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Pharm Exam 2 > Topic 15 > Flashcards

Topic 15 Flashcards

1
Q

Protamine: is ______ and _____

A

positive and alkaline

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2
Q

Heparin binds with Protamine in a 1:1 ratio, so for

every 100 units of heparin in a critter…

A

1 mg of protamine should effect heparin “reversal”

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3
Q

This Heparin:Protamine complex does not effectively interact with

A

AT III, so the coagulation pathway/cascade proceeds unimpeded

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4
Q

Protamine by itself is an anticoagulant: it decreases

A

thrombin generation by inhibiting Factor V activation

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5
Q

Protamine is eliminated rapidly from

A 
the plasma (faster than heparin) 
--so dosing protocols of 1.1:1.0 to 1.3:1.0 protamine:heparin have been developed
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6
Q

Protamine is always given _______ with a very rapid (____ minutes) onset of action

A

parenterally

<5minutes

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7
Q

Protamine has a median half-life of ______, compared to heparin’s median half-life of _____

A

~5 minutes

1-2 hours

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8
Q

The metabolic fate of the protamine:heparin complex has not been completely elucidated. One possibility is that some of the complex is degraded by

A

fibrinolysin which would liberate free heparin

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9
Q

“heparin rebound”.-Essentially, you give your dose of protamine, ACT’s (or whatever you’re using) normalize, and over time it appears that increased bleeding “happens”, often over the course of minutes to ~5 hours. Why?

A
  1. “Free” heparin released from the protamine:heparin complex
  2. Heparin’s variable half-life outlives protamine’s ~2 hour clinical effect?
  3. Heparin from tissue stores?
  4. Too much “reversal” protamine given (and given,
    and given, and given…)
  5. Some data suggests heparin rebound may not really
    occur at all (Prolene deficiency?)
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10
Q

Some studies suggest that smaller initial doses of protamine with well-regulated, well-calculated post-bolus infusions are a

A

more effective way to prevent post-op bleeding

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11
Q

Protamine is also a component of ____ insulin

A

NPH

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12
Q

Protamine- Only partially/unpredictably reverses

A

LMWH

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13
Q

Protamine has no effect on

A

fondaparinux

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14
Q

Protamine: Precautions & Problems

A
  1. Protamine is an anticoagulant

2. Protamine reactions

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15
Q

Contributing Factors to Protamine Reactions

A
  1. Rapid administration

2. Sensitization to Protamine (Redo Surgeries, Fish allergies, Diabetics, Vasectomy, ”Excessive” dosage)

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16
Q

Protamine Reactions Classically manifest themselves as

A

anaphylaxis &/ extreme hypotension,
pulmonary hypotension
cardiovascular collapse

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17
Q

Protamine reactions: Often necessitates “crashing” back on CPB. *Minimized by:

A

Slow administration
Intra-aortic administration
Administration with steroids and antihistamines

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18
Q

Vitamin K is to Warfarin as protamine is to

A

heparin

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19
Q

Vitamin K: A fat soluble vitamin essential for the production of Factors

A

II, VII, IX, & X (2, 7, 9, 10)

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20
Q

2 types of Vitamin K

A

K₁: Phytonadione (Mephyton) [veggies/supplements]

2) K₂: Menaquinone [Meat, poultry, eggs, butter, supplements]

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21
Q

So, you’ve got a patient on a VAD… How, what, and why

does Vitamin K play a huge part in patient management & survivability???

A

vitamin K can prevent warfarin from working

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22
Q

what type of vitamin K is the most “clinically” relevant form for perfusionists

A

K1

23
Q

dose of K₁ is given by injection for warfarin overdosage

A
  1. 0-2.0 mg

- This dose will lower the PT but not completely eliminate the desirable warfarin effects

24
Q

Vitamin K MUST be given

A 
slow IV (anaphylaxis is a common side effect).
•Requires at least six hours to be effective!
25
Q

Typical FFP dose for warfarin overactivity is

A

15ml/kg.

26
Q

Antifibrinolytics: drugs

A 
Aminocaproic Acid (EACA) (Amicar)
Tranexamic Acid (Cyklokapron, Lysteda)
27
Q

both Antifibrinolytics drugs are

A

synthetic derivatives of the amino acid lysine.

28
Q

Aminocaproic Acid

A

(Amicar)

29
Q

Tranexamic Acid

A

(Cyklokapron, Lysteda)

30
Q

Tranexamic is ____ times more potent than Aminocaproic Acid

A

10x

31
Q

Antifibrinolytics: Both drugs prevent plasminogen activation and directly inhibit plasmin which prevents

A

fibrinolysis

32
Q

Antifibrinolytics: Both significantly reduce post-bypass

A

hemorrhage, especially in patients who have received previous fibrinolytic therapy

33
Q

Antifibrinolytics: both are cleared

A

renally

34
Q

Antifibrinolytics: both commonly used in

A

pump primes (typically 10-15 g Amicar for example)

35
Q

Serine Protease Inhibitor: drug names

A

Aprotinin (Trasylol)

Desmopressin (DDAVP)

36
Q

Aprotinin

A

(Trasylol)

37
Q

Aprotinin blocks what

A

plasmin

- dramatically reduces post-op bleeding

38
Q

Desmopressin is a synthetic form of

A

Antidiuretic Hormone (ADH or Vasopressin), a small protein. •Much less pressor activity than Vasopressin

39
Q

Desmopressin causes the release of

A

von Willebrand’s Factor from vascular endothelium which increases Factor VIII and Factor XII activity

40
Q

Desmopressin is useful for

A

mild Hemophilia A and von Willebrand’s Disease

41
Q

Desmopressin: Causes platelets adhesiveness to increase in patients with

A

platelet dysfunction 2° to uremia or hepatic dysfunction

42
Q

***”Evidence-Based Note”: There is NO research that indicates the use of DDAVP for

A

bleeding post-bypass decreases the use of blood products (may be somewhat beneficial when administered in advance.)

43
Q

Blood Products: two types

A

Fresh Frozen Plasma (FFP)

Cryoprecipitate (Cryo)

44
Q

Fresh Frozen Plasma=

A

Plasma is separated from whole blood and stored at < 0 degrees Fahrenheit within eight hours of donation

45
Q

FFP’s use has skyrocketed…often given for

A

bleeding” post-bypass

46
Q

FFP is Preferably given with

A

ABO cross-matching

47
Q

FFP contains

A

Factors I, II, V, VII, IX, X, XI, XIII (1, 2, 5, 7, 9, 10, 11, 13)
AT-III
proteins C & S

48
Q

FFP is used for: (5)

A 
“bleeding”
immediate warfarin reversals
AT-III deficiency 
with large volumes of PRBC administration 
colloidal volume replacement
49
Q

_____ of FFP raises a patient’s AT III levels by ___%

A

20ml/kg

~20%.

50
Q

Cryoprecipitate: Derived from the precipitate that forms after

A

FFP is thawed and centrifuged

51
Q

Cryoprecipitate: Usually given as a “pooled” ( ___ units) product but ABO cross-matching is considered desirable. (A single Cryo unit is virtually never given!)

A

4-6 units

52
Q

Cryoprecipitate is used for ___, ____ and ___ replacement

A

Factor I, VIII, and von Willebrand’s
–BUT, levels of VIII and VWF are “iffy” and cryo is NOT treated in any way whatsoever to decrease the risk of viral exposure!!!

53
Q

Cryo dose

A

1 unit = 15 ml

15 ml ~250-350mg fibrinogen

Pharm Exam 2 (9 decks)

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