Anticoagulants Flashcards

1
Q

What is another name for an anticoagulant?

A

Blood thinner - but blood is not becoming thinner

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2
Q

What are the two purposes of anticoagulants?

A
  • Decrease bloods ability to clot
  • Help prevent or treat life-threatening conditions caused by a clot
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3
Q

Do most drugs help facilitate break down of existing clots or prevent clots from forming (or getting bigger)?

A

Prevent clots from forming (or getting bigger)

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4
Q

Most anticoagulation drugs do not preform what action?

A

Facilitate break down of existing clots

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5
Q

Anticoagulation drugs help to prevent or treat life-threatening conditions caused by a clot such as… (there are 4)

A
  • Ischemic strokes
  • Myocardial infarctions
  • Pulmonary embolisms
  • Venous thrombi
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6
Q

What are conditions that may cause blood clots?

A
  • Atrial fibrillation
  • Heart valve surgery/ replacement
  • Joint replacement/ orthopedic surgery
  • Blood clotting disorders
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7
Q

There are three kinds of drugs that affect blood clotting, what are they?

A
  • Anticoagulants
  • Antiplatelets
  • Fibrinolytics (Thrombolytics)
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8
Q

What treats venous abnormal clot formation such as deep vein thrombosis (DVT) and thromboembolisms?

A

Anticoagulants

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9
Q

What is a thromboembolism?

A

A DVT (clot) that travels through the venous system to the right side of the heart and into the lungs to cause a pulmonary embolism

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10
Q

What prevents excessive clotting by inhibiting platelet activity?

A

Antiplatelets

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11
Q

What often forms by abnormal platelet aggregation?

A

Arterial thrombi

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12
Q

What is used to treat arterial clots such as coronary artery occlusions and cerebral infarctions?

A

Antiplatelets

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13
Q

What facilitates the breakdown and dissolution of already formed clots?

A

Fibrinolytics (Thrombolytics)

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14
Q

What converts plasminogen to plasmin to help break down fibrin?

A

Fibrinolytics (Thrombolytics)

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15
Q

What are the three ways of administration of anticoagulants?

A
  • Parenteral
  • Subcutaneous
  • Oral
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16
Q

What is a parenteral anticoagulant and how is it administered?

A
  • Heparin (prevents clots from getting larger)
  • Through IV
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17
Q

What is a subcutaneous anticoagulant and how is it administered?

A
  • Low molecular weight heparin
  • Lovenox
  • Arixtra
  • Under the skin via needle
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18
Q

What is an oral anticoagulant and how is it administered?

A
  • Vitamin K antagonist (Coumadin aka Warfarin)
  • Administered through the mouth
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19
Q

Why is vitamin K so important when it comes to Coumadin (Warfarin)?

A
  • Vitamin K aids in the clotting process
  • Coumadin (Warfarin) takes vitamin K out of the problem
  • Patient needs to be monitored for vitamin K ingestion as it is in most foods
  • It takes hours to days to deplete the body’s stores of vitamin K
20
Q

What is the preferred test for patient on vitamin K antagonist (VKA) such as Coumadin?

A

INR - International Normalized Ratio

21
Q

What is INR?

A

Derived from prothrombin time - indirectly measures time it takes a sample of blood to clot through assessing level of several clotting factors

22
Q

INR is a ratio, what is this ratio?

A

INR = patient PT / control PT
- (PT = prothrombin)

23
Q

What is a normal INR and what does it mean?

A
  • Normal = 1
  • Takes the same time for patients blood to clot as it does for the control sample to clot
24
Q

What is a therapeutic INR?

A

INR 2-3 = takes 2-3x as long to clot

25
If a patient has a high INR they are at risk for what?
Increased risk for uncontrolled bleeding
26
If a patient has a low (near 1) INR what does that mean?
They have an INR with no therapeutic effect
27
If someone has a high INR do they have a low vitamin K level or a high vitamin K level?
Low vitamin K level
28
What medication MUST you monitor INR with?
Coumadin/ Warfarin
29
There are newer anticoagulants called direct thrombin inhibitors, how are most of these administered?
Parenterally (IV or Subcutaneously)
30
What are some Factor Xa inhibitors and how are they administered?
- Fondaparinux (Arixtra): subcutaneous - Apixaban (Eliquis): Oral - Rivaroxaban (Xarelto): Oral
31
What prevents excessive clotting caused by increased platelet activity?
Antiplatelets
32
What are examples of antiplatelet drugs?
- Aspirin (most common) - ADP receptor blockers - Glycoprotein 2b-3b blockers
33
What are some adverse effects that antiplatelets can cause?
- Increased risk of bleeding - GI irritation (with aspirin) - Kidney and liver damage
34
Fibrinolytic agents (Aka clot busters) have what kind of time window to be the most effective?
Must be administered within a 3 hour window of symptom onset
35
What are the two kinds of fibrinolytic agents?
- Streptokinase - TPA (Tissue Plasminogen Activator) (Alteplase)
36
What is the mechanism of action of Streptokinase?
- Nonenzymatic protein substance that forms a complex with plasminogen - Converts plasminogen to plasmin
37
What can streptokinase be used for?
Lysis of acute DVT, pulmonary emboli, and acute arterial thrombi
38
What are the side effects of streptokinase?
Bleeding
39
How do you administer streptokinase?
Through an IV
40
What are the contraindications of streptokinase?
Bleeding, hemorrhagic stroke
41
What is the mechanism of action of TPA?
Recombinant human thrombolytic enzyme that activates plasminogen bound to fibrin
42
What can TPA be used for?
DVT, multiple pulmonary emboli
43
What are the side effects of TPA?
Bleeding
44
How do you administer TPA?
Through an IV
45
What are contraindications to TPA?
Bleeding and hemorrhagic stoke