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Pharmacology Drugs 7
Electrolyte fluids-Hypercoagulability
| Question | Answer |
|---|---|
| what is an electrolyte | an ion in solution |
| common electrolytes? | Na+, K+, Mg++, Ca++, Cl- |
| osmolarity? | osmoles/L |
| osmolality | osmoles/kg |
| osmole? | a mole of non-diffusable particles |
| tonicity? | the ability of a solution to attract water across a semi-permeable membrane and sustain an increase an increase in osmotic pressure |
| what are the equations for finding mEq/L? | mEq/L= mmol/L x valence or (mg/dl x 10) x valence |
| normal serum osmolality? | 290-310mOsm/L |
| what are the 3 main classes of fluid types? | emergent/resuscitation; replacement; maintenance |
| From the calorie-based measurement, how do you determine the maintenance dosage of fluids to give an animal? | (30xBW in kg)+ 70 |
| what are dextrose solutions? | solutions containing a small amount of glucose, but is essentially like administering water |
| what are crystalloid solutions? | electrolyte solutions with Na+ as the major osmotically active particle |
| what are colloid solutions? | solutions wiht large particles that provide oncotic pull of fluid into vascular spaces |
| what is the use of 5% dextrose in water? | replacement of insensible free water loss or correct hypernatremia |
| what is 5% dextrose in water not good for? | shock resuscitation, maintenance or subQ administration |
| what type of solution is lactated ringers solution? | multiple electrolyte isotonic crystalloid with lactate as buffer |
| which electrolyte does lactated ringers solution contain? which electrlyte does lactated ringers not contain? | Ca++; Mg++ |
| how many mEq/L of Na+ does lactated ringer's contain? | 130 |
| how many mOsm/L does Lacted ringer's contian? | 273 |
| what is the pH of lactated ringers? | 6.5 |
| what type of solution is normosol/plasmalyte A? | multiple electrolyte isotonic crystalloid with acetate and gluconate as buffers |
| which electrolyte does normosol contain? which does it not contain? | Mg++; Ca++ |
| how many mEq/L of Na+ does normosol contain? | 140 |
| how many mOsm/L does Normosol contain? | 294 |
| of the following, which is the most acidic and which is the most basic (list pH with agent)?: plasmalyte 148, normosol-R, plasmalyte A | plasmalyte 148 (5.5) > normosol-r (6.6) > plasmalyte A (7.4) |
| what type of solution is normal saline? | physiologic saline: 0.9%NaCl and an acidifying solution |
| how many mEq/L of Na does normal saline contain? | 154 |
| when would you use normal saline in a patient? | for acute volume expansion; for treatment of hyperkalemic or hyponatremic patients; |
| with what type of patients would you not use normal saline solution? | patients with congestive heart failure |
| what is the pH of normal saline? | 5.0 |
| what percentage of NaCl does half strength saline contian? | 0.45% |
| what do you normally combine half strength saline with? | 2.5% dextrose solution |
| what percentage of NaCl does hypertonic saline contain? | 7-7.5% |
| what is hypertonic saline used for? | shock resuscitation |
| when would you not use hypertonic saline? | with congestive heart failure or with dehydration |
| what is the osmolality of hypertonic saline? | 2400mOsm/L |
| what is the volume of hyertonic saline that is given during shock treatment? over what time frame? | 4ml/kg over 2 min |
| what must hypertonic saline be following by after giving a dose? | isotonic crystalloid |
| for a sustained effect, what must follow a dose of hyperonic saline? | synthetic colloid |
| what can colloids help do? | plug leaky vessels |
| which has a stronger oncoctic pull: lots of small particle colloids or a small amount of large particle colloids in solution? | lots of small sized particles |
| what type of solution is 6%dextran 70? | a polysaccharide isotonic solution of liner glucose in 0.9% NaCl |
| how does 6% dextran 70 work? | expands the intravascular space by increasing hte colloid oncotic pressure |
| what type of solution is 6% hetastarc? | a polysaccharide isotonic solution of amylopectin in 0.9% NaCl |
| how does 6% hetastarch work? | expands the intravascular space by increasing the colloid oncotic pressure |
| with the hetastarch molecule, what happens when the C2:C6 ratio is increased? | the molecule is broken down slower, given it a longer duration of action |
| with hetastarch, what happens when you increase the molar substitution? | increases the duration of action of amylase by making it more soluble |
| what type of fluid is oxypolygelatin? | a hypotonic solution of 5.6% geltain suspended in NaCl |
| what is oxypolygelatin made from? | bonive bone marrow |
| how does oxypolygelatin work? | exands the vascular space by increasing hte colloid oncotic pressure |
| what type of solution is oxyglobin? | purified hemoglobin modified in lactated ringer's solution |
| what is the shelf life of oxyglobiN? | 3 yrs |
| how does oxyglobin work to deliver oxygen to tissues? | is small and con perfuse areas where RBC's can't pass |
| what happens to the patient when it's given oxyglobin? | discoloration of mucous membranes, sclera and urine; decreased hematocrit, increased total/plasma hemoglobin |
| what device can be used to get accurate readings even when the patient is on oxyglobin? | pulse oximetry |
| which animal is oxyglobin not approved for use in? | cats |
| what maximum dose is suggested for oxyglobin? | do not exceed 10ml/kg/hr |
| when giving oxyglobin to cats, how should you change the dosage as compared to dogs? | half the rate and double the time given over |
| why would you use 25% human albumin? | to expand plasma volume |
| what is the suggested dose for dogs? | 2ml/kg |
| what is the equation for albumin dosgae? | albumin (g)= [(desired albumin-patient albumin) x plasma volume] x 2 / 100 |
| What fluids can be given subcutaneous? | Any isotonic fluids (not colloids) |
| What fluid has the lowest concentration of Na? | LRS |
| Fluids that are truly isotonic | Normosol-R, Plasma-Lyte, Normal Saline, colloids in isotonic fluids |
| Fluids that are hypertonic – | Hypertonic Saline, Dextrose +LRS |
| With anorexic patients, must add what to fluids? | K+ to fluids (KCl or K-Phosphate; KPhos also used with diabetics) |
| What effect do colloids have on homeostasis? | Decrease homeostasis – there is a decrease in platelet function and dilutes the blood (hemodilute). There is a lack of evidence that this affects the patient clinically. |
| what are the factors that aid in the clot formation system? | platelets, coagulation factors, fibrinolytic factors, and blood vessels |
| what are some examples of normal coagulation blood loss? | epistaxis, trauma, recent surgery, GI, genitourinary, parasitism, body cavity |
| what are some reasons for coagulation abnormalities? | Coagulopathy: Vit K deficiency, DIC, caivtary bleeds. platelet disorders: thrombocytopenia, surface bleeding |
| how much blood must one lose before you see symptoms? | >20% loss; 10-15% blood loss= no symtoms; however, 50% loss or more will result in death without changes in PCV |
| how much blood must be lost before cardiac output falls? | 30-40% |
| with topical hemostatis, why must you avoid using excessive pressure on the wound? | excessive pressue will prevent platelets and clotting factors from reaching the wound |
| what are some devices you can use to stop topical hemostasis? | gauze (light topical bleeding), hemoclips, electrocautery, lasers |
| suture ligatures are better for what type of vessels? | smaller veins and arteries |
| vascular clips are better for what type of vessels? | vessels up to 5mm in diameter |
| how do gelfoam sponges work to cause coagulation? | traps local coagulation factors, provides a clot matrix, and exerts pressure on the wound |
| in what situation would you use gelfoam? | with diffuse, low pressure capillary on venous hemorrhage |
| how does surgicel work? | interacts with hemoglobin to cause hemostasis locally |
| what does surgicel need to work? | hemoglobin; so, probably won't work in an anemic animal |
| how do styptics work? | they're caustic to tissue and cause the vessels to shrink up |
| what would you use microporous polysaccharide powder for? | a slow ooze bleeding |
| how does "tissue glue" work as a tissue adhesive? | works by polymerizing on contact with moisture |
| when would you choose to use "tissue glue" | with superficial wounds |
| what is the abnormality with a primary coagulation problem? | platelets: number or function |
| what is the abnormality with a secondary coagulation problem/ | coagulation factors: absence, inhibition, comsumption |
| what is the initial reaction of platelets to vascular injury? | activation, adhesion, aggregation |
| what are the common tests used to determeine clotting factor abnormalities? | PT, PTT, ACT |
| which coagulation factor tests determine problems with the extrinsic side of the coagulation cascade? | PT |
| which coagulation factor tests determine problems with the intrinsic side of the coagulation cascade? | PTT, ACT |
| what are some causes of thrombocytopenia? | consumption, low production, destruction, sequestration, immune mediated disease |
| what are some general disorders that would cause platelet dysfunction even with suficient platelet numbers? | drugs, uremia, infections |
| how does von Willebrand factor work in the platelet scheme of things? | aids in adhesion and aggregation |
| doberman pinschers suffer which type of von Willebrand's disease? is it the most or least severe? | type 1; least severe |
| what is the most common clinical sign seen with platelet dysfunctioN? | surface bleeding; will see petechia or ecchymosis of the mucous membrane surfaces, skin, and sclera. |
| what are some tests used to determine platelet dysfunction? | CBC/PCV or MBT |
| which factors are inhibited by Vit K inhibition? | 2,7,9,10 |
| where are you likely to see hemorrhage with coagulation system problems? | body cavity or deep tissues |
| when, with treating Vit K inhibition and aftering administering Vit K, will you see a response by the patient that the therapy is working? | 12-24 hrs post admin of Vit K |
| what is hypercoagulability? is it fatal? | a predisposition to forming spontaneous blood clots; usually is fatal b/c can't readily diagnose it |
| what are some common congenital thrombophilias in humans? | Factor V mutation; Prothrombin gene Mutation; Protein S; Protein C; Antithrombin |
| what are some common acquired thrombophilias in humans? | malignancy, surgery, trauma, pregnancy, birth control, hormone replacement, immobilization, travel, heart failure, smoking, age, cardiovascular disease |
| what are some common acrquired thrombophilias seen in animals? | IMHA, parvovirus, hyperadrenocorticism, PLE/PLN, neoplasia, parasitism |
| what are some current methods used to treat hypercoagulability? | unfractionated heparin, low molecular weight heparin, coumadin, coagulation factor inhibitors, platelet function modifiers (aspirin) |
| how does unfractionated heparin work? | heparin binds antithrombin to keep factor X from binding thrombin |
| what are some drawbacks of using unfractionated heparin? | needs anti-thrombin to work; only 1/3 of the UFH molecule has polysaccharide to activate AT; very large molcule so cleared faster |
| how does low moleculear weight heparin worK | binds anti-thrombin and has a lack of an effect on thrombin |
| how does coumadin work? | inhibits activity of vitamin K dependent coag factors |
| what do you look at when monitoring treatment with heparin? | PTT |
| what do you look at when monitoring treatment with coumadin? | PT |
| what is one downside to using coumadin? | protein C and protein S are temporarily inhibited resulting in a transient hypercoabulability |
| what is the most common way to treat hypercoagulability? | aspirin therapy |
| how does aspirin work? | blocks cyclooxygenase pathway to limit formation of thromboxane A2 |
| Thienopyridines (plavix) work how? | antagonize ADP receptors to prevent platelet aggregation |
| what is tissue plasminogen activator and when do you administer it? | it is a physiologic activator of plamin produced by the endothelial cells; administer at onset of thrombosis |
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