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Anesthesia Pharm > procoagulants > Flashcards

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
Q

protamine is found on what fish’s sperm?

A

salmon

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26
Q

is protamine a negatively or positively charged acid or alkaline?

A

positively charged alkaline

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27
Q

is heparin a negatively or positively charged acid or alkaline?

A

negatively charged acid

28
Q

positively charged alkaline protamine combines with the negatively charge acid heparin to yield a stable what that is devoid of anticoagulant activity? (C)

A

complex

29
Q

dose of protamine is how many mg for how many heparin units in circulation or titration calculated by activated clotting time (ACT)?

A

1 mg for every 100 units

30
Q

does a protamine overdose reduce or prolong activated clotting time (ACT)?

A

prolong

31
Q

protamine overdose causes a dysfunction of what?

A

plt

32
Q

after protamine, a heparin rebound can be seen in what range of hours after first protamine dose?

A

2-3 hours

33
Q

if a heparin rebound occurs, what range of protamine mg should you give?

A

5-15 mg

34
Q

what are the 4 AEs of protamine? (A, APV, H, VF)

A

anaphylaxis, acute pulmonary vasoconstriction, hypotension, ventricular failure

35
Q

what 4 pts are at risk of protamine anaphylaxis? (diabetics on what type of insulin, what prior surgery, MDA, prior exposure to what?

A

NPH, vasectomy, multiple drug allergies, protamine

36
Q

protamine caused hypotension is d/t the release of what? (H)

A

histamine

37
Q

what are the 2 factor concentrates that we give?

A

fibrinogen, factor 8

38
Q

fibrinogen is a substrate for what 3 clotting enzymes? (T, F, P)

A

thrombin, factor XIIIa, plasmin

39
Q

what is the normal fibrinogen level? (mg/dL)

A

200-400 mg/dL

40
Q

usually treat a fibrinogen level less than what? (mg/dL)

A

100 mg/dL

41
Q

for low fibrinogen, can give fibrinogen or give what? (C)

A

cryoprecipitate

42
Q

1 unit of cryoprecipitate per 10 kg increases fibrinogen by what range of mg/dL?

A

50-70 mg/dL

43
Q

what are the 3 uses of fibrinogen? (CPB, T, HAMB)

A

cardiopulmonary bypass, trauma, hemodilution after major bleeding

44
Q

factor VIII is involved in what step of the clot formation? (F)

A

final step

45
Q

factor VIII does what to clots? (S)

A

stabilizes them

46
Q

what is the one use of factor VIII?

A

CPB

47
Q

what 2 factors are recombinant coagulation products?

A

factor VIIa, factor XIII

48
Q

factor VIIa works with what to produce local what resulting in hemostatic activation? (TF, T)

A

tissue factors, thrombin

49
Q

what are the 3 labeled uses of factor VIIa? (H, VWD, PWAA)

A

hemophilia, von Willebrand disease, pts with acquired antibodies

50
Q

what is mcg/kg dose range of factor VIIa?

A

30-40 mc/kg

51
Q

factor VIIa can normalize what 2 lab values without actually correcting coagulation defect?

A

PT, INR

52
Q

what are the 4 thromboembolic AEs of factor VIIa? (S, AMI, PE, V/AT)

A

stroke, acute MI, PE, venous/arterial thrombosis

53
Q

prothrombin complex concentrates contain what 4 coag factors?

A

II, VII, IX, X

54
Q

prothrombin complex concentrates quickly reverses what lab value?

A

INR

55
Q

is prothrombin complex concentrates a low or high volume infusion?

A

low volume

56
Q

do you need a crossmatch for prothrombin complex concentrates?

A

no

57
Q

prothrombin complex concentrates is a useful reverse of what med?

A

warfarin

58
Q

prothrombin complex concentrates is used for what disease? (H)

A

hemophilia

59
Q

prothrombin complex concentrates is a reversal for antagonists of what?

A

vitamin K

60
Q

topical hemostatic agents are used for intraop hemostasis at the site of what type of injury?

A

vascular injury

61
Q

what topical hemostatic agents are aka for biologic glue or fibrin tissue adhesives? (FS)

A

fibrin sealants

62
Q

fibrin sealants combine what 2 things to form a fibrin clot? (T, F)

A

thombin, fibrinogen

63
Q

what are the 4 fibrin sealants? (F,E,C,T)

A

floseal, evicel, crosseal, tisseel

64
Q

what topical hemostatic agent oxidizes regenerated cellulose to form topical clots? (S or O)

A

surgicel or oxycel

65
Q

topical thrombin works well for what pts? (B)

A

burns

66
Q

what topical hemostatic agent increases contact activation to form topical clots? (GS)

A

gelatin sponges

67
Q

what are the 3 antifibrinolytic agents? (A, T, E)

A

aprotinin, TXA, EACA

Anesthesia Pharm (6 decks)

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