pharm and transfusion (idk if ill finish this so chill yall)

Question 1

what do you give someone with anemia

Answer 1

packed red blood cells

Question 2

what do you give someone with clotting factor deficiency

Answer 2

fresh frozen plasma (coagulation factors)

Question 3

what do you give someone with a platelet deficiency

Answer 3

platelets

Question 4

what is contained in the “buffy coat” portion of the blood?

Answer 4

platelets and immune cells

Question 5

what is the difference between homologous and autologous transfusions?

Answer 5

homologous transfusions are collecting blood from a compatable donor

autologous transfusions is refusing a patients own blood back into themselves. (used during surgery sometimes)

Question 6

Be sure to go over the blood groups, antigens, antibodies ect cuz im too lazy to type that out

Answer 6

k cool

Question 7

what is the pre transfusion testing that you want to complete before a transfusion

Answer 7

tying
antibody screen
crossmatch

Question 8

what does type and screen test for

Answer 8

determines ABO and Rh phenotype of the RECIPIENTs blood (type)
identifies antibodies directed against other antigens (screen)

Question 9

what does “cross matching” test

Answer 9

takes donor blood and mixes it with recipient blood to assure it is a match.

Question 10

hen is cross and match ordered

Answer 10

only when there is a high likelyhood that the recipient will be recieving packed RBCs (not used in emergencies cuz not enough time.

Question 11

What are the three reasons someone may need a transfusion

Answer 11

1. to replace acute blood loss
2. oxygen delivery
3. morbidity and mortality

Question 12

what indicates the need for a transfusion?

Answer 12

1. Hgb <6 g/dL – Transfusion recommended except in exceptional circumstances
2. Hgb 6 to 7 g/dL – Transfusion generally likely to be indicated
3. Hgb 7 to 8 g/dL – Transfusion should be considered in postoperative surgical patients, including those with stable cardiovascular disease, after evaluating the patient’s clinical status
4. Hgb 8 to 10 g/dL – Transfusion generally not indicated, but should be considered for some populations (eg, those with symptomatic anemia, ongoing bleeding, acute coronary syndrome with ischemia)
5. Hgb >10 g/dL – Transfusion generally not indicated except in exceptional circumstances

Question 13

How do we transfuse?

Optimal transfusion practice should provide……….. but should avoid………

Answer 13

Optimal transfusion practice should provide enough RBCs to maximize clinical outcomes while avoiding unnecessary transfusions

Question 14

How do we transfuse?

how soon after transfusion can Hgb be reassessed

Answer 14

as early as 15 minutes as long as the patient is not actively bleeding

Question 15

How do we transfuse?

what is the ratio of PRBC to increase in Hgb?

Answer 15

i unit of PRBCs shoul increase Hgb by 1g/dL in average sized adults… this is usually given over 1-2 hours.

Question 16

How do we transfuse?

prior to NON EMERGENT blood transfusions what must be completed?

Answer 16

signed informed consent

probs also a cross match

Question 17

What is the main risk of transfusion?

Answer 17

transfusion reactions.

Question 18

When do transfusion reactions typically occur? What are the symptoms? what should be done if one occurs?

Answer 18

within 24 hours of the transfusion. symptoms include: fever, chills, pruritus or urticaria. stop transfusion immediately and report it to the blood bank

Question 19

What are the risks for transfusion

Answer 19

PEACHING HAI (like youre getting high off peaches:) i dont make the rules here im sorry)

Post transfusion Purpura
Electrolyte toxicity such as hyperkalemia
Allergic reactions
Circulatory Overload
Hypothermia
Iron overload
Non hemolytic reactions (febrile)
Graft versus host disease (transfusion acquired)

Hemolytic transfusion reaction
Acute lung injury related to trasnfusion
Infectious complications (viral or sepsis)

Question 20

What are the 5 types of transfusions

Answer 20

Whole blood
packed red blood cells
fresh frozen plasma
cryoprecipitate
platelets

Question 21

in what setting would you use whole blood transfusion. why is it rarely used?

Answer 21

in the setting of a massive hemorrhage, very rarely used.

stored at a temperature where RBCs are maintained but platelets become dysfunctional and clotting factors become degraded.

Question 22

what is the main effect that PRBC transfusion has on a patient and what is the volume of each PRBC unit

Answer 22

increases oxygen carrying capacity of patients with anemia.
each unit is 200ml

Question 23

what are the modifications that can be done to PRBCs

Answer 23

1. leukocyte reduced - used to reduce risk of immunologically mediated effects, infectious disease transmission or reperfusion injury
2. irradiated - used to avoid graft versus host disease in patients who are immune deficient.
3. washed - to prevent or eliminate complications associated with infusion of proteins present in the small amount of residual plasma in red cell concentrates.

Question 24

what is contained in plasma? how is it given?

Answer 24

plasma contains platelets and proteins (procoagulant and anticoagulant factors)

it is given by giving 1 unit of platelets with 1 unit of FFP

Question 25

what is the universal donor and universal recipient for plasma?

Answer 25

universal plasma donor - AB universal recipient - O

Question 26

what is FFP. what does it contain. what is it separated from. and how is it used?

Answer 26

fresh frozen plasma. this contains all the coagulation factors. it does not contain RBCs, WBCs, or platelets after obtained, it is frozen and then thawed when needed.

Question 27

once thawed, why must FFP be used within 24 hours

Answer 27

because the factor V and factor VIII will start to decline.

Question 28

what is cryoprecipitate

Answer 28

collected by thwaing FFP at 4 degrees C and collecting the white precipitate. this is rich in von willebrand factor, factor XIII, factor VIII, and fibrinogen.

Question 29

what is the advantage of cryoprecipitate

Answer 29

it allows von willebrand factor, factor VIII, XIII adn fibrinogen to be replaced using a much smaller volume than if those factors were replaced by transfusing FFP.

Question 30

a factor concentrate contains what? and what is the major indication for this?

Answer 30

Basically highly concentrated clotting factor major indication is to replace specific factor deficiencies such as in hemophilia A and B with minimal volume and without supplying extraneous proteins.

Question 31

what are platelets used to manage when are platelets indicated?

Answer 31

thrombocytopenia or platelet dysfunction when platelet count = <10,000 when platelet count = <50,000 and pt is actively bleeding when latelet count is = <100,000 and have central nervous system injury or are undergoing neurosurgery

Question 32

each unit of transfused platelets should increase the platelet count by

Answer 32

5,000-10,000

Question 33

what are the 4 hemostasis promoting agents

Answer 33

1. protamine sulfate 2. Vitamin K 3. desmopressin 4. thrombin Things that PROMOTE CLOTTING

Question 34

Protamine Sulfate Indications dosage (determined by what) black box warning

Answer 34

Indications: Neutralizes Heparin (Heparin Reversal Agent) Dosage is determined by the dosage of heparin May result in severe hypotensive or anaphylactoid-like reactions (black-box warning)

Question 35

Vitamin K Indications Dosage and route is dependent on what metabolism and excretion

Answer 35

Mephyton Indications: Reversal Agent for warfarin (Coumadin) Dosage/Administration/MOA: PO, IM, IV, or SubQ Dosage and route varies depending on severity of bleeding, INR level, procedure planned, etc. Metabolism: Rapidly hepatic Excretion: Urine and feces

Question 36

Desmopressin (vasopressin) MOA Route caution

Answer 36

MOA: Increases plasma levels of von Willebrand factor, factor VIII, and t-PA contributing to a shortened aPTT and bleeding time Route: Administered IV or Intranasal may rarely lead to hyponatremia and extreme decreases in plasma osmolality, resulting in seizures, coma, and death Restrict fluid intake Monitor sodium levels

Question 37

Topical Thrombin MOA Uses Contraindications

Answer 37

MOA: converts fibrinogen to fibrin directly at the site of bleeding. Uses: In various types of surgery to aid in hemostasis whenever oozing blood and minor bleeding from capillaries and small venules is accessible. Contraindications: patients with a known sensitivity to components of bovine origin, not for use in massive bleeding. Must not be injected or allowed to enter large vessels.

Question 38

What are the antithrombotic drugs

Answer 38

antiplatelet drugs anticoagulants fibrinolytic agents

Question 39

anticoagulants General indication General Contraindications

Answer 39

General indication for all is to prevent or treat CLOT/THROMBUS Most commonly for venous thrombosis General contraindications for all: Bleeding – current or past (not an absolute contraindication) Most are cleared by kidneys so renal function is important to assess (Not Unfrac Heparin) Allergic reaction to the drug

Question 40

To check kidney functions what do you order

Answer 40

BMP, GFR, CrCl

Question 41

what are the parenteral anticoagulants

Answer 41

Unfractionated) Heparin Low-molecular-weight heparin (LMWH) (Enoxaparin/Lovenox) Bivalirudin (Angiomax) Argatroban (Acova)

Question 42

Unfractionated heparin MOA route metabolism CI Monitoring adverse effects

Answer 42

USED INPATIENT ONLY MOA: combines to anithrombin III and enhances its activation of factor Xa and thrombin route: must be parenteral (SC or IV) Metabolism: hepatic CI - pregnancy category C (does not cross placenta), Heparin induced thrombocytopenia, active bleeding, hemophilia monitor: daily pTT Adverse effect: bleeding, thrombocytopenia, osteoporosis, elevated LFTs

Question 43

what is HIT

Answer 43

Heparin induced thrombocytopenia heparin combines with PF4 to make your IgG attatch to platelets. this causes the platelet to activate and cause clotting it also causes the spleen to destroy the platelets (thrombocytopenia)

Question 44

what are the four areas to assess when you are concerned about HIT

Answer 44

Thrombocytopenia (how much did platelet count drop) Timing of platalet count drop (how fast) thrombosis or other squeal (skin necrosis) Other causes of thrombocytopenia

Question 45

what is the management for HIT

Answer 45

stop heparin begin anticoagulation with a non heparin coagulent long term oral anticoagulation will need to be given (warfarin) for 2-3 months if no thrombotic event or 3-6 months if thrombotic event occurred list heparin allergy in chart

Question 46

Low molecular weight heparin dosing depends on metabolism adverse effects CI

Answer 46

dosing amount depends on indication but its always SC metabolized by kidney, contraindicated in ESRD adverse effects include bleeding, HIT, osteoporosis (all lest common with LMWH than with heparin) CI - HIT, active bleeding preg cat B (reccomended over heparin)

Question 47

in what circumstances before and after elective surgery or invasive procedures would "bridging" want to be done? what drug is often used as a bridging drug?

Answer 47

Lovenox is often used. in the circumstances of: emoblic stroke w/i the past 3 months previous embolic stroke or VTE during interuption of chronic anticoagulation mechanical heart valve atrial fibrillation in pt with high stroke risk

Question 48

argatroban (acova) MOA metabolism indications SE CI

Answer 48

MOA: direct thrombin inhibitor Metabolism: hepatic (measure PTT to adjust dose) indications: HIT percutaneous coronary intervention SE: bleeding CI - none really, but preg category B

Question 49

Bivalirudin MOA Metabolism Indications SE

Answer 49

MOA: non-heparin thrombin inhibitor Metabolism: renally cleared Indications: Alternative to heparin in patient undergoing percutaneous coronary intervention especially if they have hx of HIT SE: bleeding (duh)

Question 50

what are the oral forms of anticoagulants

Answer 50

warfarin DOACs

Question 51

warfarin (coumadin) Class MOA monitor CI Indications adverse reactions

Answer 51

class:vitamin K antagonists MOA: inhibits activation of vitamin K Monitor: PT/INR CI: in pregnant women! class D or X indications: prophylactic treatment of thromboembolic disorders (DVT/PE) adverse reactions: bleeding, rarely tissue necrosis or gangrene

Question 52

what are the drug and dietary interactions for coumadin (warfarin)

Answer 52

drug - literally so many, just know theres alot food - alcohol, vitamin E (increases effect), cranberry juice (increases), foods rich in vitamin K (decreases)

Question 53

what drugs are included in DOACs why are these used?

Answer 53

pradaxa, xarelto, eliquis, savaysa they are safer than warfarin and given in a fixed dose. therefore you dont have to monitor their levels! (PT/INR)

Question 54

Pradaxa MOA Indications metabolism major averse event Drug interactions

Answer 54

MOA: direct thrombin inhibitor indications: stroke prevention, Afib, DVT/PE, prophylaxis metabolism: renally, therefore decrease dose in renal impairment. CI in ESRD or HD major adverse event is GI bleeding: reversal agent is Praxbind (only used in emergent situations) Drug interactions: Ketoconazole, cyclosporine, tacrolimus

Question 55

Xarelto MOA monitor CI

Answer 55

MOA oral factor Xa inhibitor indications:stroke prevention, Afib, DVT/PE, prophylaxis monitor for kidney and liver disease, avoid taking grapefruit juice w it, no CYP3a4 inhibitors (CCB, flourquinolones)

Question 56

eliquis MOA monitor CI

Answer 56

oral factor Xa inhibitor superior to warfarin in inhibiting clots. indications: stroke prevention, Afib, DVT/PE, prophylaxis no grapefruit juice, watch for hepatic or renal impairement

Question 57

Savaysa MOA monitor CI

Answer 57

MOA: oral factor Xa inhibitor indications: stroke prevention, Afib, DVT/PE, prophylaxis avoid in patients with renal impairment, hepatic impairment or in patients who have great kidneys and clear things renally very quickly CI if pathologically bleeding

Question 58

just as a review, how do you monitor heparin. what is the reversal agent?

Answer 58

with aPTT for dosing adjusments with a CBC daily to monitor for signs of bleeidng does NOT require dose reduction in renal impairment reveral = protamine

Question 59

just as a review, how do you monitor warfarin. what is the reversal agent?

Answer 59

monitor with PT/INR for dosage adjustments does not require reduced dose in renal impairment reversal = vitamin K

Question 60

just as a review, how do you monitor DOACs.

Answer 60

no monitoring required keep an eye on kidney function esp if hx of kidney disease. may require reduced dose

Question 61

what are the platelet aggregation inhibitors that we learn about

Answer 61

Aspirin plavix Effient Ticlid Brilinta Kengreal

Question 62

aspirin MOA uses adverse events

Answer 62

MOA : inhibits COX 1 production which is critical for forming thromboxane irreversabley!! uses: prophylaxis of MI, secondary prevention in vascular events adverse events: bleeding, dyspepsia

Question 63

plavix MOA uses avoid with what

Answer 63

MOA: irreversibly blocks ADP receptor uses: primary prophylaxis of MI, standard precention in patients with hx of vascular events avoid drugs: omeprazole, esomeprazole (pralosec)

Question 64

Effient MOA CI

Answer 64

irreversibly blocks P2Y12 CI with hx of stroke or TIA

Question 65

Ticlid MOA SE

Answer 65

MOA: irreversibly blocks P2Y12 SE: not used as much because it has alot of blood side effects such as neutropenia, agranulocytosis, thrombotic thrombocytopenia purpura, and aplastic anemia THEREFORE must do routine monitoring with a CBC every 2 weeks

Question 66

Brilinta MOA SE

Answer 66

MOA: reversibly binds to P2Y12 BBW: aspirin reduces effects if aspirin is taken above 100mg daily.

Question 67

Kenreal MOA route

Answer 67

MOA reversably binds to P2Y12 only reversable one available in IV

Question 68

Integrilin and Reopro routes

Answer 68

MOA: Gp IIB/IIA receptor inhibitor IV only Given in cath lab

Question 69

fibrinolytics

Answer 69

used to break down thrombi in the setting of a life threatening or massive thrombus. can be given IV or catheter to the actual clot itself. MOA: converts plasminogen to plasmin which then degrades the fibrin matrix of thrombi and produces soluble fibrin degredation products.

Question 70

Tpa

Answer 70

given IV for PE, acute ST elevation, heart attack, DVT approved fro ischemic stroke but must be given within 3 hours. MOA: preferentially activates plasminogen that is bound to fibrin which in theory confines fibrinolysis to the formed thrombus.

Question 71

streptokinase

Answer 71

converts plasminogen into plasma given IV for PE ,stemi or severe DVT.