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Spring Pharm > Anticoags > Flashcards

Anticoags Flashcards

1
Q

Anticoagulants

A
  • prevent the formation of clots
  • best for DVTs
  • reducing formation of fibrin
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2
Q

Anticoagulants MOA

A

Inhibit synthesis cloting factors (factor x and thrombin)

- inhibits the activity of clotting factors ( Xa, thrombin)

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3
Q

Anticoagulant Uses

A
  • Prevention of venous thrombosis

- DVT, pulmonary embolism, A-Fib

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4
Q

If Clot is life threatening

A
  • IV or SQ admin

- Change to oral drug for long term use

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5
Q

Does it actually thin the blood ?

A
  • It doesn’t make blood less viscous
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6
Q

Prototype for Heparin

A

Heparin (unfractured)

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7
Q

Heparin MOA

A
  • inactivates several clotting factors
  • inhibits thrombin activity
  • suppresses formation of fibrin
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8
Q

Heparin measured in…..

A

units

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9
Q

Must be given what routes?

A

SQ (prophylaxis) or IV (immediate)

  • IV is immediate
  • SQ up to 1 hour for effect
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10
Q

Half-Life of Heparin is

A

90 minutes

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11
Q

Uses of Heparin

A
  • Preferred Rapid anticoagulation (open heart surgery, DVT, renal dialysis)
  • Prophylaxis of Venous thrombi
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12
Q

What happens if pt is too anticoagulated

A
  • you can just stop heparin drip due to short half-life
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13
Q

What is the antidote for Heparin?

A

protamine sulfate (onset 5 mins)

  • hardly ever used
  • slow IV push
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14
Q

Some things to know lab monitoring

A
  • monitor aPTT
  • in the hospitial
  • intrinsic factor
  • Normal PTT is 40 sec
  • Therapeutic level is 1.5-2x baseline (60-80 sec)
    -IV heparin: measure aPTT Q 6 hours
  • gets 4 half lives to get to therapeutic
    4 x 1.5 = 6 hours
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15
Q

Heparin SE

A

SE: bleeding, heparin induced thrombocytopenia (HIT)
After 4 days body creates antibodies causing platelets to drop
- For HIT monitor platelets. IF <100,00 or platelets reduce by 50% then stop heparin

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16
Q

Administration of Heparin

A
  • SQ abdomen

- IV intermittent or continuous

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17
Q

How to know if a patient is bleeding

A
  • pettechaie, lumbar pain, bruising, perotineal bleeding

- never give when somone has epidural

18
Q

Low Molecular Weight Heparin

A
  • LMWH: same mechanism of action but a little diff, but safer, better bioavailability
  • no frequent blood tests
  • dosage based on weight
  • Can be administered at home
  • MOA activates factor Xa, lot less able to activate thrombin
  • Half life is 6x a longer
19
Q

Low Molecular Weight Heparin is DOC for

A

DVT prevention

20
Q

Side effects of LMWH

A

Bleeding, HIT

-check platelets before admin

21
Q

Antidote for LMWH

A

Protamine Sulfate

22
Q

LMWH Admin

A

Abdomen anterior or post abdominal wall

  • 45-90 deg
  • SQ
  • don’t expel bubble
23
Q

LMWH Prototype

A

enoxaparin (Lovenox)

24
Q

Vitamin K antagonist Warfarin (Coumadin) MOA

A

MOA: inhibits hepatic synthesis of vitamin K dependent clotting factors (VII, IX,IX, X) and prothrombin

25
Q

Antidote for Coumadin

A

Vitamin K (decrease effects in 6 hours)

  • given IV risk of anaphylaxis
  • can be given oral and SQ
26
Q

Warfarin uses

A

-Prevent DVT, PE, prevent clots in patients with Afib, prosthetic heart valves or had TIA or recurrent MI

27
Q

Problems with Warfarin

A
  • highly protein bound
  • lots of drug-drug interactions
  • Drug- Food interactions: a lot of green leafy veggies
  • Pregnancy category X (not safe)
  • Have a consistent amount of green leafy veggies
  • Narrow theurapeutic index
28
Q

WArfarin SE

A

Hemorrhage

29
Q

Gentic variants can be tested for WArfarin Response

A

VKORC1 and CYP2C0

- These variants lead to increase risk of bleeding

30
Q

Lab monitoring for Warfarin

A
  • Half life of 1.5-2 days
  • 4 half lives to get to therapeutic level
  • PT or INR (extrinsic pathway) outpatient
  • PT normal 12 sec
  • Therapeutic : 1-2x baseline (12-24 sec)
  • PT varies in diff labs so INR is used
  • Internationalized ratio: 2.0- 3.0 therapeutic
  • Mechanical heart valve higher
31
Q

Nursing Consideration for Warfarin

A
  • Take same time everyday
  • Balance Vit K foods
  • Watch s/s bleeding: check labs
  • soft toothbrush
  • No staight edge razor
  • Pain control drugs dont take asprin or ibuprofen
  • Tylenol is better for pain drug
  • hold pressure if blood is drawn
  • must stop before surgery 1 week
  • Medic alert bracelet
  • Garlic and Gingko
32
Q

Direct Thrombin inhibitors ( MOA, route, uses, AE)

A

MOA: direct, reversible inhibitor of thrombin
Route: IV, SQ, and ORAl
Uses: Afib, hip/knee replacement
AE: bleeding, GI
- take with food or protein pump inhibitor or H2 blocker

33
Q

Prototype for direct thrombin

A

dabigatran (Pradaxa)

  • Oral
  • no lab monitroing
  • Lower risk of bleeding
  • few drug-drug/ drug-food interactions
  • rapid onset
  • set dose
34
Q

Antidote fro direct thrombin

A

idarucizumab ( Praxbind)

35
Q

Should direct thrombin be stopped before surgery

A

YES!

36
Q

Direct factor Xa inhibitors

A 
ACtion: binds with factor Xa and inhibits thrombin 
Route: ORal 
-Rapid onset
- No lab monitoring 
- Rapid onset 
- fixed dose 
- lower bleeding risk 
- Few drug interactions (CYP3A4)
37
Q

Direct Factor Xa inhibitors prototypes

A

Rivaroxaban (Xarelto)

Apixaban (Eliquis)

38
Q

Antidote for direct factor Xa

A

Andexanant alfa (AndexXa)

39
Q

Uses for Direct Factor Xa

A
  • Post hip/knee replacement, afib, tx of DVT/ PE
40
Q

SE for Driect FActor Xa inhibitor

A

Bleeding; spinal/epeidural hematoma

-contrraindicated; liver dz; pregnancy

41
Q

What happens when going from IV heparin -> oral agent

A
  • Stop heparin and immediately start oral doses
  • Rivaroxaban or apixaban
  • May see doubled up doses for a couple of days, then see once a day dosing
42
Q

IV heparin -> Coumadin

A
  • typically, 2-3 days simultaneous admin
  • Takes a couple of days for warfarin to take effect
  • No effect on clotting factors already in circulation
  • increased risk of bleeding
  • monitor both PTT and PT/INR

Spring Pharm (10 decks)

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