Vas 245: Medical Managment Of Dvt

Front 1

_______________ is specifically for prevention of coaguability

Back 1

Prophylaxis

Front 2

Prophylactic measures _____________

Back 2

reduce venous stasis & coagulability of blood

Front 3

How does a patient's activity level a prophylactic measure?

Back 3

- Pt's who are mobile have reduced incidence of thromboembolism

Front 4

What should surgical pt do?

Back 4

Remain active

- Pre-hospital admission

- Resume walking/physical therapy exercises ASAP post-hospital

Front 5

What are 4 ways prophylactic measures for stasis?

Back 5

- Elevation

- Mechanical Pedaling

- Pneumatic Devices

- Elastic Compression

Front 6

T or F:

Pt's should be positioned w/LE below right atrium

Back 6

FALSE:

Positioned w/LE ABOVE right atrium

Front 7

What does positioning a pt w/LE above right atrium do

Back 7

Causes an increase in venous return

Front 8

If venous return is increased than ______________

Back 8

venous stasis is reduced

Front 9

What reduces venous flow during surgery?

Back 9

anesthesia

Front 10

IF venous flow is reduced by anesthesia, then what is the best position during surgery?

Back 10

Trendelenberg

Front 11

T or F:

Pneumatic Devices is passive dorsiflexion of foot during surgery that reduces incidence of DVT

Back 11

FALSE:

MECHANICAL PEDALING is passive dorsiflexion of foot during surgery that reduces incidence of DVT

Front 12

Pneumatic Devices are an _________________ at the foot of the bed and have multiple ____________________

Back 12

- Air pump

- Multiple diaphragm cuff that fits the whole calf

Front 13

Why are elastic compressions used?

Back 13

Elastic bandages are used to collapse the superficial veins

Front 14

T or F:

Elastic compressions are used to increase flow into the superficial system

Back 14

FALSE:

- The compressions collapse the superficial veins

* Increase flow in the DEEP system

Front 15

T or F:

Compression should be minimal at the foot and maximal at the thigh

Back 15

FALSE:

Compression should be MAXIMAL AT FOOT and MINIMAL AT THIGH

Front 16

What are 4 types of prophylactic medications that are used to affect the coagulability of blood?

Back 16

- ASA

- Heparin

- Warfarin

- Lovenox

Front 17

T or F:

Aspirin dissolves clots

Back 17

FALSE:

It decreases platelet aggregation >>> prevents more from forming

* Decreases thrombus formation >>> incidence of DVT

Front 18

ASA is a ____________ agent

Back 18

antiplatelet agent

Front 19

T or F:

There is one general dosage range of ASA

Back 19

FALSE:

SEVERAL different ASA dosage ranges

Front 20

If a pt was already being anticoagulated would you expect them to also be on ASA?

Back 20

No --- ASA thins blood

* Could make pt too anticoagulated

Front 21

What are 2 comps of ASA?

Back 21

- Thrombocytopenia

- GI bleeds

Front 22

Thrombocytopenia is a comp of ASA because _____________

Back 22

the platelet count lowers to dangerous levels

Front 23

_________________ is one of the most widely used drugs for vascular pts

Back 23

Heparin

Front 24

How does Heparin make the blood thinner?

Back 24

It augments the action of Antithrombin III

Front 25

When given in adequate amts, Heparin can _____________

Back 25

-prevent formation and/or extension of thrombus

Front 26

What is standard tx if DVT is prox or in Pop V ?

Back 26

Heparin

Front 27

What is a loading dose>

Back 27

A dose higher than the avg or maintenance doses

Front 28

When is the loading dose used?

Back 28

At the INITIATION of therapy to rapidly establish a desired level of the drug

Front 29

If prophylactic measures are being taken then _______________

Back 29

the loading dose & maintenance dose are equal

Front 30

For DVT tx, Heparin is administered by IV loading bolus followed by _______________

Back 30

maintenance doses given 2-3 times/day until pt is ambulatory

Front 31

How long is therapy maintained for heparin?

Back 31

5-7 days

Front 32

What is important in avoiding comps of Heparin?

Back 32

Monitoring of the pt's anticoagulant response

Front 33

Prior to discharge a pt's heparin dosage is usually decreased and they are started on ____________

Back 33

coumadin

Front 34

T or F:

Coumadin is an IV therapy

Back 34

FALSE:

Oral anticoagulation

Front 35

The generic name for Coumadin is ___________-

Back 35

Warfarin


* Coumadin is the brand name

Front 36

Coumadin is indicated for use after ____________

Back 36

heparin or thrombolytic therapy

Front 37

Coumadin is indicated for use after heparin or thrombolytic therapy for what 5 things?

Back 37

- DVT

- PE

- Prosthetic Heart valve replacements

- Chronic A-Fib

- Intermittent A-Fib

Front 38

How does Coumadin work?

Back 38

It inhibits the synthesis of vitamin K dependent clotting factors by the liver

Front 39

Why is an effective dose a fine line?

Back 39

- Fine line between preventing clotting w/o bleeding comps

Front 40

Why would a pt have to be on coumadin long-term?

Back 40

Pt's w/DVT or PE may require long-term therapy to prevent recurrent disease

Front 41

If first episode then therapy may last

Back 41

3-6 months in the absence of other risk factors

* ( cancer & stasis)

Front 42

If pt presents w/recurring DVT _____________

Back 42

prob have to be on coumadin for several years

Front 43

If recurrent DVT & other risk factors involved _____________

Back 43

Indefinite therapy may be indicated

Front 44

What are 2 advantages of coumadin?

Back 44

- Oral form

- Long term therapy

Front 45

What are the 3 disadvantages of coumadin?

Back 45

- Prolonged action time

- Must be discontinued 2-3 days before surg/dental procedures

- Pts need to be very compliant to safely take this drug

Front 46

Prolonged action time because ______________

Back 46

may take several days to reach therapeutic levels

Front 47

What must it be discontinued 2-3 days prior to surg/dental procedures?

Back 47

To assure normal clotting

Front 48

Pt are compliant by _____________

Back 48

having regular protimes >>> taking at same time everyday

Front 49

What is another name for Lovenox?

Back 49

Enoxaparin sodium

Front 50

What is Lovenox?

Back 50

A low-molecular weight Heparin

Front 51

What does having a lower molecular weight mean?

Back 51

It is less toxic than Heparin

Front 52

It is a form of Heparin w/a ______________

Back 52

longer biologic half-life

Front 53

Smaller amounts of this preparation produced a ____________

Back 53

greater effect than traditional forms

Front 54

Lovenox has unique pharmacological properties and _____________

Back 54

more predictable anticoagulant response

Front 55

T or F:

An advantage of Lovenox is that it is long term therapy

Back 55

FALSE:

That's an advantage of Coumadin

Front 56

What is the advantage of Lovenox?

Back 56

Advantage of allowing DVT to be treated in the home setting rather than in the hospital

Front 57

It increases pt convenience and decreases ____________

Back 57

health costs

Front 58

Where is Lovenox injected?

Back 58

subcutaneously

Front 59

How often is Lovenox injected?

Back 59

Every 8-12 HR

Front 60

T or F:

The pt cannot inject themselves w/the Lovenox

Back 60

FALSE:

Either by pt or caregiver primarily at home

Front 61

Which anticoagulant is the safest for pregnancy patients?

Back 61

Lovenox

Front 62

How does protimes affect Coumadin & Levonox?

Back 62

Doses may change frequenctly depending on protime

Front 63

T or F:

Protime is decided by the pt

Back 63

FALSE:

Protimes must be checked consistently as ordered by the physician

Front 64

What are the signs to watch for when on Coumadin or Levonox?

Back 64

- Watch for signs of bleeding: gums, stools, urine

Front 65

What should be avoided while on Coumadin or Levonox?

Back 65

Excessive injuries

Front 66

What is used for assessment of coagulation?

Back 66

A widely used test in the US is PT

Front 67

What does PT stand for?

Back 67

Prothrombin time

* Also called protime

Front 68

How does PT test work?

Back 68

Measurement of clotting time is evaluated

Front 69

What is the normal plasma clotting time?

Back 69

11-13 seconds

Front 70

If a pt is on anticoagulation therapy, how should clotting time be affected?

Back 70

It should take longer for the blood to clot

Front 71

"target ranges" will vary depending on ______________

Back 71

clinical diagnosis and use

Ex: A pt w/heart valve replacement may be adjusted to show PT of 18-20 seconds

Front 72

T or F:

The INR variability is when the same test performed in different hospitals or labs can yield different results

Back 72

FALSE:

PT INVARIABILITY

Front 73

Why is PT invariability an issue?

Back 73

These variations can lead to differing tx decisions

Front 74

What was the standardized method developed to reduce this variability?

Back 74

INR = standardized PT test (internationally)

Front 75

What does INR stand for?

Back 75

International Normalized Ratio

Front 76

Pt has a 2.0-3.0 INR, what does this mean?

Back 76

It takes 2-3 times longer to clot than the control (clotting time)

Front 77

INR of 1.0 means _____________

Back 77

Indicates no anticoagulant effect at all

Front 78

What INR represents normal clotting time?

Back 78

1.0

Front 79

What INR is considered dangerous?

Why?

Back 79

INR of 5.0

- Because the pt is bleeding 5 times as fast

Front 80

T or F:

Most labs adjust anticoagulant level to the PT level

Back 80

FALSE:

Most labs adjust anticoagulant level to the INR LEVEL, not the PT level

Front 81

Therapeutic level prevents clotting w/o _________

Back 81

causing excessive bleeding or bruising

Front 82

What is a key sign of a pt being too anticoagulated?

Back 82

Significant bruising

Front 83

T or F:

PT & INR procedures can only be done by a DR in their office

Back 83

FALSE:

Can be done in commercial lab or Dr's office by lab tech, nurse, or Dr

Front 84

What is the difference between performing the PT vs the INR test?

Back 84

PT: Needle stick

INR: Finger Prick

Front 85

What is the reliability for INR & PT?

Back 85

Good reliability-- both PT & INR are usually reported

Front 86

What is another advantage of PT & IVR?

Back 86

Inexpensive

Front 87

What are the 3 factors that affect PT/INR?

Back 87

- Alcohol

- ASA -- thins blood

- Vitamin K -- multivitamin or dietary intake

Front 88

Why is vitamin K a factor for PT/INR tests?

Back 88

Vitamin K is an antagonist to Warfarin


* Counteracts the effects of Warfarin

Front 89

What are the goals of tx for DVT?

Back 89

- Prevent propagation of thrombus

- Prevent postphlebetic syndrome & valve damage

- Prevent death from PE

Front 90

What are the goals of tx for PE?

Back 90

- Support & maintain life during acute episode

- Prevent reoccurrence

Front 91

What is the more aggressive type of therapy?

Back 91

Thrombolytic therapy

Front 92

__________________ is dissolution of fibrin cloth by enzyme action

Back 92

Fibrinolysis

Front 93

What are 3 agents used for thrombolytic therapy?

Back 93

- Streptokinase

- Urokinase

- Tissue Plasminogram Activator (tPA)

Front 94

Why is thrombolytic therapy considered aggressive?

Back 94

- There is a chance that the lytic agent will travel through the bloodstream

- It eats up clots & clotting factors in entire system

Front 95

What would thrombolytic tx be indicated for?

Back 95

- Acute massive pulmonary emboli

- Acute extensive DVT

- Acute arterial thrombosis

Front 96

What is the goal of thrombolytic therapy?

Back 96

To restore venous/arterial flow w/minimal damage to the pulmonary vascular bed, venous valves or vessel

Front 97

What is important for drugs to work effectively?

Back 97

- There is a time sensitive range

- Works best for lesions <7-10 days old and in larger vessels

Front 98

What are the two clinical approaches for Thrombolytic therapy?

Back 98

- Systemic

- Regional

Front 99

How is the systemic approach administered?

Back 99

IV administration of the drug via the peripheral vein

Front 100

The goal is to achieve a _______________ that dissolves _________________

Back 100

systemic lytic state

fibrin wherever deposited

Front 101

What is a comp of the systemic approach?

Back 101

Frequent comp of bleeding

Front 102

How is the regional approach administered?

Back 102

Locally targeted instillation by catheter-directed administration

Front 103

What is the catheter-directed administered into/close to?

Back 103

Thrombotic material for enhanced effectiveness

Front 104

What is the regional approach particularly used for?

Back 104

For severe inflow/outflow disease

Front 105

What are some of the comps associated w/the regional approach?

Back 105

Comps include (but not limited to) hemorrhage & embolization

Front 106

What are the 4 contraindications for thrombolytic therapy?

Back 106

- Recent surgical procedures

- Recent trauma

- Pregnancy--including immediate post delivery

- GI Bleeding

Front 107

What are the 4 comps of thrombolytic therapy?

Back 107

- Hemorrhage

- Sensitivity Reaction

- Expense

- Lytic agents are followed by intensive Heparin therapy

Front 108

T or F:

Hemorrhage is more common in pts using thrombolytic therapy than pts using Heparin

Back 108

TRUE:

2-5 times more common than in pts using Heparin

Front 109

What is the cost difference between Streptokinase and Urokinase?

Back 109

Streptokinase: $175/24hr tx

Urokinase: > $4000/24hr tx

Front 110

Streptokinase is a protein derived from filtrates of _______________

Back 110

Streptococcus bacteria

Front 111

It combines w/plasminogen to form an ___________ which converts _____________

Back 111

activator complex

more plasminogen to plasmin

Front 112

What type of conversion is this?

Back 112

Slower conversion

* Conversion & action takes place slowly

Front 113

Given for ______________

Back 113

24-72 HR

Front 114

Which does is given first?

Back 114

The loading dose and then the maintenance dose

Front 115

Human plasma usually contains antibodies directed against streptococci so _________________

Back 115

sufficient amounts of SK must be infused to neutralize the antibodies

Front 116

T or F:

It is common to have an allergic reaction to SK

Back 116

TRUE

Front 117

T or F:

SK can be repeated after 3 months of last SK therapy

Back 117

FALSE:

SK can't be repeated w/in 6 months

Front 118

Urokinase is naturally produced by _________________

Back 118

the kidneys and excreted in the urine

Front 119

What does Urokinase convert?

Back 119

Directly converts plasminogen to plasmin

Front 120

UK is given for up to _________________--

Back 120

48 HR


* dose administration is the same as SK---loading dose and then maintenance dosing

Front 121

Why can UK be used repeatedly?

Back 121

Because it doesn't form antibodies

Front 122

Which thrombolytic therapy is used more widely?

Back 122

UK -- but physician pref

Front 123

tPA is ______________

Back 123

plasminogen converted to enzyme plasmin (by tPA) to lyse the clot

Front 124

tPA is given for ____________

Back 124

variable shorter periods

* Approx 90 min in coronary application

* 2HR for PE

Front 125

Why is there less likelihood of an allergic reaction w/tPA?

Back 125

Because it has no antigenic properties

Front 126

tPA is used most commonly in ______________

Back 126

coronary's/stroke pts

Front 127

Lytic agents ________________

Back 127

accelerate lysis

Front 128

When are lytic agents more beneficial than Heparin?

Back 128

W/massive emboli or clot

Front 129

Lytic agents are more beneficial w/ __________

Back 129

cardiopulmonary insufficiency, PE

Front 130

What are 2 benefits of Heparin?

Back 130

- Safer

- Associated w/fewer comps