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Pharmacology > 40. Anticoagulants > Flashcards

40. Anticoagulants Flashcards

1
Q

mechanisms involved in hemostasis

A
  • vasoconstriction
  • formation of platelet plug
  • sequential activation of clotting factors
  • reparation of the opening in the damaged vessel by growth of fibrous tissue
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2
Q

How does the coagulation cascade lead to formation of fibrin clot

A
  • injured cells release prothrombin activator
  • prothrombin activator changes prothrombin to thrombin
  • thrombin changes fibrinogen to fibrin
  • fibrin forms insoluble web over injured area to stop blood flow
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3
Q

atherosclerosis often involves arteries supplying what areas of the body

A
  • heart -> MI
  • brain -> stroke
  • legs -> DVT
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4
Q

3 types of antithrombotic medications

A
  • anticoagulants (prevents new clot formation -> does not dissolve formed clots)
  • antiplatelets (prevent arterial thrombosis)
  • thrombolytics (dissolve thrombi and limit tissue damage)
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5
Q

indication for use of anticoagulants

A
  • thrombophlebitis
  • DVT
  • PE
  • ACS -> PCI or STEMI
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6
Q

MOA of heparin

A
  • varies according to dosage
  • low dose: inactivates factor Xa and inhibits conversion of prothrombin to thrombin
  • high dose: inactivates IX, X, XI, XII, and thrombin and inhibiting conversion of fibrinogen to fibrin
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7
Q

side effects/adverse effects of heparin

A
  • HIT
  • ecchymosis
  • bleeding risk
  • hypersensitivity
  • N/V
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8
Q

How do you evaluate effectiveness of heparin

A

PTT in therapeutic range (based on institution); around 60-90

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9
Q

contraindications of heparin

A

severe thrombocytopenia

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10
Q

patient teaching for heparin

A
  • rotate injection sites (to be given SQ)

- increased bleeding risk (hold pressure to wounds and report severe sxs)

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11
Q

What type of medicine is enoxaparin

A

LMWH

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12
Q

MOA of enoxaparin

A

inactivates coagulation factor Xa and produces anticoagulation

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13
Q

uses of enoxaparin

A
  • DVT prophylaxis
  • ACS
  • unstable angina
  • acute DVT
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14
Q

administration of enoxaparin

A
  • peaks 3-5 hours and lasts 12 hours
  • subcutaneous injection
  • air bubble needed to follow the injection
  • don’t rub site after injection
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15
Q

adverse effects of enoxapain

A
  • injection site hematoma
  • nausea
  • peripheral edema
  • bleeding
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16
Q

safety info for enoxaparin

A
  • lower bleeding risk than heparin
  • more stable response
  • no PTT monitoring
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17
Q

antidote to heparin and enoxaparin

A

protamine sulfate

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18
Q

antibodies develop to platelet factor 4 complexed w/ heparin; may also develop w/ LMWH but less common

A

heparin induced thrombocytopenia (HIT

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19
Q

sxs of HIT

A
  • thrombocytopenia
  • thrombosis by peripheral platelet consumption and platelet activation
  • platelets decrease by 30-50% of baseline
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20
Q

MOA of warfarin

A

interferes w/ hepatic synthesis of vitamin K dependent clotting factors

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21
Q

uses of warfarin

A
  • prevention of venous thromboembolism
  • atrial fibrillation
  • embolization
  • coronary thrombosis
  • pulmonary embolism
  • inherited clotting disorders
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22
Q

adverse effects of warfarin

A
  • bleeding/hemorrhage
  • anemia
  • headache
  • fever
  • dizziness
  • lethargy
  • fetal malformations
  • abnormal bone development
23
Q

contraindications for warfarin

A
  • pregnancy

- bleeding or hemorrhaging tendancies

24
Q

How do you evaluate effectiveness of warfarin

A

PT/INR testing; should be in therapeutic range (typically 2-3)

25
Q

antidote to warfarin

A

vitamin K

26
Q

MOA of apixaban

A

factor Xa inhibitor

27
Q

uses for apixaban

A
  • nonvalvular afib
  • DVT
  • PE
  • venous thromboembolism prophylaxis (THA, TKA)
28
Q

side effects/adverse effects of apixaban

A
  • hemorrhage

- thrombosis w/ premature discontinuation

29
Q

contraindications for apixaban

A

hypersensitivity

- active bleeding

30
Q

antidote for apixaban

A

andexanet alfa

31
Q

What type of drug is argatroban?

A

direct thrombin inhibitor (DTI)

32
Q

MOA of argatroban

A

directly inhibits thrombin from converting fibrinogen to fibrin

33
Q

uses of argatroban

A
  • HIT
  • PCI for adults who have risk of developing HIT
  • treatment for DVT or PE
34
Q

how is argatroban administered

A

IV only

35
Q

adverse reactions of argatroban

A
  • bleeding
  • hypotension
  • chest pain
  • cardiac arrest
  • injection site reaction
  • N/V and GI upset
  • anemia
  • hematoma
36
Q

What is the antidote for argatroban

A

there isn’t one

37
Q

antiplatelets are used as prophylaxis for what?

A
  • prevention of MI or stroke for pts w/ FHx
  • prevent repeat MI or stroke
  • prevention stroke for pts having TIAs
38
Q

What is the recommended dose of ASA for pts w/ FHx of stroke or MI

A
  • 50-325mg/day for stroke

- 75-162 mg/day for MI

39
Q

When a pt is going in for surgery, when must antiplatelets be discontinued

A

7 days before surgery

40
Q

What type of medication is clopidogrel?

A

antiplatelet

41
Q

MOA of clopidogrel

A

inhibits platelet aggregation and prevents adenosine diphosphate (ADP) from binding to ADP platelet receptor

42
Q

use of clopidogrel

A

prevent thrombosis associated w/ unstable angina, acute MI, stroke, and TIA

43
Q

adverse effects of clopidogrel

A
  • hypotension
  • hypertension
  • bronchospams
  • elevated hepatic enyzmes
  • peptic ulcer
44
Q

pt teaching for clopidogrel

A
  • may increase bleeding
  • may increase bleeding when taking certain supplements (ginger, garlic, and green tea)
  • effects decreased w/ grapefruit juice
45
Q

when are labs for heparin dosing drawn

A

1 hour before dosing

46
Q

when are labs drawn for warfarin

A
  • daily until therapeutic

- drawn every 2-4 weeks for duration of therapy unless the dose is adjusted

47
Q

What is the goal of thrombolytic agents

A

reestablish blood flow ASAP to prevent/limit tissue damage

48
Q

What type of medicine is alteplase (Activase)

A

thrombolytic

49
Q

MOA of alteplase

A
  • converts plasminogen to plasmin -> digests fibrin and dissolves clot
  • also initiates fibrinolysis
50
Q

uses of alteplase

A
  • dissolve existing clots
  • acute MI
  • DVT
  • CVA
  • PE
  • arterial thrombosis
  • clear IV catheters
51
Q

adverse effects of alteplase

A
  • abnormal bleeding
  • stroke (LT)
  • dysrhythmias (LT)
  • pulmonary edema (LT)
52
Q

contraindications for alteplase or any thrombolytic therapy

A
  • uncontrolled severe HTN
  • aneurysm
  • AV malformation
  • known coagulopathy or internal bleeding
  • intracranial/intraspinal surgery or trauma in past 3 months
  • intracranial mass
  • recent major surgery
  • current use of oral anticoagulants
53
Q

when must alteplase be given

A
  • within 12 hours of sxs of MI

- within 3 hours of CVA

54
Q

what is the antidote to alteplase

A

aminocaproic acid

Pharmacology (22 decks)

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