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Nurs 575 Anesthesia Pharmacology > Coagulation-Procoagulants and Anticoagulants > Flashcards

Coagulation-Procoagulants and Anticoagulants Flashcards

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1
Q

What three substances are important serine proteases that exert anticoagulant/anti-inflammatory actions?

A
  • Antithrombin
  • Protein C
  • Protein S

Stoeltings, pg. 622

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2
Q

Coagulation is closely linked to ___________ responses through complex networks of plasma and cellular components

A
  • inflammatory

Stoeltings, pg. 622

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3
Q

_________ is used to evaluate the extrinsic coagulation cascade

bold on PPT

A
  • Prothrombin time

bold on PPT

Stoeltings, pg. 622

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4
Q

_________ is used to evaluate the intrinsic coagulation cascade

bold on PPT

A
  • activated partial thromboplastin time (aPTT)

bold on PPT

Stoeltings, pg. 623

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5
Q

Describe the MOA of Tranexamic Acid (TXA)

A
  • Antifibrinolytic - competetively inhibits the activation of plasminogen to plasmin
  • Not prothrombotic but rather a clot stabilizer

bold on PPT

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6
Q

What is the usual dosing of TXA?

A
  • Trauma/Total Joints: 1g IV
  • Cardiac surgery: 50 mg/kg/dose IV

PPT, slide 12

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7
Q

What is the MOA of Desmopressin (DDAVP)?

A

V2 Agonist
* V2 analog of vasopressin that stimulates release of von Willebrand factor from endothelial cells

vWF necessary for platelet adherence to site of vascular injury

Stoeltings, pg. 642

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8
Q

________ mcg/kg of Desmopressin is given IV over ___________ minutes

A
  • 0.3 mcg/kg
  • 15-30 minutes

Stoeltings, pg. 642

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9
Q

What are the possible consequences of rapid administration of desmopressin?

A
  • Hypotension

stimulates endotelial release of vasoactive mediators (nitric oxide?)

Stoeltings, pg. 643

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10
Q

DDAVP affects what test in what population?

A

Shortens Bleeding time

  • vWF disease or Hemophilia A pts
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11
Q

Protamine is the only available agent to reverse ____________

bold on PPT

A
  • unfractionated heparin

bold on PPT

Stoeltings, pg. 642

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12
Q

What is the usual dosing of protamine?

A
  • 1-1.5 mg IV per 100 units of heparin

50 mg/dose MAX

PPT, slide 17

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13
Q

How does protamine chemically reverse UFH?

A
  • Protamine is 70% argenine (polycationic - alkaline)
  • UFH is a mucopolysaccharide (polyanionic - acidic)
  • They combine ionically to form a stable compound

PPT, slide 15

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14
Q

Adverse reactions associated with Protamine?

A
  • Anaphylaxis
  • Acute pulmonary vasoconstriction
  • R. ventricular HF
  • HoTN

PPT, slide 16

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15
Q

Pts at risk for Protamine adverse reactions?

A
  • NPH insulin user
  • Prior vasectomy
  • Multiple drug allergies
  • Previous protamine exposure

PPT, slide 16

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16
Q

Fibrinogen levels are normally 200-400 mg/dL - hypofibrinogenemia is best treated with ____________? Dose?

A

Cryoprecipitate

  • 1 unit per 10 kg increases levels by 50-70 mg/dL

Stoeltings, pg. 643
PPT, slide 21

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17
Q

It is preferable to give prothrombin complex concentrates(PCCs) which contain _________ for warfarin reversal

bold on PPT

A

all four vitamin K-dependent coagulation factors (i.e. Kcentra)

  • Factors II, VII, IX, X
  • Protein C (activated) & AT

bold on PPT

Stoeltings, pg. 645
PPT, slide 23

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18
Q

The partial thromboplastin time is used to monitor what, specifically?

A
  • Lower doses of UFH
  • ~1 unit/mL

Unfractioned Heparin

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19
Q

During cardiac surgery, higher doses of what drug are monitored via what test?

A
  • UFH
  • Activated Clotting Time (ACT)
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20
Q

What variables make up a thromboelastography? How are ea. variable measured ?

5

A
  • Coag. time (seconds)
  • Clot formation- rate of fibrin polymerization (seconds)
  • Angle (in degrees)
  • Maximum clot firmness (mm)
  • Lysis time (seconds) - used for diagnosis of premature lysis or hyperfibrinolysis
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21
Q

WTF is Idarucizumab? MoA?

A
  • Dabigatran (Pradaxa) reversal
  • Binds to pradaxa & it’s metabolites, neutralizing them
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22
Q

Idarucizumab Dose & Half-life?

A

5 mg IV x1
Half-life - 10.3 hrs

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23
Q

WTF is Andexanet alfa? MoA?

Study These Flashcards
A
  • Reversal for Rivaroxaban & Apixaban
  • Binds & sequesters factor Xa inhbitor, inhibits TFPI
  • Reverses anti-Xa activity & restores Thrombin (IIa) generation
24
Q

Fibrinogen is a substrate for what three important enzymes?

Study These Flashcards
A
  • Thrombin
  • Factor XIIIa
  • Plasmin
25
At what Fibrinogen levels might you see changes on PT or aPTT? What cannot correct these levels @ this range?
**< 100mg/dL** * FFP
26
Your patient is bleeding and needs a transfusion. What is the recommended increase for fibrinogen?
Increase levels 150-200 mg/dL
27
What do Prothrombin Complex Concentrates contain (PCC)? Which factor do they contain mainly?
Factors: * II * VII * **IX** <- this one * X
28
Some differences between PCCs?
* **Only FEIBA contains VIIa <- activated form** * Profilnin & Bebulin only have low levels of VII
29
Define the convoluted unit of UFH?
* The volume of a UFH containing solution that will prevent 1mL of citrated sheep blood from clotting for 1 hr * after adding 0.2mL of 1:100 Calcium Chloride
30
MoA of UFH?
Binds and activates AT III which inactivates: * II * IX * Xa * XI * XII
31
Common Dose & Half-life of UFH?
* 2000-5000 units IV -> titrated based on ACT * Half-life: 0.5-2hr
32
Mean molecular weights of LMWH?
4000-5000 Da
33
Your patient is on enoxaparin, how long should surgery be delayed from their last dose?
**12 hours from their last dose** Longer if they have renal dysfunction
34
How long does it take for Protamine to neutralize LMWH?
**It doesn't** neutralize LMWH
35
Which drugs are Direct thrombin inhibitors?
* Bivalrudin (Angiomax) * Argatroban
36
Which direct thrombin inhibitor is a bivalent DTi? where does it bind to thrombin?
**Bivalirudin** Catalytic & Fibrinogen binding site
37
Which direct thrombin inhibitor is a univalent DTi? where does it bind to thrombin?
**Argatroban** Catalytic binding site
38
Dose & Half-Life of Bivalrudin? (Bolus/Infusion)
Bolus: 0.75mg/kg IV Infusion: 1.75mg/kg/hr for procedure Half-life: 25 min
39
Dose & Half-Life of Argatroban? (Infusion)
Infusion: 15-30 mcg/kg/min Half-life: 39-51 min
40
How do you monitor Bivalrudin? Argatroban?
* Bivalrudin - ACT * Argatroban - ACT & aPTT
41
Mechanism by which thrombolytic drugs work? | This be bolded
* Drugs act as plasminogen activators * converts endogenous plasminogen -> plasmin * Plasmin lysis clots & other proteins
42
What is the goal for thrombolytic therapy?
Restore circulation
43
What are some indications for Tissue plasminogen activator (tPA)? | Bolded
* **Acute ischemic Stroke** * **Acute MI** * **Acute massive PE** for lysis
44
When should Bivalrudin & Argatroban be stopped before surgery?
4-6 hrs
45
When should Apixaban (Eliquis) & Rivaroxaban (Xarelto) be stopped before surgery?
Low bleed risk: 1-2 days High bleed risk: 2-3 days
46
When should Warfarin be held before surgery?
~5 days before Bridge with Heparin if needed
47
How long should Heparin be held before surgery?
4-6 hrs * or reverse with protamine
48
Which antiplatelet prevents the formation of thromboxane A2? by what pathway
Aspirin * COX inhibition
49
How long should aspirin be stopped prior to surgery?
7-10 days
50
How long should LMWH be held prior to surgery?
At least 12 hrs, longer in renal dysfunction
51
Which drugs are Platelet inhibitors?
Thienopyridines & Acetylsalicylate * Clopidigrel * Prasugrel * Ticagrelor * Aspirin
52
Which Thienopyridines are direct acting or prodrugs?
Direct acting: Ticagrelor Prodrugs: Clopidogrel & Prasugrel
53
How long should Thienopyridines be held prior to surgery?
7 days
54
MoA of Thienopyridines?
Irreversibly bind to P2Y-12 receptors * block ADP binding * inhibits (ADP mediated) platelet activation & aggregation
55
Mean molecular weight of UFH?
3,000-30,000 Da

Nurs 575 Anesthesia Pharmacology (18 decks)

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