Protamine Flashcards
- What is the recommended dose of Protamine for reversing heparin?
Select 2.
A) 1 mg for every 100 units of circulating heparin activity
B) 1 mg for every 200 units of circulating heparin activity
C) 1:1 dose with heparin
D) 10 mg for every 100 units of circulating heparin activity
A) 1 mg for every 100 units of circulating heparin activity
C) 1:1 dose with heparin
Which of the following is a key safety practice when administering Protamine?
Select 2
A) Call out when half the dose is in and when all of the dose is in
B) Administer the entire dose quickly without calling out milestones
C) Ensure communication throughout the administration process
D) Administer Protamine without any preparation to save tim
A) Call out when half the dose is in and when all of the dose is in
C) Ensure communication throughout the administration process
How should Protamine be prepared for administration?
A) Dilute in a 50 mL bag for infusion
B) It can be administered undiluted as an IV bolus
C) Can be given with calcium chloride (CaCl) or pressors, if necessary
D) Mix Protamine with a 100 mL saline solution
A) Dilute in a 50 mL bag for infusion
Dilute in a 50 ml bag, +/- CaCl concomitantly, or pressors
What is the mechanism of action (MOA) of Protamine in reversing heparin?
Select all that apply.
A) Protamine is a polycation that binds to heparin
B) Protamine inactivates the acid-base interface of the heparin molecule
C) Protamine enhances heparin’s anticoagulant effect
D) Protamine acts as an anticoagulant by inhibiting thrombin
A) Protamine is a polycation that binds to heparin
B) Protamine inactivates the acid-base interface of the heparin molecule
MOA: Polycation that binds to heparin therefore reversing. Reverses unfractionated heparin by inactivating the acid-base interface of the heparin molecule.
Why should Protamine be administered slowly?
Select all that apply.
A) To reduce the likelihood of systemic vasodilation
B) To decrease the risk of pulmonary vasoconstriction
C) To increase the effectiveness of heparin reversal
D) To minimize histamine release
A) To reduce the likelihood of systemic vasodilation
B) To decrease the risk of pulmonary vasoconstriction
Which of the following are possible consequences of histamine release due to Protamine administration?
Select 2
A) Decreased systemic vascular resistance (SVR)
B) Increased systemic vascular resistance (SVR)
C) Increased pulmonary vascular resistance (PVR)
D) Decreased pulmonary vascular resistance (PVR)
A) Decreased systemic vascular resistance (SVR)
C) Increased pulmonary vascular resistance (PVR)
ADMINISTER SLOW
!! – This reduces the likelihood of systemic vasodilation and pulmonary vasoconstriction
It can cause histamine release and will ↓SVR and ↑PVR
Why should excess Protamine be avoided when reversing heparin?
Select 2
A) It can contribute to coagulopathy
B) It shortens the activated clotting time (ACT)
C) It prolongs the activated clotting time (ACT)
D) It enhances platelet function
A) It can contribute to coagulopathy
C) It prolongs the activated clotting time (ACT)
Excess protamine should be avoided when reversing heparin as it can contribute to coagulopathy (prolongs the ACT & contributes to platelet dysfunction)
**For OFF PUMP KHALAFI will ask for half dose
Which of the following conditions or histories increases the risk of a Protamine reaction?
Select all that apply.
A) NPH insulin use
B) Fish allergies
C) Vasectomies
D) Previous exposure to Protamine
A) NPH insulin use
B) Fish allergies
C) Vasectomies
D) Previous exposure to Protamine
In on-pump cases, how should the total amount of heparin be adjusted?
A) Add 10,000 units of heparin for the amount given via the pump
B) Do not adjust the heparin dose for on-pump cases
C) Add 5,000 units of heparin for every 10,000 units given via the pump
D) Add 10,000 units of heparin to the total dose to account for pump administration
A) Add 10,000 units of heparin for the amount given via the pump
+/- add 10,000 units total heparin for on pump cases for the amount given via the pump
