38. How long does it take for Vitamin K to take effect?
39. How long does it take for FFP to work?
40. How long do the effects of FFP last?
41. What does cryoprecipitate contain?
vWF, Factor VIII, and fibrinogen
42. What does FFP contain?
All factors including labile Factors V and VIII, AT- III, protein C and S
43. What is the best method for detecting pts. at risk for bleeding?
A complete history and physical exam
44. What is the most common congenital bleeding disorder?
Von Willebrand's disease
45. What factor is deficient in hemophilia A?
46. What is the preoperative treatment for hemophilia A?
Factor VIII infusion to 100% normal preoperative levels
47. What factor is deficient in Hemophilia B?
48. What is the treatment for hemarthrosis in a pt. w/ hemophilia A?
Initial therapy includes Factor VIII, joint rest, cold packs (3-5 days) and a compression dressing (3-5 days); Followed by active range of motion exercised 24 hrs. after Factor VIII therapy.
49. What receptor deficiency is found in Glanzmann's thrombocytopenia?
GpIIb/IIIa receptor deficiency; platelets can not bind to each other
50. What receptor deficiency is found in Bernard Soulier disease?
GpIb receptor deficiency; platelets can not bind to collagen
51. What are the desired platelet counts and Hct for a pt. with polycythemia vera before an elective operation?
Plt < 400,000/mL and Hct < 48%
52. What protein does Heparin bind to for its anti-coagulation effects?
Anti-thrombin III; Heparin-antithrombin III complex then binds factor IX, X, XI
53. What is the half-life of heparin?
54. What is the dose of protamine to reverse 100 U or 1 mg of heparin?
55. What signs will you see in a protamine reaction?
Bradycardia, hypotension, and decreased heart function
56. How does warfarin induced skin necrosis occur?
Protein C and S have a shorter half life than Factors II, VII, IX, and X. Coumadin leads to a decrease in Protein C and S before the other factors leading to a hypercoagulable state
57. Pts. with this deficiency are at increased risk for Warfarin induced skin necrosis?
Protein C deficiency
58. What is the desired activated clotting time for routine anticoagulation?
59. What is the desired activated clotting time for cardiopulmonary bypass?
60. What INR is a contraindication to intramuscular injection?
INR > 1.5
61. What are the absolute contraindications to the use of thrombolytics?
Recent CVA (<2 months), intracranial pathology, and active internal bleeding
62. What are the indications for an IVC filter?
Pts. who have undergone a pulmonary embolectomy, pts. with documented PE while anticoagulated, pts. with free floating femoral, ileofemoral, IVC DVT, pts. with contraindication to anticoagulation, and pts. at high risk for DVT (head injured/orthopedic injured on prolonged bed rest)"
63. What is Argatroban?
A synthetic direct thrombin inhibitor derived from L-arginine
64. What is Hirudin?
An irreversible direct thrombin inhibitor derived from leeches
65. What is Ancrod?
Malayan pit viper venom that stimulates tPA release