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Pathopharm: NAT > Anticoagulant, anti platelet, and thrombolytic drugs > Flashcards

Anticoagulant, anti platelet, and thrombolytic drugs Flashcards

1
Q

What is hemostasis?

A

bleeding is stopped

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2
Q

What does hemostasis do?

A

maintain steady blood flow

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3
Q

What are the components of hemostasis

A

platelets, blood proteins, endothelial cells, sub endothelial matrix

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4
Q

what is the initial response when a blood vessel is damaged

A

vasoconstriction or vascular spasm

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5
Q

what are the three steps of hemostasis (blood clotting)

A

vasoconstriction/spasm, platelet clot, coagulation

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6
Q

What breaks down the clot eventually

A

plasmin

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7
Q

what is the normal platelet count

A

150,000-400,000

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8
Q

what platelet count does abnormal bleeding in response to trauma occur

A

below 100,000

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9
Q

what platelet count does spontaneous bleeding episode occur

A

below 20,000: stop giving blood thinner

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10
Q

What controls platelet activation

A

endothelial cells lining blood vessels

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11
Q

What is the role of platelet activation (3)

A

regulation of blood flow, platelet to platelet interaction, clotting cascade activation

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12
Q

what happens during regulation of blood flow to damaged site

A

vasoconstriction/spasms

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13
Q

what happens during platelet to platelet interaction

A

platelet plug: stops further bleeding

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14
Q

what happens in activation of clotting cascade

A

stabilizes plug, initiates repair process

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15
Q

What happens during coagulation cascade

A

release of clotting factors: temporary plug,
chemical reactions: thrombin formation
fibrin traps blood cells: clot forms

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16
Q

How is inactivation of clotting factors accomplished

A

anti-thrombin

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17
Q

what is antithrombin?

A

does not clot

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18
Q

How is the clot removed once vessel is healed?

A

plasmin degrades: produced through plasminogen

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19
Q

What is used in the lysis of blood clots (3)

A

d-dimer, fibrin degradation, plasminogen +plasmin

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20
Q

why do you want to check d-dimer

A

lab levels will be high: can indicate if there is a blood clot

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21
Q

What is thrombophlebitis?

A

development of thrombus in vein INFLAMMATION present

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22
Q

What is phlebothrombosis?

A

thrombus in vein with NO inflammation; asymptomatic

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23
Q

What are factors for thrombus development? (3)

A

immobile pt. (slow blood flow), endothelial injury, increased blood coagulability (genetic, dehydration, pregnant)

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24
Q

What are the S+S of thrombophlebitis and phlebothrombosis?

A

often unnoticed, ache, burn, tender (DVT), fever, malaise, leukocytosis

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25
Q

What is a complication of thrombophlebitis and phlebothrombosis?

A

pulmonary embolism

26
Q

What is the treatment of thrombophlebitis and phlebothrombosis?

A

excercise, elevate, compression hose, SCD, surgery

27
Q

Who is at high risk of blood clots

A

elderly and hospital pt. b/c they are immobile

28
Q

What is an embolus?

A

the clot breaks off and travels to heart, brain, lungs

29
Q

What are embolism S+S to lungs and heart

A

chest pain, SOB, decrease O2, increased RR + BP, tachycardia

30
Q

What are the 3 major drug groups for thromboembolic disorders?

A

anticoagulants, antiplatelets, and thrombolytics

31
Q

What do anticoagulants do?

A

reduce formation, inhibit synthesis and activity of clotting factors

32
Q

What do anti platelets do?

A

suppress platelet aggregation

33
Q

What do thrombolytics do?

A

remove already formed clots

34
Q

What are the two anticoagulants

A

heparin: unfractioned and low-molecular-weight heparin

35
Q

What are anticoagulants used for

A

prevention of venous clots, reduced thrombin, suppress clot

36
Q

What is heparin unfractioned

A

rapid-acting, immediate response

37
Q

How is heparin unfractioned given

A

IV or subQ NO PO

38
Q

What are the adverse effects of heparin unfractioned

A

hemorrhage, heparin-induced thrombocytopenia

39
Q

What are the contraindications of heparin unfractioned?

A

uncontrolled bleeding, during/after surgery of eye, brain, spinal cord

40
Q

How do you evaluate effectiveness of heparin unfractioned

A

aPTT normal: 30-40 seconds

41
Q

What is the antidote for heparin

A

protamine sulfate

42
Q

What are advantages of low-molecular-weight heparin

A

longer half-life, doesn’t require monitoring, given SubQ, costs more

43
Q

example of low-molecular- weight heparin

A

enoxaprin

44
Q

What is low-molecular-weight heparin used for

A

prevent DVT after knee surgery, established DVT, ischemic complications

45
Q

Adverse effects of low-molecular-weight heparin

A

neurologic injury with spine

46
Q

What is warfarin

A

oral anticoagulant with delayed onset, doesn’t affect clots already formed

47
Q

When is warfarin used

A

long-term, never in emergencies PREVENTION

48
Q

How long does warfarin remain in bloodstream after last dose

A

2-5 days

49
Q

How do you monitor warfarin

A

international normalized ratio (INR) normal:<1 abnormal: 2-3

50
Q

adverse effects of warfarin

A

fetal hemorrhage

51
Q

what are the interactions of warfarin

A

heparin (increases), aspirin (promotes bleeding), oral contraceptives and vitamin K (decrease)

52
Q

Antidote for warfarin

A

vitamin k: IV or food

53
Q

what are some vitamin k foods

A

leafy greens, mayo, oil

54
Q

What do the direct thrombin inhibitors do

A

directly inhibit thrombin, don’t take with food

55
Q

what do the direct factor Xa inhibitors do

A

inhibits thrombin production

56
Q

What are anti platelet drugs used for

A

suppress aggregation, decrease clot formation

57
Q

What does aspirin do

A

prevents clots

58
Q

adverse effects of aspirin

A

increases GI bleed risk

59
Q

what has a similar adverse effect to aspirin

A

clopidogrel: stents

60
Q

How do you minimize bleeding risk

A

reduce moving pt, poking them, invasive procedures, concurrent anticoagulants and anti platelet drug

61
Q
A

Pathopharm: NAT (6 decks)

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