Anticoagulant Medications Flashcards
Warfarin
Use: prevent and treat various thromboembolic disorders . Also prevents clots from forming on mechanical heart valves
Mechanism of action: prevents vitamin k from becoming activated causing a reduction in clotting factors
Warfarin HYC
- Monitior a patient’s antcoagulation status closely (INR)
- Patients have to be consistent in how much vitamin k is consumed (increased vitamin K consumption = decreased INR; decreased vitamin k = increased INR)
- Bleeding ( increased HR, decreased BP, Hematomas, petechiae, “cofffee grounds” vomit, red or black stools, cloudy or discolored urine
- Use soft bristle toothbrush and electric razor
Antidote for Warfarin
Vitamin K
Antithrombins( Old Anticoagulants)
1.Enoxaparin (lovenox) (e-nox-a-PA-rin) -more predictable dose/ longer half life
2. Heparin (HEP-a-rin)- wears off fast/ cheaper
- Enoxaprin
- Heparin
Use: both used to prevent and treat various thromboembolic disorders
Mechanism of action: Inactivate clotting factors already in circulation this done by enhancing the activity of antithrombin ( works immediately instead of days later)
HYC: Bleeding
Enoxaprin administration
administered subcutaneously in the “love handles” area of the abdomen; avoid the belly button (umbilicus) area. Softy pinch this area to create a small fat bulge. You’ll also notice a small air bubble in enoxaparin syringes. Don’t try to get this air bubble out. You’re going to inject that too. When you are all done, there is a special guard that covers the needle when you press firmly on the plunger.
Lab Monitoring of Enoxaprin
To check the effectiveness of enoxaparin, the lab we check is anti-Xa. A therapeutic level is considered 0.6-1.0 units/mL
Lab monitoring of Heparin
Lab test: APTT
Most patients taking heparin we want them between 60 and 80 sec.
Antidote for Enoxaparin and Heparin
Protamine sulfate
Novel Oral Anticoagulants
- Apixaban
- Dabigatran
- Rivaroxabam
Use: prevention and treatment of blood clots ; also clots in atrial fibrillation
Mechanism of Action: Apixaban and rivaroxaban inhibit clotting factor Xa. Dabigatran inhibits clotting factor ll.
Novel Oral Anticoagulants HYC
Bleeding
GI Bleeds ( Dabigatran and rivaroxaban is more likely than warfarin to cause GI bleeds
Dabigatran storage
Must be kept dry and away from moisture. It comes in a bottle with a special cap that absorbs moisture. “If you get water ondab
igatran, you havedabit dry
immediately.”
Clopidogrel
Use: prescribes to clients w history of heart attack, ischemic stroke, and PAD.
Drug root -grel
Mechanism of action: Works by blocking receptors (P2Y12) on the platelet surface that cause platelet aggregation
Clopidogrel HYC
Bleeding and Bruising
Clopidogrel Drug Interactions
Interacts with many common meds ( many protnpump inhibitor and fluoxetine) Decrease the effects of clopidogrel.
Clopidogrel is often combined with aspirin which increases effectiveness while also increasing the risk of bleeding
What sometimes fatal condition can occur when taking heparin? Should you keep giving heparin if a client develops this ?
Heparin-induced thrombocytopenia (HIT). No, If a client receiving heparin has a severe, rapid drop in platelets, the heparin should be stopped
- What pain medication is similar to clopidogrel?
Aspirin
- What are three new (novel) oral anticoagulants? What advantages do they have over warfarin?
1Apixaban, Dabigatran, Rivaroxaban. They begin work immediately. Dosing for these drugs is much easier than warfarin; you don’t have to constantly check blood levels or worry about dietary vitamin K. They work better at preventing clots and cause fewer brain bleeds.
- What is the antidote for enoxaparin and heparin?
protamine sulfate
- What lab test do you use to monitor heparin?
APTT
- How do you administer enoxaparin?
- Enoxaparin is administered subcutaneously in the “love handles” area of the abdomen; avoid the belly button. You want to softy pinch this area to create a small fat bulge. You’ll also notice a small air bubble in enoxaparin syringes. Don’t try to get this air bubble out. You’re going to inject that too. When done there is a special guard that covers the needle when you press firmly on the plunger.
How quickly do heparin and enoxaparin start to work?
Immediately
What are some special hygiene items a person taking a blood thinner should use?
Soft bristle toothbrush and electric razor
1 What are some common signs and symptoms of DVT and PE?
- Pain in one leg. You may notice swelling, pain, and redness in that leg
- What is the antidote to warfarin overdose?
Vitamin K
- What are some of the less obvious signs that someone is bleeding ?
Increased heart rate, decreased blood pressure, hematomas, petechiae, “coffee grounds” vomit, red or black stools, cloudy or discolored urine
What type of dietary change would interfere with warfarin therapy?
Dietary changes in vitamin K
What laboratory value should you check if someone is taking warfarin?
INR
How long does it take for warfarin to start working? Why?
5 days , A person’s genetics and diet can significantly impact how warfarin therapy. Hence, we have to monitor a patient’s anticoagulation status closely.
Stated very briefly, how does warfarin work?
- Warfarin prevents vitamin k from becoming activated. This causes a reduction of clotting factors II, VII, IX, and X.
Do the anticoagulants discussed in this lesson dissolve blood clots? If not, what does?
- No , Alteplase (TPA) does .
