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Advanced Pharmacology
Coagulation
20
Medical
Graduate
12/12/2010

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Cards

Term
What is the gold standard for coagulation?
Definition
*Heparin
Term
What pathway(s) does heparin work on?
Definition

*Intrinsic

*Common Pathway

Term
What lab values are affected by Heparin?
Definition

*PTT

*ACT

Term
The presence of what factor is required for Heparin to work?
Definition
*Antithrombin III
Term
What does AT III do?
Definition
*Increases the effectiveness of heparin by 1000 fold
Term
What is the onset of heparin and when is someone said to be fully heparinized?
Definition

*Onset: immediate

*fully heparinized: 3 minutes

-ACT should be 400-450

Term
What is the dose of heparin?  What is the half life?
Definition

*50-300u/kg

*60-90 minutes

Term
What are the side effects of heparin?
Definition

*Hemorrhage

*Thrombocytopenia

*Hypotension (Less common)

Term
What is the reversal for heparin?  What is the most common reason for heparin not working?
Definition

*Protamine Sulfate

*AT III Deficiency

Term
What is protamine sulfate used for?
Definition
*Heparin reversal
Term
What is the dose of Protamine sulfate for heparin reversal>
Definition
*1mg to 100u Heparin
Term
How does Protamine sulfate inactivate Heparin?
Definition

*Neutralization Reaction

*Forms a complex

Term
What is the onset and duration for Protamine Sulfate?
Definition

*30 sec - 1 minute

*Duration: 2 hours

Term
What can occur with rapid IV administration of Protamine Sulfate?
Definition

*A huge histamine release

-Hypotension

-Bronchospasm

-Tachycardia

Term
Which patients are at an increased risk for allergy?
Definition

*Pts allergic to fish

*Past vasectomy

*Previous exposure to protamine

*NPH insulin use

Term
What is the MOA of desmopressin acetate?
Definition
*Increases plasma levels of Factor VIII by causing release of vWF from endothelial cells
Term
What is the MOA of aspirin?
Definition
*Irreversible acetylation of cyclooxygenase
Term
What are the effects of aspirin and what are the anesthetic implications?
Definition

*Impaired platelet aggregation

*May prolong PT time

*Irreversibly binds for life of platelet

-7-10 days

*If pt is on ASA and emergency surgery is necessary, administer platelets

Term
What is the MOA of NSAIDS?
Definition
*Temporary inhibition of COX pathway
Term
What are the effects of NSAIDS and anesthetic implications?
Definition

*Platelet aggregation is impaired 

*No reversal

*Medications should be stopped 72 hours prior to surgery

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