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Clinical medicine A > pharm and transfusion (idk if ill finish this so chill yall) > Flashcards

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

1
Q

what do you give someone with anemia

A

packed red blood cells

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2
Q

what do you give someone with clotting factor deficiency

A

fresh frozen plasma (coagulation factors)

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3
Q

what do you give someone with a platelet deficiency

A

platelets

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4
Q

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

A

platelets and immune cells

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5
Q

what is the difference between homologous and autologous transfusions?

A

homologous transfusions are collecting blood from a compatable donor

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

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6
Q

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

A

k cool

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7
Q

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

A

tying
antibody screen
crossmatch

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8
Q

what does type and screen test for

A

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

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9
Q

what does “cross matching” test

A

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

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10
Q

hen is cross and match ordered

A

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

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11
Q

What are the three reasons someone may need a transfusion

A
  1. to replace acute blood loss
  2. oxygen delivery
  3. morbidity and mortality
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12
Q

what indicates the need for a transfusion?

A
  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
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13
Q

How do we transfuse?

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

A

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

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14
Q

How do we transfuse?

how soon after transfusion can Hgb be reassessed

A

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

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15
Q

How do we transfuse?

what is the ratio of PRBC to increase in Hgb?

A

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

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16
Q

How do we transfuse?

prior to NON EMERGENT blood transfusions what must be completed?

A

signed informed consent

probs also a cross match

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17
Q

What is the main risk of transfusion?

A

transfusion reactions.

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18
Q

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

A

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

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19
Q

What are the risks for transfusion

A

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)

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20
Q

What are the 5 types of transfusions

A

Whole blood
packed red blood cells
fresh frozen plasma
cryoprecipitate
platelets

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21
Q

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

A

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.

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22
Q

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

A

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

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23
Q

what are the modifications that can be done to PRBCs

A
  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.
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24
Q

what is contained in plasma? how is it given?

A

plasma contains platelets and proteins (procoagulant and anticoagulant factors)

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

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25
Q

what is the universal donor and universal recipient for plasma?

A

universal plasma donor - AB
universal recipient - O

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26
Q

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

A

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.

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27
Q

once thawed, why must FFP be used within 24 hours

A

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

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28
Q

what is cryoprecipitate

A

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.

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29
Q

what is the advantage of cryoprecipitate

A

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.

30
Q

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

A

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.

31
Q

what are platelets used to manage

when are platelets indicated?

A

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

32
Q

each unit of transfused platelets should increase the platelet count by

A

5,000-10,000

33
Q

what are the 4 hemostasis promoting agents

A
  1. protamine sulfate
  2. Vitamin K
  3. desmopressin
  4. thrombin

Things that PROMOTE CLOTTING

34
Q

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

A

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)

35
Q

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

A

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

36
Q

Desmopressin (vasopressin)
MOA
Route
caution

A

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

37
Q

Topical Thrombin
MOA
Uses
Contraindications

A

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.

38
Q

What are the antithrombotic drugs

A

antiplatelet drugs
anticoagulants
fibrinolytic agents

39
Q

anticoagulants
General indication
General Contraindications

A

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

40
Q

To check kidney functions what do you order

A

BMP, GFR, CrCl

41
Q

what are the parenteral anticoagulants

A

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

42
Q

Unfractionated heparin
MOA
route
metabolism
CI
Monitoring
adverse effects

A

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

43
Q

what is HIT

A

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)

44
Q

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

A

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

45
Q

what is the management for HIT

A

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

46
Q

Low molecular weight heparin
dosing depends on
metabolism
adverse effects
CI

A

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)

47
Q

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?

A

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

48
Q

argatroban (acova)
MOA
metabolism
indications
SE
CI

A

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

49
Q

Bivalirudin
MOA
Metabolism
Indications
SE

A

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)

50
Q

what are the oral forms of anticoagulants

A

warfarin
DOACs

51
Q

warfarin (coumadin)
Class
MOA
monitor
CI
Indications
adverse reactions

A

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

52
Q

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

A

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

53
Q

what drugs are included in DOACs

why are these used?

A

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)

54
Q

Pradaxa
MOA
Indications
metabolism
major averse event
Drug interactions

A

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

55
Q

Xarelto
MOA
monitor
CI

A

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)

56
Q

eliquis
MOA
monitor
CI

A

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

57
Q

Savaysa
MOA
monitor
CI

A

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

58
Q

just as a review, how do you monitor heparin.

what is the reversal agent?

A

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

59
Q

just as a review, how do you monitor warfarin.

what is the reversal agent?

A

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

reversal = vitamin K

60
Q

just as a review, how do you monitor DOACs.

A

no monitoring required

keep an eye on kidney function esp if hx of kidney disease. may require reduced dose

61
Q

what are the platelet aggregation inhibitors that we learn about

A

Aspirin
plavix
Effient
Ticlid
Brilinta
Kengreal

62
Q

aspirin
MOA
uses
adverse events

A

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

63
Q

plavix
MOA
uses
avoid with what

A

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

64
Q

Effient
MOA
CI

A

irreversibly blocks P2Y12
CI with hx of stroke or TIA

65
Q

Ticlid
MOA
SE

A

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

66
Q

Brilinta
MOA
SE

A

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

67
Q

Kenreal
MOA
route

A

MOA reversably binds to P2Y12
only reversable one available in IV

68
Q

Integrilin and Reopro
routes

A

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

69
Q

fibrinolytics

A

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.

70
Q

Tpa

A

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.

71
Q

streptokinase

A

converts plasminogen into plasma

given IV for PE ,stemi or severe DVT.

Clinical medicine A (32 decks)

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