Pharma Chapter 9

Coagulation

Anticoagulants

Inhibit blood clotting

Does not help already present clots

Coagulants

Promote, accelerate, or make coagulation possible

Hemostatics

Enhance clot formation

Reduce bleeding

Thrombolytics

Fibrinolytics

Dissolve blood clots

Fibrinolysin

Clot dissolving enzyme in the body

Stage 1 of Coagulation

Thromboplastin formation

Stage 2 of Coagulation

Thrombin formation

Stage 3 of Coagulation

Fibrin formation

Mesh of protein threads

Traps blood cells to form clot

What converts fibrinogen into fibrin

Thrombin

Vitamins/Minerals needed for clotting

Ca+ needed for all stages

K+ needed for synthesis of factors

Avitene mesh

Absorbable collagen sponges

Apply with dry instruments

Formation/Presence of blood clot in vascular system

Thrombosis

Absorbable gelatin examples

FloSeal

Gelfilm

Gelfoam Powder/Sponge

Gelita-Spon

Surgiflo

Surgifoam

Absorbable Collagen Sponge - what is it

Purified bovine collagen

Cut to shape

Promote platelet aggregation

Downside of Absorbable Collagen Sponge

May reduce bonding strength of PMMA

Pledgets

Small gelfoam used during tympanoplasty

Floseal

Flowable gelfoam

Use withing 4 hours

Surgicel

Hemostat and bactericidal

G+ and G-

Bone wax

beeswax

Ortho and Neuro

Mechanical

Avitene

Microbibrillar collagen hemostat

Purified bovine collagen

Apply dry

Very commonly used

Hemostat that can be applied dry or moist and comes in film, powder, or sponge

Absorbable gelatin

Thrombin

Used to be bovine but due to allergies now is human-derived

spray bottle or powder- mix with water

Immediate use or fridge

Topical only

Silver nitrate

Cauterizing chemical agent

Wart removal

Never use near eye or ear - burns

Monsel’s solution

Ferrous sulfate, sulfuric acid, nitric acid, diluted with water

Cervical cone biopsy

Systemic coagulants

Pre-op or intra-op

R

Contradicted with history of malignant hyperthermia (systemic)

Calcium salts

Minor hemorrhage signs

Epistaxis (nose bleed)

Hematuria (blood in urine)

Melena (blood in feces)

Bleeding gums

Risk of IV K+

Higher risk of anaphylaxis

Takes about 6 hours to take affect

Use fresh frozen for emergencies

Heparin sodium measurement

Measured in units

Always write down what strength

Most common parenteral anticoagulant

Heparin sodium

IV, subcutaneous, topical

Heparin sulfate administration methods

IV, Subcutaneous, topical

How does heparin sulfate work

Inhibits factor X

Interfere with platelet aggregation

Interfere with prothrombin-to-thrombin convertion

How long does heparin take for onset

5 minutes

Duration of heparin sulfate

2-4 hours

Heparin sulfate concentration NOT used from back table

150

(We have 1k, 5k, 10k)

Single use vials

Specialties that use heparin sulfate

Cardio/peripheral vascular,

Solution dilution of heparin

5000 units to 1000 mL saline

Protamine sulfate

Antagonist to heparin sulfate

DVT management

Oral medication

Coumarin

Warfarin sodium

Inhibit vit K in liver

Oral blood thinner - do not use with acetylsalicylic acid

Need to be close to hospital if taking this due to high right of hemorrhaging

Aspirin

Acetylsalicylic acid

Anti-platelet drug

Thrombolytics

IV to dissolve blood clot

Hemostatic used on areas of capillary bleeding

Topical

Hemostatic agents are effective against major arterial or venous bleeding.

False

AquaMEPHYTON.

Vit K

Absorbable gelatin specialties

General

ENT

Ortho - more rare

Neuro

Absorbable gelatin administration

Topical only

Contradiction for using most coagulants

Infection

Microfibrillar collagen administration

Topical only

Dry instrument

Platelet

Thrombocytes

Used for coagulation

Oxidized cellulose examples

Surgicel

Oxycel

Oxidized cellulose adminitration

Topical

Oxidized cellulose specialties

Neuro

ENT

Thromus

Blood clot within blood vessel

Surgiflo

Mix thrombin and floseal

makes thrombin more potent

2 syringes mix over back table

How long does the intrinsic pathway take to form a clot?

Minutes

Embolus

Venous clot moves to heart

Tannic acid

Cauterization - chemical

Tonsillectomy

QuikClot

Battlefield for traumatic bleeding

Calcium salts

IV

Promotes clotting in all 3 stages

DO NOT USE with malignant hypothermia

Heparinized saline uses

Soak vascular graft

AV fistula

Anticoagulation during CV surgeries (suturing etc. can cause clot) - irrigation/flush

Hemostatic agents causes adhesion formation if it comes in contact with nonbleeding tissues

Avitene

Why cant we use Acetylsalicylic acid post-op

Hemorrhaging

Surgery most often cause DVT

Total hip or knee

Anything that takes a long time- pressure = blood flow slows

Thrombolytics examples

Alteplase (Activase)

Uremia

High urine in blood

Kidney failure

PE

Pulmonary embolism

CVA

Cerebral accident

TIA

Transient ischemic attack

Warfarin onset

12-72 hours

Warfarin duration

8-12 days

Antagonist for warfarin

Vit K injection