Pharmacology/Transfusion Flashcards
_______ is a possible complication of any anticoagulation
bleeding
long term use of heparin is associated with what side effect?
reduced bone mineral density
What is the reversal agent for UFH or LMWH?
protamine sulfate
complete reversal for UFH only partial reversal for LMWH
What is the goal PTT for UFH?
1.5-2.5x the normal range
What lab test can you measure for LMWH?
anti-Xa level
Which of the following statements about fondaparinux is NOT true.
a. it is a reliable once-daily SQ injection
b. it is metabolized by the kidneys
c. there is no risk of HIT
d. the reversal agent is protamine sulfate
d. the reversal agent is protamine sulfate
* NO FDA-approved reversal agent*
Which of the following statements about Lovenox is NOT true.
a. dosage is weight-based
b. it has a longer half-life than UFH
c. it has an increased risk of HIT compared to UFH
d. it can be incompletely reversed with protamine sulfate
c. it has an increased risk of HIT compared to UFH
* DECREASED RISK*
Coumadin inhibits what Factors and Proteins?
II, VII, IX, X, PC, PS
2,7,9,10
What is the goal INR with Coumadin?
2.0-3.0
How often is monitoring required with Coumadin?
weekly!
How is coumadin metabolized?
liver
How is Coumadin reversed?
FFP for immediate treatment + Vitamin K for long term
What are the 3 approved DOACs?
- dabigatran
- rivaroxaban (Xarelto)
- apixaban (Eliquis)
What is the reversal agent for factor Xa inhibitors?
andexanet alpha
What is the reversal agent for dabigatran?
Praxbind OR dialysis
What are the 2 common indications for IV direct thrombin inhibitors?
- patients with HIT
- patients with MI
What are the 2 IV direct thrombin inhibitors?
- Argatroban
- Bivalirudin
Bivalirudin is cleared by the _______, while argatroban is cleared by the _______.
- bivalirudin = renal
- argatroban = hepatic
What is the best lab test for HIT?
anti-platelet factor 4/heparin antibody test
What agents can be used as an antidote for tPA?
Antifibrinolytic agents
What are the 2 antifibrinolytic agents?
- E-aminocaproic cid (EACA)
- Tranexamic acid (TXA)
A patient undergoes a blood transfusion. He later develops hypotension, fever, chills and renal failure. What is the diagnosis?
acute hemolytic transfusion reaction
What is the most common transfusion reaction?
febrile non-hemolytic transfusion reaction
A patient undergoes a blood transfusion with FFP. He develops hypoxemia, respiratory failure, fever, and bilateral pulmonary infiltrates. What is the diagnosis?
Transfusion-related acute lung injury (TRALI)
A patient undergoes a blood transfusion and develops heart failure. What is the diagnosis?
Transfusion-associated circulatory overload (TACO)
In this test, patient’s serum is added to reference RBCs to identify antibodies directed against minor blood group antigens in the patient’s serum
Type and screen
In this test, patient’s serum is added to a sample of the donor RBCs, checked for agglutination of RBCs
type and cross
Each unit of PRBCs increases Hgb by ____ g/dL and Hct by ____%, on average
Hgb = 1 g/dL Hct = 3%
In emergency situation, like a trauma, what type of blood do you give?
O negative
One dose/unit of platelet is expected to bring Plt count up by about _____.
25-30 thousand
Patients with ______________ are not expected to respond to platelet transfusion.
immune thrombocytopenia (ITP)
When we want to replenish fibrinogen what do we give?
cryoprecipitate
What is the treatment for ITP?
steroids
