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Questions and Answers
What type of substances are coagulants?
What type of substances are coagulants?
Which vitamin is primarily involved in the synthesis of prothrombin and coagulation factors?
Which vitamin is primarily involved in the synthesis of prothrombin and coagulation factors?
What is the primary source of Vitamin K1?
What is the primary source of Vitamin K1?
What is the onset time for the effect of oral Vitamin K?
What is the onset time for the effect of oral Vitamin K?
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What can be a rare side effect of rapid IV infusion of emulsified Vitamin K?
What can be a rare side effect of rapid IV infusion of emulsified Vitamin K?
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Which form of Vitamin K is not recommended for use in practice due to ineffectiveness?
Which form of Vitamin K is not recommended for use in practice due to ineffectiveness?
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What is a common indication for administering Vitamin K?
What is a common indication for administering Vitamin K?
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Where is Vitamin K absorbed in the body?
Where is Vitamin K absorbed in the body?
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What is the primary purpose of using lyophilized plasma fractions and recombinant factors?
What is the primary purpose of using lyophilized plasma fractions and recombinant factors?
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How often is the factor IX-albumin conjugate Idelvion administered for hemophilia A treatment?
How often is the factor IX-albumin conjugate Idelvion administered for hemophilia A treatment?
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Which coagulant is specifically used for treating bleeding associated with von Willebrand disease?
Which coagulant is specifically used for treating bleeding associated with von Willebrand disease?
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What is a common side effect of plasma concentrates?
What is a common side effect of plasma concentrates?
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Which factor is activated by recombinant factor VIIa to initiate the clotting pathway?
Which factor is activated by recombinant factor VIIa to initiate the clotting pathway?
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What type of preparation is often used for factor IX deficiency due to its prolonged half-life?
What type of preparation is often used for factor IX deficiency due to its prolonged half-life?
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What distinguishes long-acting factor preparations from standard preparations?
What distinguishes long-acting factor preparations from standard preparations?
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Which coagulant is used to control bleeding specifically in hemophilia and factor VIII deficiency?
Which coagulant is used to control bleeding specifically in hemophilia and factor VIII deficiency?
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Which of the following is a recombinant Von Willebrand factor used for treatment?
Which of the following is a recombinant Von Willebrand factor used for treatment?
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What is the mechanism of action for aminocaproic acid?
What is the mechanism of action for aminocaproic acid?
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Which of the following is a local coagulant that can control bleeding?
Which of the following is a local coagulant that can control bleeding?
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What is a potential adverse effect of using aminocaproic acid?
What is a potential adverse effect of using aminocaproic acid?
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Desmopressin acetate is typically administered in which two forms?
Desmopressin acetate is typically administered in which two forms?
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Which systemic coagulant is a synthetic inhibitor of fibrinolysis?
Which systemic coagulant is a synthetic inhibitor of fibrinolysis?
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What is the primary pharmacokinetic characteristic of tranexamic acid?
What is the primary pharmacokinetic characteristic of tranexamic acid?
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In which condition would you most likely use aminocaproic acid as an adjunctive therapy?
In which condition would you most likely use aminocaproic acid as an adjunctive therapy?
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Study Notes
Coagulants
- Coagulants are substances that promote coagulation and are used for hemorrhagic disorders
- Coagulants are found in fresh whole blood, plasma, and are classified into systemic and local
- Systemic coagulants are used to treat bleeding disorders in the whole body
- Local coagulants are used to treat localized bleeding
- Systemic coagulants can either be transfusional, or non transfusional
- Transfusional coagulants are blood-based products, primarily used for clotting factor deficiencies
- Non transfusional coagulants can be further divided into Plasma fractions, Vitamin K, and Fibrinolytic inhibitors
- Examples of transfusional systemic coagulants include plasma, blood, fibrinogen, and factor concentrates
- Examples of non transfusional systemic coagulants include Vitamin K and Desmopressin
Vitamin K
- Vitamin K is a cofactor for the synthesis of the coagulation factors II (prothrombin), VII, IX, and X in the liver.
- Vitamin K sources include dietary intake (green leafy vegetables), intestinal bacterial synthesis (Vitamin K2), and synthetic Vitamin K (Vitamin K3)
- The synthetic form of Vitamin K3 can be lipid soluble (menadione) or water soluble (menadione sodium bisulfate).
- Water soluble Vitamin K3 should not be used in practice because it is ineffective
- Vitamin K1 is administered orally and parenterally
- Oral and parenteral forms of Vitamin K1 are fat soluble and require bile salts for absorption
- Onset of action for Vitamin K takes 6 hours and its effects are complete by 24 hours
- Vitamin K is metabolized in the liver and excreted in bile and urine
- Vitamin K is used to treat:
- Hemorrhagic disease of vitamin K deficiency in newborns
- Warfarin overdose
- Vitamin K deficiency related to:
- Obstructive jaundice and malabsorption
- Poor diet in hospitalized patients especially in intensive care units
- Parenteral nutrition
- Recent surgery
- Multiple antibiotic therapies
- Severe hepatic disease
Plasma fractions
- Plasma fractions are concentrated preparations of coagulation factors used to treat coagulation factor deficiencies
- Plasma fractions include highly purified or intermediate purity lyophilized factors and recombinant preparations
- Plasma fractions are administered intravenously
- Recombinant preparations are safer than lyophilized preparations because they are purified and do not carry the risk of transmitting infectious agents
- Plasma fractions are used to treat hemophilia A and B, and von Willebrand disease
Hemophilia Treatment with Plasma Fractions
- Hemophilia A is treated with factor VIII concentrates (lyophilized human plasma concentrates or recombinant factor VIII)
- Hemophilia B is treated with factor IX concentrates (lyophilized human plasma concentrates or recombinant factor IX)
- Long acting factor VIII and IX preparations are used for the prophylaxis and treatment of hemophilia
- Eloctate is a long acting factor VIII-Fc domain conjugate, that prolongs the factor VIII half-life, and is administered twice a week
- Idelvion is a long acting factor IX-albumin conjugate, with a half-life of 100 hours, and administered once a week
Treatment of Bleeding in Von Willebrand Disease with Plasma Fractions
- Intermediate purity factor VIII concentrates contain significant amounts of von Willebrand factor
- Humate-P is a factor VIII concentrate used to treat bleeding associated with von Willebrand disease
- Vonicog alfa is a recombinant von Willebrand factor
Fibrinolytic Inhibitors
- Fibrinolytic inhibitors are drugs that prevent the breakdown of fibrin clots and promote coagulation.
- Examples of fibrinolytic inhibitors are aminocaproic acid and tranexamic acid
- Both are synthetic inhibitors of fibrinolysis
- Tranexamic acid is an analog of aminocaproic acid and has the same properties
- Both agents inhibit the activation of plasminogen (a precursor to plasmin, an enzyme that breaks down fibrin clots)
- Both drugs are rapidly absorbed after oral administration, and are excreted in urine
- Clinical uses include: - Hemophilia - Bleeding from fibrinolytic therapy - Postsurgical gastrointestinal bleeding - Vaginal bleeding
- Adverse Effects:
- Intravascular thrombosis from inhibition of plasminogen activator
- Hypotension, myopathy, abdominal discomfort, diarrhea, and nasal stuffiness
Other Systemic Coagulants
- Fibrinogen is a clotting factor used to control bleeding in hemophilia, factor VIII deficiency, and acute afibrinogenemia
- Desmopressin acetate is an analog of vasopressin that increases factor VIII activity in patients with mild hemophilia A or von Willebrand disease
- Adrenochrome monosemicarbazone reduces capillary fragility, controls bleeding from surfaces, and prevents microvessel bleeding
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Description
This quiz covers the essential aspects of coagulants, including their classification, uses, and specific examples of systemic and local coagulants. Additionally, it delves into the role of Vitamin K in coagulation factor synthesis. Test your knowledge of these important substances in treating bleeding disorders.
