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procoagulants Flashcards

1
Q

what are 6 causes of periop bleeding secondary to trauma/surgery? (CA, FP, IP, DC, H, SF)

A

coagulation activation, fibrinolytic pathway, inflammatory pathway, dilutional changes, hypothermia, surgical factors

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2
Q

what are the 2 synthetic lysine analog?

A

tranexamic acid (TXA), epsilon aminocaproic acid (EACA)

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3
Q

what is the one natural lysine analog?

A

aprotinin

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4
Q

what do lysine analogs slow down?

A

fibrinolysis

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5
Q

lysine analogs decrease the need for what and decrease end organ damage d/t what? (BT, H)

A

blood transfusions, hypotension

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6
Q

synthetic lysine analogs competitively inhibit activation of what to what

A

plasminogen to plasmin

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7
Q

what is the function of plasmin?

A

degrade fibrin clots

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8
Q

by inhibiting activation of plasmin, synthetic lysine agents prevent what and there is formation of a more stable what and decreased what? (F, C, B)

A

fibrinolysis, clot, bleeding

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9
Q

what are the 3 uses for synthetic lysine analogs? (C, O, T)

A

cardiac, ortho, trauma

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10
Q

what is an AE of TXA at high doses? (S)

A

seizure

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11
Q

for synthetic lysine analogs, do studies show and increased risk of venous thromboembolic events?

A

no

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12
Q

for synthetic lysine analogs, is safety data known at this time but they are still widely used?

A

yes

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13
Q

what polypeptide enzyme does aprotinin inhibit?

A

protease

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14
Q

by inhibiting protease, what does aprotinin inhibit?

A

plasmin

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15
Q

what is the only FDA approved surgery use of aprotinin?

A

CABG

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16
Q

what are the 2 AEs of aprotinin? (AR, increase risk of what?

A

allergic reaction, death

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17
Q

desmopressin is a synthetic analogue arginine of what hormone? (V)

A

vasopressor

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18
Q

desmopressin allows the release of what factor?

A

von willebrand factor

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19
Q

von willebrand factor is necessary for adequate activity of what factor and for optimal adhesion fo what?

A

factor VIII plt

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20
Q

what are the 3 uses of desmopressin? (mild-moderate what?, what disease, CS)

A

hemophilia A, von willebrand’s disease, cardiac surgery

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21
Q

what is desmopressin mcg/kg dose range and give it over what minute range?

A

0.3-0.5 mcg/kg over 15-30 minutes

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22
Q

what are the 3 AEs of desmopressin? (systemic what d/t dilation where, changes in what ion, increased risk of what?

A

systemic hypotension d/t peripheral dilation, sodium, MI

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23
Q

what is the only agen that can reverse UFH?

A

protamine

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24
Q

can protamine reverse LMWH?

A

no

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25
protamine is found on what fish's sperm?
salmon
26
is protamine a negatively or positively charged acid or alkaline?
positively charged alkaline
27
is heparin a negatively or positively charged acid or alkaline?
negatively charged acid
28
positively charged alkaline protamine combines with the negatively charge acid heparin to yield a stable what that is devoid of anticoagulant activity? (C)
complex
29
dose of protamine is how many mg for how many heparin units in circulation or titration calculated by activated clotting time (ACT)?
1 mg for every 100 units
30
does a protamine overdose reduce or prolong activated clotting time (ACT)?
prolong
31
protamine overdose causes a dysfunction of what?
plt
32
after protamine, a heparin rebound can be seen in what range of hours after first protamine dose?
2-3 hours
33
if a heparin rebound occurs, what range of protamine mg should you give?
5-15 mg
34
what are the 4 AEs of protamine? (A, APV, H, VF)
anaphylaxis, acute pulmonary vasoconstriction, hypotension, ventricular failure
35
what 4 pts are at risk of protamine anaphylaxis? (diabetics on what type of insulin, what prior surgery, MDA, prior exposure to what?
NPH, vasectomy, multiple drug allergies, protamine
36
protamine caused hypotension is d/t the release of what? (H)
histamine
37
what are the 2 factor concentrates that we give?
fibrinogen, factor 8
38
fibrinogen is a substrate for what 3 clotting enzymes? (T, F, P)
thrombin, factor XIIIa, plasmin
39
what is the normal fibrinogen level? (mg/dL)
200-400 mg/dL
40
usually treat a fibrinogen level less than what? (mg/dL)
100 mg/dL
41
for low fibrinogen, can give fibrinogen or give what? (C)
cryoprecipitate
42
1 unit of cryoprecipitate per 10 kg increases fibrinogen by what range of mg/dL?
50-70 mg/dL
43
what are the 3 uses of fibrinogen? (CPB, T, HAMB)
cardiopulmonary bypass, trauma, hemodilution after major bleeding
44
factor VIII is involved in what step of the clot formation? (F)
final step
45
factor VIII does what to clots? (S)
stabilizes them
46
what is the one use of factor VIII?
CPB
47
what 2 factors are recombinant coagulation products?
factor VIIa, factor XIII
48
factor VIIa works with what to produce local what resulting in hemostatic activation? (TF, T)
tissue factors, thrombin
49
what are the 3 labeled uses of factor VIIa? (H, VWD, PWAA)
hemophilia, von Willebrand disease, pts with acquired antibodies
50
what is mcg/kg dose range of factor VIIa?
30-40 mc/kg
51
factor VIIa can normalize what 2 lab values without actually correcting coagulation defect?
PT, INR
52
what are the 4 thromboembolic AEs of factor VIIa? (S, AMI, PE, V/AT)
stroke, acute MI, PE, venous/arterial thrombosis
53
prothrombin complex concentrates contain what 4 coag factors?
II, VII, IX, X
54
prothrombin complex concentrates quickly reverses what lab value?
INR
55
is prothrombin complex concentrates a low or high volume infusion?
low volume
56
do you need a crossmatch for prothrombin complex concentrates?
no
57
prothrombin complex concentrates is a useful reverse of what med?
warfarin
58
prothrombin complex concentrates is used for what disease? (H)
hemophilia
59
prothrombin complex concentrates is a reversal for antagonists of what?
vitamin K
60
topical hemostatic agents are used for intraop hemostasis at the site of what type of injury?
vascular injury
61
what topical hemostatic agents are aka for biologic glue or fibrin tissue adhesives? (FS)
fibrin sealants
62
fibrin sealants combine what 2 things to form a fibrin clot? (T, F)
thombin, fibrinogen
63
what are the 4 fibrin sealants? (F,E,C,T)
floseal, evicel, crosseal, tisseel
64
what topical hemostatic agent oxidizes regenerated cellulose to form topical clots? (S or O)
surgicel or oxycel
65
topical thrombin works well for what pts? (B)
burns
66
what topical hemostatic agent increases contact activation to form topical clots? (GS)
gelatin sponges
67
what are the 3 antifibrinolytic agents? (A, T, E)
aprotinin, TXA, EACA

Anesthesia Pharm (6 decks)

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