Pharmacology Hematology

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Pharmacology Hematology
2015-06-29 09:41:06
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  1. Name 7 classes of hematological meds
    • Parenteral anticoagulant
    • Oral anticoagulant
    • Direct thrombin inhibitor
    • Direct inhibitor of Factor XA
    • Antiplatelets
    • Thrombolytic
  2. Name a low molecular weight heparin (LMWH)
  3. Name the parenteral anticoagulant prototype and its antidote
    • heparin
    • Protamine sulfate
  4. When would LMWH typically be used as opposed to Heparin
    • DVT
    • PE
    • MI complications
  5. Name 4 common side effects of heparin
    • Hemorrhage
    • Thrombocytopenia
    • Hypersensitivity
    • Toxicity/Overdose
  6. Name an effect of enoxaparin that does not occur with heparin
    Neuro damage from hematoma from spinal/epidural anesthesia
  7. What is the normal value of aPTT
    60-80 seconds
  8. At what platelet level should heparin be discontinued
  9. What 3 labs should be monitored for a patient on heparin
    CBC, platelets, Hct
  10. How often should the rate of infusion of heparin be monitored
    q 30-60 min
  11. Where should deep subcutaneous injections of heparin be administered
    2 in from the umbilicus
  12. What do you instruct the patient not to do when administering enoxaparin at home
    expel the air bubble
  13. Prototype and antidote of oral anticoagulant
    • Warfarin
    • Vitamin K
  14. 3 side effects of warfarin
    • Hemorrhage
    • Hepatitis
    • Toxicity
  15. What labs should be monitored for a patient on warfarin
    PT and INR (also CBC, platelet, Hct)
  16. What is the normal value of PT? INR?
    • 18-24 sec
    • 2-3 sec
  17. How long does it take for warfarin to take effect
    • Starts: 8-12 hrs
    • Full effect: 3-5 days
  18. How long does warfarin last after it is discontinued
    5 days
  19. Name the prototype of Direct thrombin inhibitors and another drug in its class
    • Dabigatran
    • Argatroban
  20. Name 2 common side effects of direct thrombin inhibitors
    • Bleeding
    • GI (n/v, esophageal reflux, ulcer)
  21. How do you instruct a patient to take dabigatran
    with food to minimize GI upset
  22. Name 2 side effects of direct inhibitors of Factor XA
    • Bleeding
    • Increased liver enzymes (AST/ALT, bilirubin)
  23. What is the prototype of Direct inhibitor of Factor XA
  24. Name 2 sub-classes that fall under Antiplatelets and their prototype
    • Salicylate: Aspirin
    • ADP inhibitors: Clopidogrel
  25. 3 common side effects of aspirin
    • Bleeding
    • Tinnitus
    • GI (n/v, dyspepsia)
  26. Name 2 side effects of clopidogrel
    • Bleeding
    • GI (diarrhea, dyspepsia, pain)
  27. What dose of aspirin is recommended to prevent stroke, MI, and reinfarction
    81 mg
  28. What dose of aspirin should be taken during initial acute MI
    325 mg
  29. When should clopidogrel be discontinued before surgery
    7 days prior
  30. What is the prototype of thrombolytic meds
    Alteplase (plase)
  31. When is a thrombolytic agent most effective
    As soon as manifestations occur (within 3 hours)
  32. Name 3 sub classes of Growth Factors
    • Erythropoeitic
    • Leukopoeitic
    • Thrombopoeitic
  33. What is the prototype of Erythropoeitic growth factor
    Epoetin alfa
  34. 4 common side effects of erythropoeitin growth factor
    • HTN
    • Risk for thrombotic event or seizures
    • Risk for DVT in pre-op
    • HA/body aches
  35. What is the prototype of Leukopoeitic growth factor
  36. 3 side effects of Leukopoeitic growth factor
    • Bone pain
    • Leukocytosis (WBC <100,000 or absolute neutrophil count >10,000)
    • Splenomegaly (LUQ pain, shoulder tip pain)
  37. Name 5 important types of blood and blood products
    • Whole blood
    • FFP
    • PRBC
    • Platelet
    • Albumin
  38. When would whole blood be given
    • Replace acute blood loss from injury or surgery
    • (burns, dehydration, shock)
  39. When would PRBC be given
    Severe anemia (Hgb 6-10)
  40. When would platelets be given
    • Thrombocytopenia (<20,000)
    • Aplastic anemia
    • Chemo BMS
    • Active bleed (<50,000)
  41. When would FFP be given
    • Hemorrhage
    • Burns
    • Shock
    • DIC
    • TTP
    • Reverse warfarin
    • Replace coagulation factors
  42. When would albumin be given
    • Hypovolemia/albuminemia
    • Burns
    • Acute respiratory distress
    • Bypass surgery
    • Hemolytic disease of newborn
  43. Name 8 types of side effects from administration of blood or blood products
    • Acute hemolytic
    • Febrile nonhemolytic
    • Anaphylactic
    • Mild allergic
    • Circulatory overload
    • Sepsis
    • Hyperkalemia
    • Graft-vs-host disease
  44. Adverse reaction when administering blood products that has symptoms of chills, fever, LOW BACK PAIN, tachycardia, tachypnea, and hypotension
    Acute hemolytic reaction
  45. Adverse reaction when administering blood products that has symptoms of SUDDEN CHILLS, fever, HA
    Febrile nonhemolytic
  46. Adverse reaction when administering blood products that has symptoms of flushing, itching, urticaria
    Mild allergy
  47. Adverse reaction when administering blood products that has symptoms of cough, SOB, crackles, HTN, tachycardia, JVD
    Circulatory overload
  48. Adverse reaction when administering blood products that has symptoms of RAPID onset of chills and fever, v/d, hypotension, shock
  49. Adverse reaction when administering blood products that has symptoms of bradycardia, hypotension, irregular heartbeat, paresthesia of extremities, muscle twitching
  50. Adverse reaction when administering blood products that has symptoms of N/V, weight loss, hepatitis, and thrombocytopenia 1-2 weeks following transfusion
    Graft-vs-host disease
  51. List the steps to take in the event of a blood transfusion reaction
    • STOP transfusion
    • Notify PCP
    • Administer 0.9% NaCl through new tubing
    • Document
    • Monitor VS and UO (stay with pt)
    • Send blood bag & IV tubing to blood bank
    • Get urine specimen (if hemolytic suspected insert indwelling catheter)
    • Repeat type & cross match, obtain CBC and bilirubin
    • Complete transfusion log sheet
  52. What should the nurse do PRIOR to administering a blood transfusion
    • Assess lab values & blood transfusion history
    • Verify prescription
    • Informed consent signed
    • Assess risk for fluid overload
    • Baseline vitals
  53. What gauge needle should be used to administer blood products
    20 gauge
  54. What do you prime IV and tubing with when administering blood products
    0.9% NaCl
  55. When should whole blood or PRBC transfusion be completed
    2-4 hrs
  56. When should platelet transfusion be completed
    15-30 min/unit
  57. When should FFP transfusion be completed
    30-60 min/unit
  58. What blood product should be administered for a client with increased aPTT