Brainscape's Knowledge GenomeTM

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


See full index

N365: Pharmacology in Nursing > Week 12: Hematologic > Flashcards

Week 12: Hematologic Flashcards

1
Q

Prototype Hematologic (Anti-anemia and Anticoagulation) Drugs

A
  1. Ferrous sulfate (Feosol)
  2. Vitamin B12 (Cyanocobalamin)
  3. Folic Acid (Folvite)
  4. Erythropoietin (Epogen)
  5. Heparin
  6. Enoxaparin (Lovenox)
  7. Protamine Sulfate
  8. Warfarin (Coumadin)
  9. Vitamin K (AquaMephyton)
  10. TPA (Alteplase)
  11. Aminocaproic Acid (Amicar)
  12. Transexamic Acid (Lysteda)
  13. Filgrastim (Neupogen)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What varies between iron supplements

A

the amount of elemental iron found in the salt

ex: Ferrous sulfate has more iron than Ferrous gluconate

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

Anemia

A

A SYMPTOM of an underlying problem

Not a diagnosis by itself usually

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

The most common anemia …

A

iron deficiency anemia

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

Prototype Iron Replacement Drug

A

ferrous sulfate (Feosol)

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

Ferrous Sulfate (Feosol)

A

Class: Iron Replacement

Most common med for increasing Fe stores in people

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

Action of Ferrous Sulfate

A

Replace iron in the body whihc is then used in normal fxning- ESP. in aiding O2 carrying capacity of RBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What route is Ferrous Sulfate usually given

A

Oral

However it can be given parenterally for those who cannot absorb it thorugh the GI tract

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

What is interesting about the absorption of ferrous sulfate/iron

A

If body stores of iron are high already less iron absorption will occur. but when the stores are too low it will absorb more easily

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

___% of ferrous sulfate is absorbed when body stores are low while ___% is absorbed if the stores are high

A

15%; 2-3%

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

What are some things that may increase iron absorption

A

Vitamin C!!!

Orange Juice (Uncertain)

Low Body Stores of Iron

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

What is interesting about the Metabolism of Ferrous sulfate/iron

A

Iron is used in the body and is broken down and usually reutilized or stored

VERY LITTLE IS EXCRETED DAY TO DAY d/t ITS IMPORTANCE

Most health people do not lose a lot and do not need much more daily

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

4 People at risk for Iron Loss/Iron Deficiency Anemia

A
  1. Menstruating Women
  2. Periods when the body is growing - Puberty and INfancy
  3. GI BLeeding
  4. Pregnant women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If a patient is found to be anemic one of the first thing that is checked is…

A

whether there is small or large bleeding occurring in the GI tract and if its iron deficiency anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ADRs of Ferrous Sulfate

A
  1. Constipation AND Diarrhea
  2. GI Effects (when taken orally)

Other: HA, Anorexia, Gastric Pain, NV

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

What is important to know about ferous sulfate therapy following dips in body iron stores

A

If there is small dips in iron stores there should be improvement within 2-3 weeks

However if there is severe iron loss and anemia (Empty ferratin stores) it could take almost a year to get iron levels back to normal

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

How often is the dosage of ferrous sulfate usually taken

A

1 time a day at 325 mg (sometimes 2 but it increases ADRs)

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

What is important about the stool of someone on ferrous sulfate

A

Stools will be black (or green) in color and can appear as though is it blood/old blood

It is not, that is staining that occurs

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

What is an important consideration about solution/liquid iron

A

Give it through a straw since it can cause staining

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

Always keep tablet ferrous sulfate…

A

AWAY FROM CHILDREN - high doses can be lethal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Never take ___ with iron. Why?

A

Antacids; They will bind oto the iron and carry it out of the body without any of the iron being absorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does the elemental iron content differ between preparations of: Ferrous Sulfate, Ferrous Gluconate, and Dried Ferrous Sulfate

A

Ferrous Sulfate - 20% elemental iron (ex: 100 mg pill is 20 mg iron)

Ferrous Gluconate - 12%

Dried Ferrous Sulfate - 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is the best time to take your iron supplement

A

on an empty stomach

*however this can cause NV so someitmes for the first week you take with food then take without after that

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Some people cannot take oral iron due to malabsorption syndromes or issues from age, so they may need it IV or IM. What 2 important things need to be kept in mind regarding this route?

A
  1. Proper Z Track is needed to prevent skin staining
  2. High risk/rate of anaphylaxis when given IV so they must be monitored
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

deferoxamine (Desferal)

A

Antidote for iron/ferrous sulfate

it will bind to iron and allow its removal via the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

The biggest problem for Iron supplement adherence is…

A

the ADRs (GI GI GI - Constipation, Diarrhea, Abdominal Discomfort, NV, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What 2 prototype drugs are included for Macrocytic Anemia treatment

A

Vitamin B12 (cyanocobalamin)

folic acid (Folvite)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Vitamin B12 (cyanocobalamin)

A

Oral/Parenteral vitamin that mostly comes from animal products

Used for RBCs AND Myelin Sheathes in the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Action of Vitamin B12

A

Restores Vitamin B12 to the body which is needed in formation of RBC (and the myelin sheathe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Where does most Vitamin B12 come from and why is this a problem

A

animal products - this then is a problem for vegans and vegetarians

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Other than RBC what else does Vitamin B12 work on

A

the myelin sheathes in the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Main Route of Vitamin B12

A

IM or Deep SubQ (Parenteral)

Oral can be given but the absorption is poor with only 1-2% of uncomplexed B12 absorbing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

ADRs of Vitamin B12

A

RARE - only concern may be a drop in Potassium (K)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the 2 issues with a lack of Vitamin B12

A

RBC - Macrocytic Anemic

Neurological Impairment/Damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is needed in order to absorb and use Vitamin B12 effectively

A

Intrinsic factor for the parietal cells in the stomach and gastric mucosa

So, gastric modification, illness, or surgery can alter B12 absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What must be done while first starting Vitamin b12 therapy

A

patients must be evaluated for 4-6 months to make sure the therapy is effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

If a patient does not have intrinsic factor how must they take Vitamin B12

A

Large oral doses to have an effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Megaloblastic/Macrocytic Anemia

A

An anemia due to deficiency in folic acid or vitamin B12

Causes Large Cell Aenami where there are large RBCs, fewer RBCs, and they are less useful in O2 delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Folic Acid (Folvite)

A

Vitamin

Plays an essential role in DNA production leading to RBC production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

In what foods is folic acid found

A

green leafy vegetables

liver

milk

eggs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

In what kinds of people might folic acid levels and absorption be decreased

A

those with celiac disease

those ingesting large quantities of alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Action of Folic Acid

A

plays an active role in development of enzymes which are necessary for DNA production

(If inadequate DNA, erythropoiesis is affected and macrocytic RBC occur)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Absorption and Route of Folic Acid

A

Usually give oral, can be put in TPN as well

Even if someone has malabsorption issues, they can still be given larger doses of this for effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

ADRs of Folic Acid

A

NONTOXIC

Rare Allergic Rxns can occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How does dosage differ for folic acid

A

depends on the situation

For isntance, if a woman is deficient early in pregnancy she may be given a lot more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Once folate stores return to normal, do you need to continue on folic acid supplements?

A

No once stores return to normal dietary sources are usually adequate in preventing further issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Folic acid plays a very important part at what stage of development

A

It plays an important part in the formation of the unborn fetus because it prevents neural tube defects (NTDs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How did the government plummet the rate of NTDs in the US

A

In the 1960s they added folic acid to cereal and grain products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Prototype Drug that is a Biological Response Modifier

A

erythropoietin (Epogen, Procrit)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

erythropoietin (Epogen, Procrit) Classification

A

biological response modifier

recombinant human erythropoietin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Action of erythropoietin

A

mimics the effect of natrually made erythropoietin - helps production of RBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What type of patient may be receiving synthetic erythropoietin regularly

A

a chronic renal failure patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is an illegal use for erythropoietin that can now be detected

A

professional cyclers may take it to increase RBC and performance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What route is erythropoietin given?

A

IV - through hemodialysis or Subcutaneously

Parenteral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is important to know about the absorption of erythropoietin

A

It is broken down in the GI tract so it has to be given parenterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

ADRs of Erythropoietin

A
  1. HTN
  2. Increased clotting of AV grafts
  3. Limb pain and sweating up to 12 hours after injection

Other: Cardiovascular Events (Black Box Warning), NVD, SOB, Rash, Cough, Fatigue, Paresthesia, HA, Encephalopathy, Seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Black Box Warning of Erythropoietin

A

Increased incidence of TIA, MI, and CVA (Thromboemboli production)

You are increasing a hypercoagulable state so there is slower moving blood and pooling occurring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Why does erythropoietin cause HTN

A

because it makes more volume and a more viscous blood volume due to increasing RBC production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the dosage of erythropoietin

A

50-100 U/kg individualized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Why is erythropoietin dosage individualized

A

to prevent black box issues like thromboemboli formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the % goal for therapeutic erythropoietin use

A

Maintain a HCT of 30-36%

HCT and HGB rise within 2-6 weeks (Takes a little bit)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Indications for erythropoietin therapy

A

Chronic Renal Failure

HIV/AIDS (Esp. if tx with Zidovudine)

Adjunct to cancer chemotherapy

Elective non cardiac or non vascular surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Why is erythropoietin only given to elective non cardiac or non vascular surgeries

A

because vascular and cardiac surgeries try to get the blood moving but this makes it slower and more viscous with risk for clotting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

erythropoietin is naturally made in the ____

A

kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What finding should be monitored for and as a result erythropoietin dose should be lowered if it occurs?

A

Watch for rapid Hct increases (>4 points in 2 weeks) - the dose will need to be lowered as this leaves the patient predisposed to HTN and clotting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What does synthetic erythropoieting response depend on

A

the endogenous erythropoietin amount in the plasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

At what levels of endogenous erythropoietin will therapeutic use of synthetic erythropoietin be affected

A

> 500 U/L - syn. ery. will probably not respond

<500 U/L - syn ery will probably respond

Basically if you make a sufficient amount or some amount it works less than if you made none at all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is needed concurrently with synthetic erythropoietin treatment

A

adequate iron supplementation!

You cannot make empty RBCs, you need the iron for it as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is another benefit some taking erythropoietin may achieve

A

increased appetite and wellbeing

originally the company oversold the bonus energy effects for chemotherapy treatment but it does help with anemia

70
Q

Anticoagulants

A

Class of drugs

PREVENT blood clotting, NOT break down existing clots

71
Q

4 Prototype Anticoagulant Drugs

A

Heparin

Enoxaparin (Lovenox)

Warfarin)

DOACs (Direct Oral Anticoagulants)

72
Q

Heparin

A

Anticoagulant

“Standard Heparin” / Unfractionated

73
Q

Action of Heparin

A
  1. Inhibits thrombin mediated conversion of fibrinogen to fibrin - SUPPRESSES FIBRIN
  2. Markedly potentiates actions of plasma antithrombin (Anti clotting factor) which neutralizes thrombin and Factor Xa
74
Q

The Outcome of the action of Heparin

A

2 Prong Approach:

Not much fibrin is being made and thrombin is neutralized leading to the nromal clotting cascade from being inhibited and prevents the action fo factor Xa which inhibits clots

75
Q

Fibrin

A

mesh like substance that holds blood clots together

76
Q

Antithrombin (Thromboplastin)

A

A naturally occurring ANTI Clotting factor that neutralized thrombin and factor Xa

77
Q

What route is heparin given and why?

A

parenteral (SubQ or IV)

It is NOT given orally because it is VERY POLAR and CANNOT CROSS MEMBRANES

78
Q

What is the distribution of heparin like?

A

IV Onset = Immediate and lasts 4-6 hours

SubQ Onset - Delayed but lasts 8-10 hours

Half life depends on dose but avg is 1.5 hours

79
Q

ADRs of Heparin

A
  1. HEMORRHAGE (Minor/Major Bleeding)
  2. Hypersensitivity Reaction (chills, fever, urticaria, anaphylactic shock, hives)
  3. Mild Thrombocytopenia
80
Q

What are some of the minor bleeding ADRs of heparin

A
  1. GI TRACT BLEEDING

Gu Tract Bleeding

Petechiae

Ecchymosis

81
Q

What are some fo the majro bleeding ADRs of heparin

A
  1. GI TRACT HEMORRHAGE

(CAN KILL)

Death occurring from bleeding in CNS (brain)

82
Q

Thrombocytopenia

A

drop in platelet count

83
Q

Why is mild thrombocytopenia as an ADR of heparin concerning

A

because it leaves that even MORE risk for bleeding

84
Q

What are dose and effectiveness of Heparin based on

A

PTT (Partial thromboplastin time) OR APTT (Activated partial thromboplastin time)

The pt. values then are measured against a heparinized lab standard

85
Q

How do therapeutic levels vary for heparin

A

Levels are usually 1.5-2x the control value

ex: If PTT was 30 then the range would be 45-60

86
Q

Why is heparin NOT given IM

A

because of risk of local hematoma since muscles are too vascular

87
Q

Black Box warning for Heparin

A

epidural or spinal hematomas with spinal anesthesia, etc!!

These hematomas are in the CNS and lead to bleeding around the spinal cord

88
Q

What population is reported more sensitive to heparin

A

elderly women

89
Q

What does Heparin NOT have an effect on regarding clotting

A

platelet aggregation- there is no effect on platelet function at all but it can lower the numbers

90
Q

What is a potentially fatal condition from heparin use

A

HIT - Heparin induced thrombocytopenia

91
Q

Protamine Sulfate

A

antidote for heparin (1mg/100units of heparin)

Binds heparin and stops it from working

Also acts as an anticoagulant itself

92
Q

What is the antidote to heparin

A

protamine sulfate

93
Q

Why can heparin be given during pregnancy

A

because it cannot cross membranes and hurt the fetus

94
Q

Prototype Low molecular weight heparin/anti-coagulant drug

A

enoxaparin (Lovenox)

95
Q

enoxaparin (Lovenox)

A

Anticoagulant/Low molecular weight heparin

It is a smaller molecule than standard heparin that is given SubQ and does not generally need lab monitoring

Made by depolymerizing standard heparin

96
Q

Action of enoxaparin (Lovenox)

A

Preferentially inactivates factor Xa MORE than thrombin

Prevents clots from forming by preferentially inactivating Factor Xa ONLY

97
Q

When is the peak of enoxaparin (Lovenox) experienced after a SubQ injection?

A

3-5 hours after - given once daily

98
Q

What route is enoxaparin usually given

A

subQ

99
Q

ADRs of Enoxaparin (Lovenox)

A
  1. Bleeding (Minor/Major - but since its not IV major is more rare)
  2. HIT (less so than standard heparin)

Other: Edema, Rash, Pain at injection site, ANGIOEDEMA

100
Q

What is the dosage of enoxaparin like

A

It is given 1-2x daily infixed doses based on body weight and generally does NOT need lab monitoring

101
Q

What is the big difference between long term enoxaparin and heparin therapy

A

you need to monitor APTT/PTT and lab values when taking heparin but you dont need to watch lab values with enoxaparin

102
Q

What is interesting about the dose of enoxaparin once on it

A

It is never really changed once you learn what dosage is needed

103
Q

What may be found in the name of a drug that is a portion/type of heparin

A

-parin

104
Q

Avoid enoxaparin use in patients with …

A

increased risk of hemorrhage

105
Q

When is enoxaparin given after surgery

A

usually the initial does is not given until 12-24 hours post op if hemostasis is stable and they are not bleeding

106
Q

What is enoxaparin approved for following Hip and Knee Replacements

A

prophylaxis and treatment of DVT and PE

107
Q

Protamine Sulfate

A

Heparin (and enoxaparin) antidote

108
Q

What route is protamine sulfate usually given

A

IV for rapid effect - instantaneous

occasionally IM

109
Q

When is protamine sulfate used

A

usually in emergency bleeding situations otherwise you can just stop IV and SubQ infusions

110
Q

Where does protamine sulfate come from

A

Fish - so it is important to know if the person is allergic to fish

111
Q

What is an interesting secondary effect of protamine sulfate other than beign an antidote

A

It is a mild anticoagulant itself if given alone but neutralizes other anticoagularn activities

112
Q

Action of protamine sulfate

A

Combines with heparin/enoxaparin and each neutralize the anticoagulant activity of the other

Has antithromboplastin actvity not as active as in heparin which causes its anticoagulant effects

113
Q

ADRs of Protamine Sulfate

A

Only in cases of Rapid Injection

Dyspnea

Flushing

Bradycardia

Hypotension (Perhaps from Histamine Release)

OVERDOSE - causes anticoagulation leading to hemorrhage

114
Q

What is the dosage of protamine sulfate like

A

Varies and depends on amount of heparin given in the last 3-4 hours

Given slowly over IV and is 1mg/100units of heparin remaining in the body

115
Q

What is an important consideration with protamine sulfate

A

Can cause hypersensitivity reactions in pts allergic to fish as it comes from the sperm and testes of certain fish

116
Q

Prototype Oral Anticoagulant and Vitamin K Antagonist

A

Warfarin (Coumadin)

117
Q

Action fo warfarin (Coumadin)

A

Blocks Vitamin K Dependent clotting factors by competitively interfering with Vitamin K

NO effect on platelet function

Stops vitamin K to prevent coagulation cascade

118
Q

Route of warfarin (coumadin)

A

oral - very good absorbs from small intestine

Food will decrease its rate of absorption but not extent of absorption - just takes longer

119
Q

What is important to know about the distribution of warfarin (Coumadin)

A

it is highly protein bound so only 1% is every working at one time since 99% is always protein bound

This means it takes a long time to get to therapeutic levle, but it also has a 2 day half life so it takes a while to get rid of as well

This means there can be trouble when dosing

120
Q

ADRs of warfarin (Coumadin)

A
  1. Hemorrhage - Minor to Life threatening
  2. Diarrhea
  3. Leukopenia occasionally

*Similar to other anticoagulants

121
Q

What is warfarin dose and effectiveness determined by

A

PT -prothrombin time - and the INR (international normalized ratio)

Patient values are measured against the control INR

122
Q

Where do we want people’s INR to be

A

between 2-3

Higher means they are more likely to bleed and below indicated clotting

123
Q

Therapeutic levels of warfarin are determined…

A

by going 1.5-2.0 times the control value

124
Q

Antidote to warfarin

A

Vitamin K

125
Q

Can warfarin be used in pregnancy

A

NO it can cross membranes

126
Q

What are the benefits of new DOACs (Direct oral anticoagulants) like pradaxa, xarelto, and eliquis over something like warfarin

A
  1. Eating a lot of vitamin K (like in green elafy vegis) can negate warfarin but theres no diet restriction on these
  2. The DOACs act on Factor Xa similar to enoxaparin
  3. all given orally
  4. prevent blood clots and PE and all have their own antidote
  5. rapid onset and offset
  6. do not need blood monitoring

one issue is that BID dosing leads to reduced compliance though

127
Q

Antidote to DOACs

A

Factor Xa (they are its competitive antagonist so more will over come them)

128
Q

Prototype Drug that is a Vitamin, Hemostatic Agent, and Warfarin Antidote

A

Vitamin K (phytonadione - Aqua Mephyton)

129
Q

Vitamin K action

A

essential for hepatic synthesis of prothrombin and factors VII, IX, and X

130
Q

Never give Vitamin K what route

A

IV (unless emergency because of risk of anaphylaxis and shock)

131
Q

ADRs of Vitamin K

A

relatively non toxic

132
Q

What is important to keep in mind about giving a patient Vitamin K when they may need warfarin

A

It will render the patient resistant to warfarin for 10-14 days (2 weeks) and this can occur either from administering Vitamin K or a high vitamin K diet

133
Q

What normally makes vitamin K

A

normally synthesized by enteric bacteria

need bile to aid absorption from the intestine though

134
Q

Thrombolytics

A

Break down formed blood clots!!!!

Includes t-Pa (tissue plasminogen activator) and streptokinase (older drug)

“Clot Busters”

135
Q

What has to be done prior to giving a thrombolytic

A

you MUST rule out intracranial bleeding via CT scan before use

136
Q

When must a thrombolytic be given

A

ASAP after onset of symptoms

esp in evolving MI or CVA

137
Q

Prototype Thrombolytic Agent

A

Tissue Plasminogen Activator (t-Pa) (Activase, Alteplase)

138
Q

-ase means

A

enzyme

139
Q

Action of t-Pa

A

Enzyme that selectively binds to the fibrin in a thrombus (already existing clot) and converts entrapped plasminogen into plasmin

Plasmin then initiates fibrinolysis (pac man) which chews up the fibers of the clot

140
Q

Route of t-Pa

A

IV

141
Q

Dosage of t-Pa

A

given in an IV bolus usually in decreasing amounts after the loading dose, 30 minutes, then 60 minuutes

142
Q

ADRs of t-Pa

A
  1. Internal bleeding - GI, GU, retroperitoneal, intracranial
  2. Superficial bleeding - at distrubed sites like venipuncture, catheter insert sites, oozing blood when brushing teeth
  3. Dysrhythmias

Other: N/V, higher stroke incidence than if streptokinase was used

143
Q

What about t-Pa causes dysrhythmias

A

it causes irritability for the heart if its breaking down a blood clot from an MI - but this effect tells us the heart muscle is still alive and working at least

There is electrical instability from the reperufsion in 80% of patients

144
Q

Indications/Uses for t-Pa

A

Management of acute MI and CVA

145
Q

When should t-Pa be initiated for use

A

as soon as possible after symptom onset (not at ER, but when symptoms started - WITHIN 6 HOURS) - use when suspecting MI or stroke

146
Q

Contraindications for t-Pa

A

ACTIVE INTERNAL BLEEDING

CVA within the last 2 months

Intracranial or intraspinal surgery or trauma

Known bleeding problems

Severe uncontrolled HTN (high risk for hemorrhagic stroke)

CPR (couldve broken a rib)

Pregnancy

147
Q

What is often given simultaneously with t-Pa

A

Heparin to prevent new clot formation - but this is expensive

148
Q

Important administration notes for t-Pa

A

Mix with sterile water (not bacteriostatic) and dilute with D5W or NS and do not give with other meds

Can be used to clean a PICC line

very expensive

149
Q

Prototype thrombolytic antidote and hemostatic agent/Antifibrinolytic

A

aminocaproic acid (Amicar)

150
Q

Uses for aminocaproic acid (Amicar)

A

antidote to thrombolytics like t-PA but also in bleeding conditions can be used to stop bleeding very well in conditions where there is trouble stopping it - like acute leukemia bleeding

151
Q

Action of aminocaproic acid

A

COMPETITIVE ANTAGONIST to Plasminogen which prevents plasmin generation (stops thrombolytic action)

Also directly inhibits plasmin to a lesser degree

152
Q

Route of aminocaproic acid

A

oral - tablet or syrup ; can also be IV

153
Q

What is important about the IV dosage of aminocaproic acid

A

it is 4-5 g given OVER 1 HOUR then 1 g over 8 hours or unti,l desired response obtained

154
Q

ADRs of aminocaproic acid

A

MOST DONT OCCUR IF GIVE SLOW/CORRECTLY IV!!!

HA, Dizziness, NV, Abdominal Pain, Diarrhea, Tinnitus, Malaise, Stuffy Nose, thrombophlebitis, GRAND MAL SEIZURE

If given too rapidly parenterally - hypotension, bradycardia, arrhythmias

155
Q

What is a newer anti-fibrinolytic / hemostatic used sometimes in the place of aminocaproic acid

A

Transexamic Acid (Lysteda)

156
Q

What differentiates transexamic acid from aminocaproic acid

A

it is 8-10 times more potent

stills inhibits plasminogen and plasmin in conditions where clots are broken down quickly, but it works better and can be given oral for excessive menstrual bleeding, and uncontrolled post op bleeding

157
Q

Both Transexamic Acid and Aminocaproic acid are for what conditions

A

uncontrolled hemorrhage

whether associated with trauma/post op bleeding, excessive menstrual bleeding or dental procedures for those with hemophilia

158
Q

What are the ADRs of transexamic and aminocaproic acid like

A

htey are both generally well tolerated with MILD ADRs

159
Q

What is one thing to watch for when giving transexamic or aminocaproic acid

A

watch for increased thrombosis!!! - increased clotting - if they bleed somewhere like the urinary tract for example it can clot and cause an obstruction

160
Q

Prototype granulocyte colony stimulating factor

A

filgrastim (Neupogen/Neulasta (long acting form))

161
Q

Action of filgrastim

A

acts in bone marrow to increase production of neutrophils

stimulates granulocyte colony growth by functioning the same as a granulocyte colony stimulating factor (G-CSF)

162
Q

Route for filgrastim

A

IV or SubQ

Oral is destroyed in the digestive tract

163
Q

ADRs of filgrastim

A
  1. BONE PAIN (Mild to Moderate - bone marrow is squeezing stuff out) - mostly occurs in the 1-2 days after chemo

Other: Increases in uric acid, lactate dehydrogenase, and alkaline phosphatase

164
Q

When is filgrastim given

A

at least 24 hours after the end of chemotherapy

165
Q

What is important to know about the vials and doses of filgrastim

A

only 1 dose per vial should be used

166
Q

Neulasta

A

the long acting form of filgrastim

167
Q

OnPro

A

a new formulation of filgrastim put on a patient that automatically injects medicine 24 hours late eliminating need to return to the chemo center for one injection

168
Q

If a patient with severe iron deficiency anemia is prescribed iron, how long might it take to return to normal body stores?

a. Within 72 hours
b. Within 2-3 weeks
c. Over 6-10 months
d. Within 1-3 months

A

C. Over 6-10 months

(See effect in 2-3 weeks but the rise and stores dont go back for a while when severe)

169
Q

A thrombolytic agent like t-PA could be safely used in the setting of

a. CVA within the last 2 months
b. Acute MI beginning within the last 3 hours
c. Recent, serious GI bleeding
d. Obstetrical delivery

A

B. Acute MI beginning within the last 3 hours

170
Q

To monitor a patient’s response to filgrastim (Neupogen) you would assess which lab finding

A. H&H

B. WBC and/or ANC

C. Serum electrolytes

D. RBC Count

A

B. WBC and/or ANC

N365: Pharmacology in Nursing (15 decks)

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