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Pharmacology πŸ’Š > Anticoagulants > Flashcards

Anticoagulants Flashcards

1
Q

What is heparins drug class?

A

Anticoagulant

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2
Q

What is the antidote for heparin?

A

Protamine sulfate

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3
Q

What is heparin mechanism of action?

A

It combines with antithrombin 3 to inactivate factors 9-12

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4
Q

True or false:
heparin is a clot buster.

A

False, it prevents further clotting, but does not dissolve

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5
Q

Is heparin, short, acting, or slow releasing.

A

Short acting takes about 20 to 30 minutes

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6
Q

What are the therapeutic uses of heparin?

A

Prevention of management of thromboembolic disorders, such as DVT, PE, and a fib

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7
Q

Is heparin used prophylactically? If so, how?

A

It is used prophylactically in patients with…
MI heart failure, and stroke
history of thrombophlebitis, major abdominal/thoracic surgery
restrictions of bedrest for 5+ days
Recent gynecologic surgery (especially in patients who take estrogen/oral contraceptive)

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8
Q

What are the two most common side effects of heparin?

A

Hemorrhaging (drug hypersensitivity, local irritation was subQ administration)
HIT (heparin induced thrombocytopenia)

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9
Q

What does heparin induced thrombocytopenia do?

A

Lowers platelet counts (low platelets= no clotting factors)

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10
Q

How do we administrate heparin?

A

We administrate SubQ or IV, does not absorb in G.I.

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11
Q

What are the nursing actions we take when administering heparin?

A

APTT (activated partial thrombin time)
Levels need to be between 46-70

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12
Q

When aPTT levels are below 70. What are our 3 priority actions?

A

1.stop the drug
2. Prepare protamine sulfate (antidote)
3. Reassess labs (1 hour)

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13
Q

What are some patient teachings when administering heparin?

A

Bleeding risk
obtain labs regularly
how to observe signs and symptoms of bleeding
correct self administration

Chamomile, garlic, ginger, ginkgo, ginseng, and high doses of vitamin E can increase the effects of the drug

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14
Q

What pregnancy category is heparin?

A

C

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15
Q

What is the brand name for warfarin?

A

Coumadin

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16
Q

What drug class is warfarin?

A

Anticoagulants (Vit K Antagonist)

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17
Q

What is the most common oral anticoagulant?

A

Warfarin (Coumadin)

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18
Q

What is warfarin (Coumadin) mechanism of action?

A

Works in liver to block synthesis of vitamin K dependent factors: 2,7,9 and 10

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19
Q

Warfarin is highly bound to plasma proteins, such as…

A

Albumin 98%

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20
Q

How many days does warfarin (Coumadin) take to work?

A

Takes up to five days, PT on Lovenox while on loading dose

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21
Q

What are the therapeutic uses of warfarin (Coumadin)?

A

prevention and management of venous, thromboembolism disorders:
DVT, PE, and embolization associated with a fib and prosthetic heart valves
Use after MI to: decrease reinfection, stroke, venous, thromboembolism, and death

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22
Q

What are side effects of warfarin (Coumadin)?

A

Bleeding (more likely pts with a hepatic disease because of decreased synthesis of vitamin K in plasma proteins)
Nausea, vomiting, abdominal pain, alopecia, urticaria, dizziness, joint and muscle pain

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23
Q

What is the antidote for warfarin (Coumadin)?

A

Vitamin K

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24
Q

What are nursing actions we take when administering warfarin (Coumadin)?

A

INR (internal national normalized ratio)

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25
Q

What should the levels be of INR?

A

2 to 3
2.5 to 3.5 (heart valve replacement)

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26
Q

What are patient teaching when administering warfarin (Coumadin)?

A

Obtain regular lab test
Search for signs and symptoms of bleeding
Prevent blood clots from forming and legs
Do not change vitamin K and take (dark leafy greens) BE CONSISTENT
LET PROVIDER KNOW ABOUT TOBACCO USE
Safe self administration’s

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27
Q

True or false: warfarin (Coumadin) has a black box warning

A

True for fatal bleeding

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28
Q

What pregnancy category is warfarin (Coumadin) and why?

A

Pregnancy category X because it can crossable center and calls fetal hemorrhaging

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29
Q

What is the brand name of clopidogrel?

A

οΏΌ Plavix

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30
Q

What drug class is clopidogrel (plavix)

A

Antiplatelet

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31
Q

What is the mechanism of action of clopidogrel (Plavix?)

A

It irreversibly blocks the ADP receptor on platelets or surface

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32
Q

What are the side effects of clopidogrel (Plavix)?

A

Pruritus, rash, purpura, and diarrhea
Thrombotic thrombocytopenic Purpera, TTP
Hemorrhage and severe neutropenia

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33
Q

What are the therapeutic uses of clopidogrel (Plavix)?

A

Reduces MI, stroke and vascular death in pts w/ atherosclerosis, and in those after Coronary artery stent

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34
Q

People with afib who can’t take vitamin K antagonistic, take what drug?

A

οΏΌ Clopidogrel (Plavix)

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35
Q

What should the lab levels be when taking antiplatelets?

A

οΏΌ Hemoglobin: > 7 (anything below 7 you’re sending your pts to heaven)
Platelets: 150,000-400k (anything below 150 is always iffy. Anything below 50 is extremely risky!!!)

36
Q

Nursing actions for clopidogrel (Plavix):

A

No INR or PTT needed

37
Q

What patients teachings do we give when administrating clopidogrel (Plavix?)

A

Report any sign of bleeding (excessive bruising, blood in urine and stool)
TAKE WITHOUT FOOD
Obtain labs regularly
Prevent injury
If superficial bleeding occurs, apply pressure for 3-5 minutes

38
Q

What are some safety measures when administrating clopidogrel (Plavix?)

A

This drug may accumulate in patients with hepatic impairment
It may increase your risk of hemorrhagic stroke in elderly

39
Q

True or false:
Clopidogrel has a black box warning

A

True that has a black box warning, for patients who are reduce metabolizers of drugs (2-14%)

40
Q

What pregnancy category is Clopidogrel?

A

B

41
Q

What drug class is aspirin

A

Antiplatelets

42
Q

What is aspirins mechanisms of action?

A

It’s a thromboxane A2 inhibitor
Provides antiplatelet properties it makes red blood cells less sticky
Lower platelets aggregation

43
Q

What are the therapeutic uses of aspirin?

A

Prevents am MI, CVA, and TIA (transient ischemic heart attack)
Treats ACS
artificial heart valves; it prevents clots
Used after setting bypassed and used after PCI (percutaneous coronary intervention)

44
Q

What drug does aspirin interact with?

A

NSAIDS but not acetaminophen

45
Q

Side effects of aspirin

A

Antiplatelet activity reverses after drug is stopped

46
Q

οΏΌ What are some nursing actions for aspirin?

A

No, PTT or INR
No new IV or IM after administration

47
Q

What are some patient teachings with aspirin?

A

Signs and symptoms of bleeding.
Be careful falling
use electric razor
Report to provider if urine has blood or if youre having black stools.

48
Q

What are key signs of aspirin toxicity?
What are some key signs of bleeding while taking aspirin?

A

Tinnitus /hyperventilation = toxicity
Tachycardia and hypertension equals bleeding

49
Q

What drug class is rivaroxaban (xarelto)?

A

Anticoagulant (direct factor xa inhibitor)

50
Q

What is rivaroxaban (xarelto) mechanism of action?

A

Inhibits platelet activation and fibrin clotting factor of xa

51
Q

Xarelto is as effective as __________ but associated with ______ ________

A

War-farin
Less bleeding

52
Q

True or false (why or why not):
Warfarin (xarelto) is slowly absorbed

A

False, rapidly absorbed, it’s highly bound to plasma proteins

53
Q

Warfarin (xarelto) undergoes partial metabolism by _____ and exceeded by ______

A

Cytochrome P450
Urine

54
Q

What are the therapeutic uses of Rivaroxaban (xarelto)?

A

Used in treatment and prevention of Venous thromboembolism
stroke prevention in pts with non valvular afib
At home use following knee and hip surgery for prevention of venous thrombus

55
Q

What are the side effects of Rivaroxaban (Xarelto) ?

A

Bleeding (intercranial, GI, and retinal)
-can increase if taken with other drugs that alter hemostasis (NSAID’s and aspirin)
Can cause spinal epidural hematoma if given while getting epidural for surgery

56
Q

What Nursing actions done take when administering rivaroxaban (xarelto)?

A

No labs are necessary

57
Q

What specific pts do we not give xarelto

A

Pts w/ creatine clearance less than 15mL
Pts with hepatic disease
Pts who are critically ill

58
Q

What patients teachings dowe give when administering Rivaroxaban (xarelto)?

A

Safe use/administration
Prevent bleeding as well as symptoms and signs
Obtain regular labs

59
Q

What foods increase the effect of xarelto?
What foods decrease?

A

Increase:
-Grapefruit!!!!!!
-Bilberry, alfalfa, and anise
Decrease:
-St John β€˜S wort

60
Q

What medication increase serum concentration of xarelto?

A

Clarithromycin.

61
Q

What are some safety measures of Rivaroxaban?

A

Estrogen derivatives decrease effect
On beers criteria list

62
Q

What drug class is alteplase (TPA)?

A

Thrombolytic

63
Q

What are the mechanisms of action of alteplase (rTPA)?

A

Encourages plasminogen to plasmin, which breaks down clot
Lyses unwanted clot

64
Q

What does rTPA stand for?

A

Recombinant tissue plasminogen activator

65
Q

What are Thera partic uses for alteplase (rTPA)?

A

Treatment of:
- ischemic stroke, mi, acute PE

66
Q

Side effects for alteplase are…

A

Bleeding, symptomatic Brain hemorrhage, increase risk of cerebral embolism
With pt’s who have afib/ aflutter

67
Q

What are the contraindications with alteplase (tpa)?

A

Severe hypertension
Aneurysm
Intracranial or intraspinal surgery /trauma/mass
Current use of oral anticoagulants
Arterovenous malformation

68
Q

What Nursing actions do we take when administering Alteplase?

A

Minimize IM injections (bruising, bleeding, and hematoma may occur)
Assess pts for cardiac dysthymia’s such as: (SB, PVC’s, and Vtach)
Check INR, aPTT, platelets count and fibrinogen to establish baseline

69
Q

True or false? Why or why not?
Only specific nurses are allow to give Alteplase (rTPA)

A

Only ED/critical care nurses or settings with cardiac and other monitoring available

70
Q

Patient teachings when administering Alteplase (rTPA)?

A

Bleeding
Special care brushing teeth (reduce gum bleeding)

71
Q

Does Alteplase have a black box warning? Why or why not?

A

Yes!!! HIGHEST RISK FOR BLEEDING

72
Q

Safety for alteplase?

A

No iv, no subq, no IM, no ABGs
Avoid giving pt with:
-active bleeding -uncontrolled HTN 180/110+
-recent surgery

73
Q

What are the 3A’s when giving Alteplase?

A

Aneurysm, accident, av malformation

74
Q

What drug class is Cholestyramine?

A

Fibrates (bile acid sequestrants)

75
Q

What is choleStyramine’s mechanism of action?

A

Binds w/cholesterol in intestine and prevents absorption

76
Q

What are the therapeutic uses of cholestyramine?

A

Reduces LDL (15-30%)
little to no effect of HDL (3-5% elevation)

77
Q

What are these effects of cholestyramine?

A

GI issues: constipation, abdominal pain/ discomfort, nausea, vomiting, diarrhea, anorexia and flatulence
Contradicted with biliary obstruction
May decrease absorption of oral medications

78
Q

What Nursing actions are required when giving Cholestyramine?

A

Observe decreased levels of total term cholesterol, LDL, triglycerides, & HDL

79
Q

What are the patient teachings when administering Cholestyramine?

A

Adequacy of fat soluble vitamin: A, D, E and K (supplements may be required)
Oat bran/ pectin increase effects
Take meds with water or other fluids

80
Q

What safety measures do we take when administering Cholestyramine?

A

Do not take 4-6 hrs within other medications

81
Q

What pregnancy category is Cholestyramine?

A

C

82
Q

What are the mechanism of action for Fibrates?

A

Increase oxidation of fatty acids in liver
Decrease hepatic production of Tchol, LDL, triglycerides, and HDL

83
Q

What are the side effects when taking fenofibrate?

A

GI discomfort/diarrhea
Increase cholesterol concentration in biliary tract and formation of gallstones

84
Q

What nursing actions do we take when administering Fenofibrate?

A

Assess and test Tchol, LDL, triglycerides, HDL
We administer the drug with food to increase absorption

85
Q

What patient teachings do we follow when administering Fenofibrate?

A

Pt needs to report symptoms
Periodic blood tests

86
Q

What pregnancy category is Fenofibrate?

A

C

Pharmacology πŸ’Š (8 decks)

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