Anticoagulant Medications

Question 1

Warfarin

Answer 1

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

Question 2

Warfarin HYC

Answer 2

• 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

Question 3

Antidote for Warfarin

Answer 3

Vitamin K

Question 4

Antithrombins( Old Anticoagulants)

Answer 4

1.Enoxaparin (lovenox) (e-nox-a-PA-rin) -more predictable dose/ longer half life
2. Heparin (HEP-a-rin)- wears off fast/ cheaper

Question 5

1. Enoxaprin
2. Heparin

Answer 5

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

Question 6

Enoxaprin administration

Answer 6

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.

Question 7

Lab Monitoring of Enoxaprin

Answer 7

To check the effectiveness of enoxaparin, the lab we check is anti-Xa. A therapeutic level is considered 0.6-1.0 units/mL

Question 8

Lab monitoring of Heparin

Answer 8

Lab test: APTT
Most patients taking heparin we want them between 60 and 80 sec.

Question 9

Antidote for Enoxaparin and Heparin

Answer 9

Protamine sulfate

Question 10

Novel Oral Anticoagulants

Answer 10

1. Apixaban
2. Dabigatran
3. 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.

Question 11

Novel Oral Anticoagulants HYC

Answer 11

Bleeding
GI Bleeds ( Dabigatran and rivaroxaban is more likely than warfarin to cause GI bleeds

Question 12

Dabigatran storage

Answer 12

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.”

Question 13

Clopidogrel

Answer 13

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

Question 14

Clopidogrel HYC

Answer 14

Bleeding and Bruising

Question 15

Clopidogrel Drug Interactions

Answer 15

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

Question 16

What sometimes fatal condition can occur when taking heparin? Should you keep giving heparin if a client develops this ?

Answer 16

Heparin-induced thrombocytopenia (HIT). No, If a client receiving heparin has a severe, rapid drop in platelets, the heparin should be stopped

Question 17

1. What pain medication is similar to clopidogrel?

Answer 17

Aspirin

Question 18

1. What are three new (novel) oral anticoagulants? What advantages do they have over warfarin?

Answer 18

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.

Question 19

1. What is the antidote for enoxaparin and heparin?

Answer 19

protamine sulfate

Question 20

1. What lab test do you use to monitor heparin?

Answer 20

APTT

Question 21

1. How do you administer enoxaparin?

Answer 21

• 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.

Question 22

How quickly do heparin and enoxaparin start to work?

Answer 22

Immediately

Question 23

What are some special hygiene items a person taking a blood thinner should use?

Answer 23

Soft bristle toothbrush and electric razor

Question 24

1 What are some common signs and symptoms of DVT and PE?

Answer 24

• Pain in one leg. You may notice swelling, pain, and redness in that leg

Question 25

1. What is the antidote to warfarin overdose?

Answer 25

Vitamin K

Question 26

1. What are some of the less obvious signs that someone is bleeding ?

Answer 26

Increased heart rate, decreased blood pressure, hematomas, petechiae, “coffee grounds” vomit, red or black stools, cloudy or discolored urine

Question 27

What type of dietary change would interfere with warfarin therapy?

Answer 27

Dietary changes in vitamin K

Question 28

What laboratory value should you check if someone is taking warfarin?

Answer 28

INR

Question 29

How long does it take for warfarin to start working? Why?

Answer 29

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.

Question 30

Stated very briefly, how does warfarin work?

Answer 30

• Warfarin prevents vitamin k from becoming activated. This causes a reduction of clotting factors II, VII, IX, and X.

Question 31

Do the anticoagulants discussed in this lesson dissolve blood clots? If not, what does?

Answer 31

• No , Alteplase (TPA) does .