Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Perf Tech II (exam 1) > Topic 3 - Heparin Neutralization > Flashcards

Topic 3 - Heparin Neutralization Flashcards

1
Q

Protamine derived from?

A

salmon sperm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Protamine - is a?

A
  • polycationic polypeptide protein (67%arginine)

- strongly alkaline with numerous positive charges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Protamine binds with Heparin to form?

A

a stable salt precipitate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Heparin-Protamine Clearance current theory

A

its cleared by the reticuloendothelial system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

RES (reticuloendothelial cystem)

A

responsible for clearing stuff
consists of monocytes, macrophages(macrophage are circulating monocytes), tissue histiocytes and Kupffer cells(located in liver, spleen and lymph nodes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

RES is now referred to as?

A

MPS - mononuclear phagocyte system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Protamine as insulin? (2 kinds)

A
  • Neutral Protamine Hagedorn insulin(NPH)
    T1/2 like 24hours
  • Protamine-Zinc insulin (PZI)
    T1/2 about 36 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Viable alternative to Protamine?

A

THERE IS NO Viable Alt to Protamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

anticoagulation effect of protamine ?

A

becomes clinically significant at doses 3X amount needed for heparin neutralization
- effect clinically significant only when large amounts given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Anticoagulation effect of protamine seen at what doses?

A

at excess protamine doses of 6-15mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anticoagulation effect of protamine caused by?

A

inhibition of platelet induced aggregation by the heparin-protamine complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Protamine dose most patients should tolerate

A

1-2mg/kg w/out adverse effects effects on hemostasis

our normal values calculation is 1-1.3mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lower doses of protamine tend cause? (3)

A
  • cause less chest tube drainage
  • provides for higher platelet counts
  • more normalized clotting times
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Methods of Calculating Protamine dose (4)

A
  • Fixed dose
  • ACT/heparin dose response curve
  • heparin concentration
  • protamine titration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Fixed dose method for calculating Protamine

A

give fixed dose of protmine for each unit of heparin that was given
- norm 1-1.3mg per 100units of heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Heparin ACT Dose Response Curve method for calculating Protamine

A

Plot pre and post heparin ACT, plot curve and determine slope. Measure ACT after termination
Calculates total heparin load
dose usually 1.3mgs per 100units of total heparin load

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Heparin Concentration method for calculating Protamine done where?

A

must be done in the laboratory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Heparin Concentration method for calculating Protamine advantages

A

consistently results in lower protamine dose versus ACT response curve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Heparin Concentration method for calculating Protamine disadvantages

A

takes time so not always good correlation of actual concentrations and clotting times
have to estimates pt plasma volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Protamine Titration method for calculating Protamine

A
  • Tubes of various dilutions of a protamine solution, fixed volume of hepranized whole blood added to each tube
  • tube with lowest concent/shortest clotting time is best representation
  • Actual protamine dose calculated bases on assumed neutralization ratio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Protamine Titration method for calculating Protamine advantages

A
  • usually give less protamine than fixed dose
  • less post op bleeding
  • less exposure to blood products
  • absence of heparin rebound
22
Q

Protamine Titration method for calculating Protamine disadvantages

A
  • estimation of patient’s blood volume

- variability of heparin and protamine preparations

23
Q

How does the Heparin-Protamine complex activated the complement cascade?

A

via the classical pathway

24
Q

Adverse Protamine Reaction - reaction classification 1, Type 1

A
  • Mild hypotension due to histamine release(rapid infusion)
  • Can be ameliorated by giving protamine intra-arterial(intra-aortic) (bc it then goes straight to the lungs, most mast cells tend to live in the respiratory tract, so its a way to prevent reaction
25
Q

Histamine does what? (5)

A
  • increase sensitivity to pain and itching
  • dilation of arterioles and precapillary sphincters
  • increased HR (both direct and reflex effect)
  • most bronchoconstriction
  • increase GI motility
26
Q

Cromolyn sodium is?

A

a mast cell membrane stabilizer and helps prevent mast cell degranulation before its occurrence

27
Q

Adverse Protamine Reaction - reaction classification 1, Type IIa

A

True anaphylaxis; IgE mediated. Anamnestic response(means memory of the immune system)

28
Q

Adverse Protamine Reaction - reaction classification 1, Type IIa – systemic effects?

A

Decrease SVR, PA, LA, & RA pressures +/- bronchospasm

29
Q

Adverse Protamine Reaction - reaction classification 1, Type IIb

A

Immediate anaphylactoid; No IgE involvement

Mediated by thromboxane

30
Q

Adverse Protamine Reaction - reaction classification 1, Type IIb - systemic effects

A

leads to pulmonary vasoconstriction and bronchoconstriction

31
Q

Adverse Protamine Reaction - reaction classification 1, Type IIc

A
  • delayed Anaphylactoid
  • increased post-op pulmonary edema
  • also related to complement activation with histamine/thromboxane/ect release
32
Q

Adverse Protamine Reaction - reaction classification 1, Type III occurs in what % of population

A

BAD ONES
Occurs in .6% of adult cardiac surgical patients
No long term negative sequelae

33
Q

Adverse Protamine Reaction - reaction classification 1, Type III effects

A
  • Catastrophic pulmonary vasoconstriction (IgG/complement-mediated) seems to be thromboxane-mediated
  • Noncardiogenic pulmonary edema
34
Q

Adverse Protamine Reaction - reaction classification II, Type A

A

Pharmacologic histamine release

35
Q

Adverse Protamine Reaction - reaction classification II, Type B

A

True anaphylaxis (IgE mediated)

36
Q

Adverse Protamine Reaction - reaction classification II, Type C

A
  • Anaphylactoid thromboxane release
  • Pulmonary vasoconstriction
  • Bronchoconstriction
37
Q

Fish allergy what % of population?

A

up to 27% of general population

  • risk factor to having an adverse reaction to Protamine
38
Q

Antibody development can occur from prior exposure in…? (4)

(aka Risk factors to having an adverse reaction to Protamine)

A
  • re-op patients
  • dialysis patients
  • Neutral protamine Hagedorn(NPH) Insulin preparation
  • Heparin/Protamine in Cath lab
39
Q

What is the Increase in True allergic response..

when patient has had prior reaction to protamine?

A

Increase 189x

40
Q

What is the Increase in True allergic response..

when patient has fish allergy ?

A

increase 24.5X

41
Q

What is the Increase in True allergic response..

when the patient has exposure to NPH insulin?

A

Increase 8.2X

42
Q

What is the Increase in True allergic response..

when patient has allergy to any drug?

A

Increase 3X

43
Q

What is the Increase in True allergic response..

when patient has prior exposure to protamine?

A

No increase

44
Q

Neutral Protamine Hagedorn insulin

A

Protamine added to regular insulin

45
Q

Suggested Rate of Protamine administration

A

no faster than 5mg/min (although 15mg/min might be more common)

46
Q

Alternatives to Protamine? (7)

A
  • allow heparin to be metabolized
  • Platelet concentrates
  • Hexadimethrine
  • Intra-aortic protamine injections
  • Heparinase I
  • Lactoferrin
  • Heparin-Removal devices
47
Q

Platelet concentrations (that you give)

A

alternative to protamine (don’t work that well)

  • PF4 released from actived platelets combines with and neutralizes protamine
  • Does not restore coagulation following bypass
  • Recombinant form failed clinical trials
48
Q

Hexadimethrine

A

alt to protamine

  • Synthetic polycation
  • has probs with renal toxicity
  • can produce pulmonary vasoconstriction if given to quickly
  • use to avoid true allergic reactions
49
Q

Lactoferrin

A

alternative to protamine

Demonstrated modest neutralizing capacity

50
Q

Protamine resistance

Classification 1, typeII, a, b, and c

A

a - True anaphylaxis; IgE mediated. Anamnestic. Decrease SVR, PA, LA, & RA pressures +/- bronchospasm ~50% of IDDM patients taking NPH insulin have antiprotamine IgE
b - Intermediate anaphylactoid, No IgE involvement
c - Delayed Anaphylactoid; Increased post-op pulmonary edema

51
Q

Protamine adverse reaction, classification II, type A, B, C

A

A - Pharmacologic histamine release
B - True anaphylaxis (IgE mediated)
C - Anaphylactoid thromboxane release; Pulmonary vasoconstriction; Bronchoconstriction

Perf Tech II (exam 1) (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions