Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Hem/Onc > hemostasis pharmacology and transfusion therpay > Flashcards

hemostasis pharmacology and transfusion therpay Flashcards

(129 cards)

Start Studying
1
Q

major blood group systems

A

ABO
Rh

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

3 pre-transfusion testing

A
  1. typing - ensures ABO/Rh compatibility
  2. antibody screen - tests for unexpected antibodies
  3. crossmatch - tests patient’s serum against prospective unit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Type testing determines the ABO and Rh phenotype of ____ blood

A

recipients

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

how to perform a type and screen test?

A
  1. mix recipient’s blood with type O that contains major antigens of other blood group systems
  2. observe for agglutination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when do you only order a cross-match test?

A

when there is a high likelihood that patient will receive PRBCs

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

what do you use during an emergency setting with not enough time to type or match blood?

A

use O-

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

3 reasons why we use transfusion therapy

A
  1. replace acute blood loss
  2. oxygen delivery
  3. morbidity and mortality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

who do we recommend transfusion for?

A

hgb <6 g/dL - transfusion recommended except in exceptional circumstances

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

assessment post-transfusion hgb lvl can be performed as early as ?

A

15 mins

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

1 unit of PRBCs should increase hgb ___ in avg sized adults

A

1 g/dL

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

prior to non-emergency transfusions, what must you obtain?

A

signed informed consent

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

transfusion reactions occur when?

A
  1. during transfusion
  2. within 24 hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the most common sign of a transfusion reaction?

A

febrile non-hemolytic reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the top 2 causes of death from transfusion reaction

A
  1. circulatory overload
    - CHF, renal failure more at risk
  2. transfusion related acute lung injury
    - smokers, asthma more at risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

5 types of transfusion products

A
  1. whole blood
  2. packed RBC (PRBC)
  3. fresh frozen plasma (FFP)
  4. cryoprecipitate
  5. platelets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what type of transfusion product provides O2-carrying capacity and volume expansion and commonly used during settings of massive hemorrhage

A

whole blood

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

what type of transfusion product increases the oxygen-carrying capacity in anemic pts

A

PRBC

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

3 modifications of RBCs to prevent reactions

A
  1. leukocyte reduced - reduces risk of immunologically-mediated effects
  2. irradiated - reduces graft-vs-host disease (GVHD)
  3. washed - reduces complications associated with infusion of proteins in residual plasma in red cell concentrates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what contains platelets and proteins (procoagulant and anticoagulant factors)

A

plasma

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

what 6 components are contained in fresh frozen plasma (FFP)

A
  1. coagulation factors
  2. fibrinogen
  3. antithrombin
  4. albumin
  5. protein C
  6. protein S
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

why is FFP the most commonly used plasma product?

A

can correct deficiencies of any of the circulating coagulation factors

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

main advantage of cryoprecipitate

A

allows vWF, factor VIII, factor XIII, and fibrinogen to be replaced using a much smaller volume

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

main advantage of factor concentrates

A

replaces specific factor deficiencies with minimal volume ONLY (no extra proteins)

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

4 indications for transfusion of PLT in critically ill pt that may be therapeutic or prophylactic

A
  1. PLT <10k - prevents hemorrhage
  2. PLT <50k
    - actively bleeding
    - scheduled for invasive procedure
    - qualitative intrinsic PLT disorder
  3. PLT <100k
    - CNS injury
    - multisystem trauma
    - neurosurgery
  4. normal PLT
    - active bleeding
    - PLT dysfunctions - congenital PLT disorder, chronic aspirin use, uremia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
each unit of transfused PLT should increase the PLT count by ?
5-10k
26
4 hemostasis promoting agents
1. protamine sulfate 2. vit K 3. desmopressin 4. thrombin
27
neutralizes heparin and could result in severe hypotensive or anaphylactoid-like reactions (BBW)
protamine sulfate reverses anticoagulant effect of heparin
28
dosage of protamine sulfate
depends on dosage of heparin
29
what is the reversal agent for warfarin (coumadin)
vitamin K (phytonadione)
30
dosage and route of vit K depends on:
1. severity of bleeding 2. INR 3. procedure planned
31
MOA of desmopressin (DDAVP)
increases plasma level of vWF, factor VIII, and tPA = shortened activated partial thromboplastin time (aPTT) and bleeding time
32
indication for desmopressin and what must you monitor
hemostasis - restrict fluid intake - monitor sodium levels
33
MOA of topical thrombin
converts fibrinogen to fibrin directly at site
34
indication for topical thrombin
hemostasis whenever oozing blood and minor bleeding
35
contraindications for topical thrombin
1. sensitivity to components of bovine origin 2. massive bleeding 3. large vessels
36
3 classes of antithrombotic drugs
1. antiplatelet 2. anticoagulant 3. fibrinolytic agents
37
general indication for anticoagulants
prevent or treat clots!
38
contraindications for anticoagulants (3)
1. bleeding 2. impaired renal function 3. allergic
39
4 parenteral anticoagulants
1. heparin (unfractionated) 2. low-molecular-weight heparin (LMWH) 3. bivalirudin (angiomax) 4. argatroban (acova)
40
MOA of unfractionated heparin
binds to antithrombin (III) = no activation of factor Xa and thrombin
41
no dosage adjustment is necessary for who when taking unfractionated heparin
renal patients
42
when on unfractionated heparin, you must monitor:
activated partial thromboplastin time (aPTT) order daily CBC, monitor signs of bleeding
43
4 SE of unfractionated heparin
1. bleeding 2. thrombocytopenia 3. osteoporosis 4. elevate levels of transaminases
44
7 contraindications for unfractionated heparin
1. HIT 2. hypersensitivity 3. active bleeding 4. hemophilia (inherited bleeding disorder in which the blood does not clot properly) 5. significant thrombocytopenia 6. purpura 7. severe HTN
45
what is HIT?
heparin-induced thrombocytopenia induces immune antibody response resulting in PLT clearance and may also induce hypercoagulable state
46
when can HIT occur?
any dose, schedule, and route *more common in females*
47
what is the most common manifestation of HIT
thrombocytopenia a platelet count drop of >50% of baseline is typical
48
typical onset of HIT occurs ? after the initiation of heparin
5-10 d takes 5-7 d to return to baseline following withdrawal
49
what is the most common thrombi in HIT and where is it most common
venous sites: leg veins, cardiac vessels, small venules of skin
50
5 signs of suspected HIT
1. new onset of thrombocytopenia <150k 2. drop in PLT of +50% from prior value 3. venous/arterial thrombosis 4. necrotic skin lesions at injection site 5. acute systemic reactions
51
what is the 4Ts scoring system for assessing HIT
1-3 = low 4 or 5 = intermediate 6-8 = high
52
how do you manage HIT
1. **STOP** heparin 2. **start anticoagulation with a non-heparin anticoagulant** 3. long-term oral anticoagulation (warfarin) with bridging drug (lovenox) (do not give platelet transfusion)
53
lovenox
LMWH
54
enoxaparin
LMWH
55
MOA of LMWH
enhance inhibition of factor Xa by AT III = less direct inhibition of Xa and virtually no direct inhibition of thrombin
56
contraindication for LMWH
renal impairment/ESRD reduced dosing with CrCl <30
57
monitoring for LMWH
not necessary most of the time recommended in: - pregnancy - CrCl <30 - morbid obesity
58
SE of LMWH
same as heparin but less common - bleeding - HIT -osteoporosis
59
what is recommended over heparin?
LMWH LMWH is pregnancy cat. B heparin is pregnancy cat. C
60
what are the pros and cons of LMWH over heparin?
advantages: - better bioavailability and longer half-life - dose-independent CL - predictable anticoagulant response - lower risk of heparin-induced thrombocytopenia - lower risk of osteoporosis consequences: - can be given SQ 1-2x daily for both prophylaxis and treatment - simplified dosing - coagulation monitoring is unnecessary in most patients - safer tan heparin for short/long term - safer than heparin for extended administration
61
what is often used as a bridging drug?
lovenox
62
when should bridging should be done?
before and after surgery or invasive procedures in a pt already on warfarin with the following circumstances: 1. embolic stroke within past 3 months 2. previous embolic stroke or VTE during interruption of chronic anticoagulation 3. mechanical heart valve 4. A Fib with high stroke risk
63
MOA of argatroban
direct, highly-selective thrombin inhibitor reversibly binds to active thrombin site = inhibits fibrin formation
64
Dose reduction of argatroban with who? how do you adjust dosing?
liver impairment measure aPTT to adjust dose
65
onset of argatroban is ____
immediate
66
indications for argatroban
HIT
67
what is the most severe SE of argatroban
bleeding
68
MOA of bivalirudin
direct, highly-selective thrombin inhibitor reversibly binds to the active thrombin site
69
CL of bivalirudin
renally must reduce dosing with renal impairment
70
indications for bivalirudin
alternative to heparin in pt underoging percutaneous coronary intervention (PCI), esp hx of HIT
71
2 oral anticoagulants
1. warfarin 2. DOACs
72
what is a vitamin K antagonist
warfarin
73
MOA of warfarin
inhibits vit K oxide reductase complex subunit I = inhibits factors II, VII, IX and X
74
when on warfarin, you must monitor ___ for dosage adjustments
PT/INR *no dosage adjustments with renal impairment*
75
what is the pregnancy risk factor of warfarin
preg cat D for those with mechanical heart valve and X for all others
76
indications for warfarin
1. prophylaxis and tx for thromboembolic disorders (DVT/PE) 2. embolic complications arising from afib or cardiac valve replacement
77
major SE of warfarin
bleeding
78
dietary interactions of warfarin
1. alcohol - avoid!! - binge drinking - decreases metabolism of warfarin, increases PT/INR - chronic daily alc - increases metabolism, decreases PT/INR 2. foods - rich in vit K - can decrease effects of warfarin - vit E - can increase - cranberry juice - can increase (maintain a consistent diet)
79
dabigatran (pradaxa)
DOAC
80
rivaroxaban
DOAC
81
apixaban
DOAC
82
edoxaban
DOAC
83
MOA of dabigatran (pradaxa)
inhibits thrombin direct thrombin inhibitor
84
indications for DOACs
1. stroke prevention in: - nonvalvular afib - DVT/PE - DVT/PE prophylaxis after hip/knee arthroplasty
85
what is given to pts on dabigatran (pradaxa) to reverse anticoagulant effects for emergency surgery/urgent procedures or in life-threatening or uncontrolled bleeding
praxbind (idarucizumab)
86
MOA of rivaroxaban (xarelto)
inhibits factor Xa
87
why are DOACs more convenient to administer than warfarin
given in fixed doses without routine coagulation monitoring *no monitoring required for dosage adjustment*
88
what is given to pts on rivaroxaban (xarelto) to reverse anticoagulant effects for emergencies
AndexXa
89
MOA of apixaban (eliquis)
inhibits factor Xa
90
pts on apixaban (eliquis) should not take with _____
grapefruit juice avoid cyp3A4 inhibitors
91
what is given to pts on apixaban (eliquis) to reverse anticoagulant effects during emergencies
AndexXa
92
MOA of edoxaban (savaysa)
inhibits factor Xa
93
DOACs dosing are reduced with ?
renal impairment
94
Main SE of DOACs
bleeding
95
MOA of aspirin
inhibits COX-1 production - enzyme in biosynthesis of thromboxane A2
96
what irreversibly acetylates COX enzymes
aspirin
97
when taking clopidogrel, what should you avoid?
other drugs that inhibit CYP2C19 - omeprazole - esomeprazole can reduce effects of clopidogrel
98
MOA of clopidogrel (plavix)
1. inhibit ADP pathway of PLT 2. *irreversibly* blocks ADP receptor (P2Y12) **requires metabolic activation**
99
MOA of prasugel (effient)
*irreversibly* blocks ADP receptor (P2Y12) **requires metabolic activation**
100
contraindication for prasugrel (effient)
hx of TIA or CVA
101
what irreversibly blocks ADP receptor (P2Y12) and triggers activation of GPIIb/IIIa receptor complex = reduces platelet aggregation
ticlopidine (ticlid)
102
SE of ticlopidine
hematologic rxns: - neutropenia - agranulocytosis - thrombotic thrombocytopenia purpura (TTP) - aplastic anemia
103
MOA of ticagrelor (brilinta)
*reversibly* and non-competitively binds to ADP P2Y12 receptor on platelets = prevents ADP-mediated activation of the GPIIb/IIIa receptor complex = reduces platelet aggregation *does NOT require metabolic activation*
104
MOA of cangrelor (kengreal)
*reversibly* and non-competitively binds to ADP P2Y12 receptor on platelets = prevents ADP-mediated activation of the GPIIb/IIIa receptor complex = reduces platelet aggregation
105
what is the onset of cangrelor (kengreal)
immediate
106
MOA of eptifibatide (integrilin), Abciximab (reopro)
GPIIb/IIa receptor inhibitor = blocks receptors = inhibiting PLT aggregation and activation
107
SE of eptifibatide (integrilin), Abciximab (reopro)
1. bleeding 2. thrombocytopenia - immune mediated
108
major SE platelet aggregation inhibitors
bleeding
109
what do you use to breakdown thrombi in a life-threatening setting or massive thrombi
fibrinolytics
110
MOA of fibrinolytics
converts plasminogen to plasmin = degrades fibrin matrix of thrombi = makes soluble fibrin degradation products
111
alteplase (tPA)
fibrinolytic
112
streptokinase
fibrinolytic
113
what activates plasminogen already bound to fibrin, which confines fibrinolysis to the formed thrombus = avoiding systemic activation
alteplase (tPA)
114
what is a protein created by streptococci that combines with proactivator plasminogen = catalyzes conversion of inactive plasminogen to active plasmin
streptokinase
115
contraindication of streptokinase
ischemic stroke
116
why must plasma be transfused within 24h once thawed?
concentrations of factor V and VIII declines
117
monitoring for DOAC
none!
118
Which DOAC does not have an emergency reversal
edoxaban
119
what inhibits COX-1 and competes with ASA at the catalytic site
NSAIDs
120
ASA should be taken at least ____ before or ____ after NSAIDs
60mins 8hrs
121
BBW of ticagrelor (brilinta)
reduced effectiveness with concomitant use of ASA above 100 mg daily
122
contraindications for ticagrelor (brilinta)
severe liver failure active bleeding
123
which platelet aggregation inhibitor requires routine monitoring
ticlopidine (ticlid)
124
pts on rivaroxaban (xarelto) should avoiding taking ____
grapefruit juice avoid CYP3A4 inhibitors
125
what DOAC should you not use if CrCl > 95 mL/min
edoxaban (savaysa)
126
what are the 3 platelet aggregation inhibitors that can be given IV
1. congrelor - kengreal 2. eptifibatide - integrilin 3. abciximab - reopro
127
why is bridging necessary when on warfarin
to avoid skin necrosis
128
3 non-heparin anticoagulants
1. argatroban 2. fondaparinux 3. bivalirudin
129
drug interactions with dabigatran (pradaxa)
ketoconazole, cyclosporin, tacrolimus

Hem/Onc (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions