Schoenwald - Lab Review/Coagulation

Question 1

are abnormal labs called in to the provider/nursing staff

Answer 1

no!

Question 2

what labs are called into the provider/nursing staff

Answer 2

critical lab values

Question 3

what are critical labs

Answer 3

values that are potentially life threatening to the pt

Question 4

what med can have major ddi w. Warfarin

Answer 4

Bactrim

also Rifampin

Question 5

critical values for platelets

Answer 5

< 2,000 → brain hemorrhage

>1,000,000 → clots

Question 6

critical value for INR

Answer 6

>400

Question 7

critical value for bands

Answer 7

>30%

Question 8

bands >10%

Answer 8

left shift

Question 9

critical value for HCT

Answer 9

<14%

>60%

Question 10

critical value for WBC

Answer 10

<2.0

>35.0 x 10³

Question 11

critical value for serum glucose

Answer 11

< 40

>500

Question 12

critical value for K+

Answer 12

<2.5

>6.5

Question 13

what antibiotic can cause hyperkalemia

Answer 13

bactrim

Question 14

critical values for Na

Answer 14

< 120

>160

Question 15

critical value for pO2

Answer 15

40 mm Hg

Question 16

critical pH value

Answer 16

<7.2

>7.6

Question 17

critical value for CO2

Answer 17

<20

>70

Question 18

critical microbiology labs

Answer 18

(+) blood culture

gram stains on CSF/body fluids

(+) strep screen

(+) flu

(+) COVID

positive cdiff

Question 19

for COVID, antivirals/monoclonal abs need to be started w.in

Answer 19

5 days

Question 20

antivirals for flu need to be started w.in

Answer 20

48 hr

Question 21

prothrombin time (PT) depends on

Answer 21

vitamin K dependent factors:

II

V

VII

X

Question 22

clotting factor deficiencies can be caused by (3)

Answer 22

inherited

acquired

meds

Question 23

8 conditions that may result in factor deficiency

Answer 23

liver dz

DIC

fibrinolysis

congenital deficiency

heparin

warfarin

AI

vit K deficiency

Question 24

PT measures __ pathways (2)

Answer 24

extrinsic

common

Question 25

what lab is used to monitor warfarin

Answer 25

PT

Question 26

therapeutic range for pt on Warfarin (w. no prosthetic valve)

Answer 26

2.0-3.0

Question 27

PTT measures __ pathways (2)

Answer 27

common intinsic

Question 28

PTT is used to measure __ therapy, but not __ therapy

Answer 28

heparin lmwh

Question 29

d-dimer is a fragment of __ degradation

Answer 29

fibrin

Question 30

Ddimer has a high negative predictive value for \_\_

Answer 30

DVT/PE

Question 31

3 major rf for clotting

Answer 31

pregnancy/recent childbirth antiphospholipid syndrome factor V Leiden

Question 32

2 main sx of DVT

Answer 32

unilateral leg pain/swelling discoloration of leg

Question 33

2 major sx of PE

Answer 33

SOB chest pain worse w. taking deep breath or coughing

Question 34

what do you think when you see lowe platelets in someone on heparin

Answer 34

heparin induced thrombocytopenia (HIT)

Question 35

what do you think when you see autoimmune cardiolipin abs

Answer 35

antiphospholipid syndrome

Question 36

abs associated w. antiphospholipid syndrome (3)

Answer 36

lupus anticoagulant anticardiolipin anti B2GPI

Question 37

lab criteria for antiphospholipid syndrome

Answer 37

positive for 1 autoantibody on 2 or more occasions 12 weeks apart

Question 38

tx for antiphospholipid syndrome

Answer 38

lifelong coagulation

Question 39

tx for antiphospholipid in pregnant pt

Answer 39

LMWH

Question 40

warfarin is a class __ in pregnancy

Answer 40

X

Question 41

t/f: NOACS are contraindicated in pregnancy

Answer 41

F!

Question 42

mc **hereditary** blood coagulation d.o in US

Answer 42

factor V leiden

Question 43

other inherited clotting d.o

Answer 43

prothrombin 20210 mutation MTHFR mutation protein C protein S

Question 44

only anticoagulant that prevents activation of new clotting factors

Answer 44

warfarin

Question 45

3 indications for Warfarin

Answer 45

prophylaxis and tx for: DVT PE afib

Question 46

warfarin inhibits __ clotting factors

Answer 46

vit K

Question 47

what lab value is used to monitor warfarin

Answer 47

INR

Question 48

con of warfarin

Answer 48

many DDI's

Question 49

method of administration for unfractionated heparin

Answer 49

IV only → used for bridging

Question 50

monitoring for unfractionated heparin

Answer 50

PTT CBC (for HIT)

Question 51

reversal agent for unfractionated heparin

Answer 51

protamine sulfate

Question 52

other names for LMWH

Answer 52

fragmin lovenox

Question 53

3 indications for LMWH

Answer 53

prophylaxis of DVT/PE unstable angina nonQ wave MI

Question 54

LMWH is used as a bridge w. __ until INR is therapeutic

Answer 54

warfarin

Question 55

t/f: LMWH is contraindicated in pregnancy

Answer 55

F!

Question 56

reversal agent for LMWH

Answer 56

protamine sulfate

Question 57

black box warning for LMWH

Answer 57

epidural catheter, lumbar puncture, or spinal hematoma cam result in **permanent paralysis at the level of the procedure**

Question 58

you must wait __ after spinal procedure to administer LMWH

Answer 58

24 hr

Question 59

t/f: the NOACs/DOACs do not have risk for paralysis if used \< 24 hr after spinal procedure

Answer 59

F! → must also wait 24 hr after procedure to administer

Question 60

what are the DOACs

Answer 60

bivalirudin (angiomax) dabigatran (pradaxa) apixaban (eliquis) rivaroxaban (xarelto) edoxaban (savaysa)

Question 61

which of the NOACs are direct thrombin inhibitors

Answer 61

bivalirudin (angiomax) dabigatran (pradaxa)

Question 62

which NOACs are factor Xa inhbitors

Answer 62

apixaban (eliquis) rivaroxaban (xarelto) edoxaban (savaysa)

Question 63

andexxa is the reversal agent for

Answer 63

apixaban rivaroxaban

Question 64

3 sx of von willibrand dz

Answer 64

frequent nosebleeds easy bruising excessive bleeding w. procedures

Question 65

pharm for von willibrand dz

Answer 65

DDACP → synthetic vasopressin

Question 66

labs for von willibrand

Answer 66

prolonged bleeding time +/- PTT elevation *normal PT*

Question 67

inappropriate clotting mechanism → futile clotting AND bleeding

Answer 67

DIC

Question 68

tx for DIC

Answer 68

heparin

Question 69

labs for DIC

Answer 69

everything out of whack!

Question 70

only value that is decreased in DIC

Answer 70

platelets → they are getting used up quicker than they can be produced