ABG/heme Flashcards

Question

Carboplatin (paraplatin) ADE

Answer 1

Myelosuppresion Lyte imbalance Neuropathy Nephrotoxicity

Answer 2

Myelosuppresion Hepatotoxicity Neurotoxicity Photosensitivity Pulmonary toxicity Nephrotoxicity

Answer 3

Photosensitive Myelosuppresion Anorexia Hypotension Flu like symptoms

Answer 4

Myelosuppresion Lyte imbalance Neuropathy Nephrotoxicity

Answer 5

N/V Rash Flu like symptoms Myelosuppresion Neurotoxicity Ocular toxicity

Answer 6

Diarrhea Myelosuppresion Mucositis Photosensitive Cardio toxicity

Answer 7

N/V Rash Flu like symptoms Fever Diarrhea Myelosuppresion Edema Elevated transminases

Answer 8

Constipation Myelosuppresion Alpaca Bone pain Mailed Toxic effects on colon

Answer 9

Constipation, toxic effect of colon Peripheral neuropathy Alopecia

Answer 10

Diarrhea Myelosuppresion Neuropathy Alopecia Edema Mucositis

Answer 11

N/v/d Red orange urine Myelosuppresion Cardiotoxic in certain doses

Answer 12

N/v/d Red orange urine Myelosuppresion Cardiotoxic in certain doses

Answer 13

N/v/d Fever Hypotension Myelosuppresion Alopecia Fatigue

Answer 14

Involves popliteal vein, femoral vein, iliac veins above the knee DVT in superficial femoral veins are still DVTs and should be treated as such Higher mm and complications Treated with anticoagulants u less contraindications

Answer 15

Confined to veins of the calf below the knee Less risk for PE may not require treatment 1/3 will extend to the proximal vein within first two weeks of dx

Answer 16

Low moderate or high risk High greater than 2 Moderate 1-2 Low 0

Answer 17

Usually from proximal DVT Large S wave in lead 1 and Q wave in lead 3, inverted T wave in lead 3 Wells criteria for PE CTA first if contraindications to contrast, renal disease, CHF, hypotension inability to lay flat do VQ scan with or without Doppler of LE

Answer 18

Can tx if OP IF-hemodynamically stable, low risk for bleed, has normal renal function, compliant IP if-intractable pain or complete venous obstruction leading to impaired arterial flow If they do not need low risk criteria they need to be hospitalized If unstable need ICU-hypoxia, hypotension, tachypnea, tachycardia, right ventricular strain, or failure, SS of CHF, large or multiple PEs, saddle PE If stable can do floor

Answer 19

All proximal DVTs All PEs some instances a segmental may not need tx, if no involvement of proximal arteries and no proximal DVT then they can just be monitored Chronic DVTs do not generally need anticoagulants Isolated distal DVTs without severe symptoms or RF or extension can be monitored for serial imaging in 2 weeks if propagation occurs then TX is needed Anticoagulants can be deferred if clot does not extend

Answer 20

Contraindications-active bleed, severe bleeding diathesis, platelets less than 50,000 recent planned or emergent high bleeding risk surgery or procedure, major trauma, history of ICH Use IVC filter then Xarelto, Eliquis mono therapy Dabigatran or edoxaban after tx with LMWH Warfarin in conjunction with heparin, LWMH, fondaparinux Or LMWH which has better efficacy than heparin

Answer 21

Heparin-80 unit per kg bolus then 18 unit per kg per hr, titration for aPTT 1.5-2.5 times normal, prior, 6 hrs start and 6 hours after change, reverse with protamine sulfate, RISK FOR HIT, monitor platelets daily, ok to use in renal pts do not use if platelets less than 50,000 Lovenox-1 mg /kg, no lab requires, no reversal agent, moderate risk for HIT, do not use in platelets less than 50,000 contraindicated in CC less than 30 Fondaparinux- weight based, no labs needed, no reversal agent, low risk for HIT, do not use in platelets less than 50,000 contraindicated in CC less than 30

Answer 22

Proximal provoked and unprovoked DVT and PE should be treated for 3 months Isolated distal DVT should be treated for 3 months CA with a VTE and a low risk of bleeding means indefinite anticoagulants If high risk then 3 months of therapy First and second unprovoked VTE with low and medium bleeding risk should be treated indefinitely

Answer 23

Greater than 50,000 adequate 30-50 rarely have purpura even with trauma 10-30 asymptomatic, increased risk for bleeding 10 develops spontaneously bleeding, petechiae present

Answer 24

Unstable with SBP less than 90 tx with thrombolytics if no contraindications otherwise embolectomy if there Failed thrombolytic therapy, shock will cause death, high risk for bleed rtPA 100 mg over two hours followed by heparin drip no bolus High risk for bleed so only use if unstable

Answer 25

Preferred in pt with GI cancers as Xarelto can increase risk of bleeding

Answer 26

Most common is factor V Leiden Can be acquired due to pregnancy, elevated factor 8, oral contraceptive, presence of antiphospholipid antibodies, protein S deficiency, malignancy

Answer 27

Most common in whites Inherited thrombophilia Excess prothrombin Dx with prothrombin G20210A and mutation in PCR

Answer 28

Autosomal dominant Protein S Activates protein C which inactivates factor Va and VIIIa Eval with free protein S level Do not perform if on anticoagulants or for three months post thrombus Heparin and LMWH do not interfere with test

Answer 29

Autosomal dominant Protein C is activated by protein S to form APC which inactivates 5a and 8a Eval with protein C functional assay Do without anticoagulants DIC or liver disease or within 3 months of clot, cancer, cancer therapy, uremia, infection or inflammatory condition

Answer 30

Autosomal dominant Antithrombin slowly inactive thrombin May be resistant to heparin Eval with Antithrombin functional assay if abnormal draw an Antithrombin antigen to determine subtype Perform 3 months after thrombotic event and off anticoagulants

Answer 31

Acquired deficiencies in B6, B12 or folic or generic-autosomal recessive Causes alteration in the enzyme methylenetetrahydrofolate reductase normally helps to covert homocysteine to methionine thus elevates homocysteine level Eval with homocysteine level TX- vitamin supplementation do not have any effect on the incidence or recurrent of VTE, TX or screening is not recommend in person with VTE

Answer 32

Post op Hemodilution Hypersplenism HIV, bone marrow failure, viral infections-rubella, mumps, varicella, parvovirus, hep C, Epstein Barr, alcohol, bacteria, sepsis, malignancy, B 12 or folate deficiency: SLE Drugs- sulfas, levaquin, quinine, heparin, rifampin, beta lactams, tegretol, vanco, linezolid, pipercillin, depakote, Dilantin, anti platelets

Answer 33

Thrombocytopenia with microangiopathic hemolytic anemia and thrombosis results in organ damage Medical emergency Neurological or renal SS but can affect any organ Large amounts of VWF and lack AdamTS13 protein-leads to platelet aggregation and thrombi Antibodies with AdamsTS13 Due to autoimmune, congenital, HIV, CA, drugs-quinine, mitomycin, cyclosporine, cisplatin, bleomycin, clopidogrel, other anti platelets, post OP CBC, PT, aPTT, decreased heptagon, schistocytes, fibrinogen normal to high, d dimer may be normal or high, BUN/CR elevated, LDH elevated, bilirubin elevated ADAMTS13 Less than 10% is diagnosis and confirms Consult heme Plasma exchange, steroids, retuximab

Answer 34

Inherited bleeding disorder Autosomal dominant Decreased VWF plasma VWF antigen, factor 8 for diagnostic testing TX consult heme, recommend VWF, DDVAP

Answer 35

Primary- acquired due to autoimmune platelet destruction Secondary- triggered by another condition Severe if platelets less than 20 Can be due to viral infection, CLL, SLE Platelet destruction IgE SS of bleeding and low platelets DX by exclusion, isolated low platelet less than 100 Good H&P! h pylori testing HIV and HCV testing PT/PTT Thyroid levels BM biopsy Vitamin B12and folate level ANA TX- platelet transfusion, IVIG, steroids if severe, minor TX with steroids, IVIG

Answer 36

Type 1- decrease platelet count 2 days post heparin start, mild, and returns ti normal with continued heparin admin, ok to continue heparin Type 2*-immune mediated drug reaction results in platelet destruction, severe, stop heparin HIT antibodies, binds to factor 4, causing thrombosis and thrombocytopenia Heparin for more than 1 week, less with LMWH Platelet count drop 5-10 after suspect if receiving heparin and drop is greater than 50%, new thrombocytopenia less than 150 and no Cannot otherwise explain drop DX-4 T score (thrombocytopenia, timing, thrombosis, presence of other cause thrombocytopenia), test for moderate to high probability, use ELISA for anti platelet factor 4 antibodies, if not confirmatory use serotonin release assay Use of non heparin anticoagulants TX-Stop heparin and avoid forever, argatroban can be used do not use Coumadin initially Avoid platelet transfusions

Answer 37

Usually seen in Stage 5 CKD Multi factorial causes Platelets in uremic state cannot aggregate Dialysis does improve platelet dysfunction but does not improve risk of bleeding Heparin can also contribute TX-HD, DDAVP, correct anemia, estrogen, cryopreciptiate

Answer 38

Coagulopathy- joint bleeds, tissue hematomas, large lumps ecchymosis, bleeding post surgery, trauma or injury tends to be delayed Thrombocytopenia-mucosal bleeding, petechiae, bleeding immediately after trauma or injury

Answer 39

Sex linked recessive mainly males Bleed in joints and GIB Spontaneous bleeding is indicative of more severe disease Normal players Normal PT Prolonged aPTT Decreased factor 8 Avoid NSAIDs Heme consult Factor replacement DDVAP

Answer 40

Sex link recessive disorder Affects more male Joint bleeds and GIB Spontaneous bleeding indicates severe disease Normal platelets Normal PT Prolonged aPTT Decreased factor 9 tx same as type A but replace factor 9 and cannot use DDVAP

Answer 41

Underlying disease usually due to CA, sepsis, obstetrics cx, trauma; hemolytic reactions, malaria, ARDS, rhabdo, snake bites Coagulation cascade and fibrinolytic cascade Organ failure Prolonged PT and PTT Low fibrinogen Elevated d dimer Less than 100 platelets Increased thrombin time Rule our severe liver disease, HIT, TTP

Answer 42

4.5-10 with no bleeding no Tx needed Greater than 10 and no bleeding oral vitamin K Major bleeding use factor 4 with vitamin K 5-10 mg IV FFP can be used to reverse Coumadin but not effective as factor 4

Answer 43

Dabigatran 2.5-3.4 days after last dose Xarelto 1-2 days after last dose Eliquis 1.5-3 days after last dose Edoxaban 1.3-2 days after last dose Bextrixaban 4-5.5 days after last dose PT/PTT not reliable for coagulation status

Answer 44

Dabigatran-idarucizumab Eliquis and Xarelto- andrxanet alpha

ABG/heme Flashcards

(69 cards)