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Pharmacology Drugs 7

Electrolyte fluids-Hypercoagulability

QuestionAnswer
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
Created by: clcxrf