukopoietic Growth Factor
Contraindications

A

Sensitivity to E. coli derived proteins
ARDS
Currently undergoing chemo or radiation

56
Q

Thrombopoietic Growth Factor
Prototype

A

oprelvelkin (Interleukin-11 and Neumega)

57
Q

Thrombopoietic Growth Factor
Indication

A

Treats thrombocytopenia from myelosuppresive chemo for non-myeloid cancers (decreases need for platelet transfusions)

58
Q

Thrombopoietic Growth Factor
MOA

A

Stimulates synthesis of megakaryocytes (precursor of platelets) in bone marrow

59
Q

Thrombopoietic Growth Factor
Adverse effects

A

Fluid retention and dilutional anemia
Dysrhythmias secondary to fluid retention
Hypersensitivity
Conjunctival infection is common

60
Q

Thrombopoietic Growth Factor
Admin

A

Baseline CBC, electrolyte panel
Subq QD 4-6 hours after chemo and do not administer more than 21 days

61
Q

Thrombopoietic Growth Factor
Interventions

A

Monitor for dysrhythmias
Monitor fluid intake and output and signs of retention
Monitor for allergic reaction

62
Q

Thrombopoietic Growth Factor
Contraindication

A

Use with caution with HF or pleural effusion
Use with caution with myeloid cancer

Pharmacology ATI (19 decks)

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