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Pharm Anticoagulant > Anticoagulants > Flashcards

Anticoagulants Flashcards

0
Q

Heparin-induced thrombocytopenia

  • potentially fatal
  • caused by antibody development
  • reduce platelet counts
  • paradoxical increase in thrombotic events
A

Heparins adverse effects

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1
Q

Bleeding
Localized bruising,petichiae, purpura
Nose bleeds, gum bleeding
Black tarry stool

Systemic hemorrhage
-tachycardia, hypotension

A

Heparin adverse effects

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2
Q

Low platelet count

A

Thrombocytopenia

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3
Q

Heparins contraindications

A
  • Thrombocytopenia
  • uncontrollable bleeding
  • surgery on eye, brain or spinal cord
  • spinal puncture/epidural
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4
Q

Heparins general info. How to give…

A
  • Give it subcutaneous not IM
  • inject in fatty areas- abdomen
  • rotate sites
  • don’t give injections within 2” of incisions, umbilicus,scars etc.
  • don’t aspirated or massage injection site
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5
Q

Massaging or aspirating injection sites for heparins causes

A

Hematoma formation

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6
Q

Heparin IV doses are double checked with…

A

Another nurse

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7
Q

Labs run for heparin to monitor…

A

Coagulation effects

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8
Q

Normal Coagulation values are

A

25-35 seconds

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9
Q

Coagulation values goal w/ heparin…

A

1.5-2.5 times the norm. 45-70 sec.

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10
Q

What is the antidote for excessive anti coagulation?

A

Protamine

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11
Q

Prototype low-molecular-weight heparins

A

Enoxaparin ( Lovenox )

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12
Q

How is Enoxaparin ( Lovenox ) given?

A

1-2x/day subcutaneous

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13
Q

Does Enoxaparin require labs?

A

No. Can be given at home.

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14
Q

General info on Enoxaparin

A

Synthetic Heparin
Provides a more predictable response than Heparin.
Inactivates Xa(10a), less able to inactivate thrombin

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15
Q

What is hemostasis?

A

The process that halts bleeding.

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16
Q

How many stages to hemostasis?

A

2

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17
Q

Hemostasis stage 1 is

A

Formation of platelet plug

-platelet aggregation

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18
Q

Stage 2 hemostasis

A

Coagulation

  • intrinsic coagulation
  • extrinsic coagulation
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19
Q

Result of coagulation system

A

Fibrin… A clot forming substance

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20
Q

Conditions that cause clot (thrombus) formation

A

Stroke
MI
Deep vein thrombosis
Pulmonary embolism

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21
Q

What are the coagulation modifier drugs?

A

Anticoagulants
Antiplatelets
Thrombolytics

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22
Q

What are the different Anticoagulants?

A 
Heparin
Low Molecular Weight Heparin
    -Enoxaparin (Lovenox)
Selective Factor Xa(10a) Inhibitors
    -Fondaparinux (Arixtra)
Warfarin(Coumadin)
Direct Thrombin Inhibitors
    -Dibigatran (Pradaxa)
Direct Factor Xa (10a) Inhibitors
    -Rivaroxaban (Xarelto)
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23
Q

Low molecular weight heparin drug…

A

Enoxaparin (Lovenox)

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24
Q

Selective factor Xa drug

A

Fondaparinux (Arixtra)

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25
Q

Direct thrombin inhibitors drug

A

Dibigatran (Pradaxa)

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26
Q

Direct factor Xa inhibitors

A

Rivaroxaban (Xarelto)

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27
Q

Heparin (Unfractionated) mechanism of action

A

Inhibits clotting action IIa & Xa which enhances antithrombin and inhibits the formation of fibrin

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28
Q

Heparins indications

A 
Prevention & Treatment of
Low dose therapy postoperatively
Deep vein thrombosis
Pulmonary embolism
Stroke
MI
Unstable angina
Atrial fibrillation
Mechanical devices like valves
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29
Q

Basic info on Heparin unfractionated

A

Rapid acting
Half life only 1-2hrs
Effects seen immediately
IV or SC only

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30
Q

Reversal agent for Heparin

A

Protamine Sulfate

It binds with Heparin given IV

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31
Q

Fondaparinux general info

A

Indirectly enhances activation of antithrombin
It suppresses coagulation
Given SC once a day

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32
Q

Fondaparinux does not affect

A

Prothrombin time, aPTT, bleeding time or platelet aggregation

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33
Q

General info in Warfarin

A

Inhibits vitamin K synthesis

Inhibits vitamin K-dependent clotting factors

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34
Q

Therapeutic uses of Warfarin

A

Prevention of clot formation
Not useful in emergencies due to slow onset
-half life 6hrs-2.5 days

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35
Q

Warfarin adverse effects

A

Bleeding

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36
Q

Warfarin contraindications

A

Pregnancy cat X
Thrombocytopenia
Eye, brain,spinal cord surgery
Vitamin K deficiency, liver disorder

37
Q

Warfarin interactions-anticoagulant effects increased

A

Acetaminophen, sulfonamides, cephalosporins,heparin, aspirin….these all increase anticoagulant effects

38
Q

Warfarin interactions-decreased anticoagulant effects

A

Phenobarbital, carbamazepine, phenytoin, rifampin, oral contraceptives, vitamin k

39
Q

Labs to monitor for warfarin

A

Prothrombin time (PT)

  • normal: 11-13 sec
  • goal: 18 sec

INR

  • normal:1
  • goal: 2-3.5
40
Q

Give ________for warfarin toxicity or OD.

A

Vitamin K

41
Q

Warfarin nursing implications

A 
Can be started while on heparin
Full therapeutic effects take several days
Monitor PT-INR regularly 
Avoid foods high in vitamin K
   -dark green leafy vegi
   -cabbage, broccoli, Brussels sprouts
   -mayo, canola oil, soybean oil
42
Q

Dabigatran (Pradaxa) general info

A

Directly inhibit thrombin
Given orally twice daily
Does not require monitoring

43
Q

Dibigatran indication

A

A fib

44
Q

Dibigatran adverse effects

A

Bleeding

GI discomfort

45
Q

Other Direct Thrombin Inhibitors

A

Argatroban, Bivalirudin, Lepirudin which is off the market now

46
Q

Rivaroxaban general info

A

Directly binds with Factor Xa which inhibits thrombin production and suppresses coagulation
Does not require drug monitoring
Given orally twice a day

47
Q

Rivaroxaban indication

A

Prevention of venous thromboembolism in adults undergoing elective hip or knee replacement

48
Q

Rivaroxaban contraindications

A

Renal failure

49
Q

Antiplatelets drugs prototypes

A 
Aspirin
Clopidogrel (plavix)
50
Q

Aspirin general info

A 
Inhibits cyclooxygenase in the platelet
Prevents formation of TAX2
Reduces vasoconstriction & platelet aggregation
1 dose lasts for life of platelet-7 days
81mg/day
51
Q

Clopidogrel (plavix)

A

ADP inhibitor
Inhibits platelet aggregation
More expensive than aspirin

52
Q

Antiplatelets drug indications

A

Stroke prevention
TIA prevention
Reduce risk of MI
prevention of reinfarction after MI

53
Q

Antiplatelet contraindications

A 
Thrombocytopenia 
Active bleeding
Leukemia
Injury
GI ulcer
Brain bleed
Recent stroke
54
Q

Aspirin adverse effects

A 
Dizziness, tinnitus, hearing loss
GI
Bleeding
Thrombocytopenia
Stroke
55
Q

Clopidogrel adverse effects

A

GI

Bleeding-less than aspirin

56
Q

Antiplatelet drug interactions

A

Drugs that cause bleeding such as

Heparin warfarin aspirin NSAIDs

57
Q

Antiplatelet nursing implications

A

Discontinue 7 days before surgery

58
Q

What do Thrombolytics do?

A

Clot busters
Break down Lyse clots that are already formed
Converts plasminogen to plasmin which destroys fibrin

59
Q

Thrombolytic prototype drug

A

Alteplase (Cathflo Activase)

60
Q

General info on alteplase

A

Given IV
Streptokinase
-increase risk of allergic reactions & hypotension
-less risk of brain bleed

61
Q

Alteplase indications

A 
Acute MI
Arterial Thrombolysis 
DVT
Pulmonary Embolus
Acute ischemic stroke
Occlusion of shunts or catheters
62
Q

Alteplase adverse effects

A

Serious risk of bleeding

Nausea, vomiting, hypotension

63
Q

Alteplase contraindications

A 
Prior brain bleed
Structural cerebral vascular lesion
Active internal bleeding
Brain tumor
Suspected aortic dissection
64
Q

Alteplase nursing implications

A

Monitor IV sites for bleeding redness pain
Bleeding from mucus membranes
Watch for increased pulse, restlessness

65
Q

Risk of Coronary Heart Disease if cholesterol is higher than 300 is 3-4x greater than if less than 200

A

.

66
Q

Cholesterol screening

A

Every 5 years
Total less than 200
LDL less than 100
Tri less than 150

67
Q

Antilipemic treatment info

A

Used to lower lipid levels in combo with diet & exercise

68
Q

HMG-CoA reductase Inhibitors prototype drug

A

Statins…Atorvastatin (Lipitor)

69
Q

HMG-CoA mech of action

A

Inhibit HMG-CoA reductase used by liver to make cholesterol
Liver increase LDL receptors
Takes 6-8 weeks to see max results

70
Q

HMG-CoA contraindications

A

Pregnancy-cat X

Hepatitis

71
Q

HMG-CoA adverse effects

A

GI
Liver enzyme elevation
Muscle pain-myopathy

72
Q

HMG-CoA interactions

A

Fibrates & oral antidiabetic drugs increase risk of Rhabdomyolysis
Grapefruit juice & Erythromycin increase levels of statins

73
Q

Bile Acid Sequestrants prototype drug

A

Colesevelam (WelChol)

2nd line drug

74
Q

Colesevelam (WelChol) mech of action

A

Prevent resorption of bile acids from small intestine which are necessary for absorption of cholesterol.
Liver tries to compensate by adding more LDL receptors thus less LDL in circulation

75
Q

Colesevelam (WelChol) interactions

A

Hyperlipoproteinemia
Relief of puritis
Can be used with statins

76
Q

Colesevelam (WelChol) adverse effects

A

Constipation
Heartburn, nausea, belching, bloating
-tend to go away in time

77
Q

Colesevelam (WelChol) contraindications

A

Biliary or bowel obstruction

78
Q

Colesevelam (WelChol) interactions

A

Other drugs taken at the same time

Take other drugs 1 hr before or 3-4 hrs after

79
Q

Niacin general info

A

Nicotinic Acid
Vitamin B3
Lipid lowering requires much higher dose than vitamin
Effective, inexpensive, used in combo with other drugs
Start low initial dose and gradually increase

80
Q

Niacin Indications

A

Lowers triglycerides & LDL

Increases HDL better than any other drugs

81
Q

Niacin adverse effects

A 
Flushing-diminishes after a few weeks, can take aspirin 30 min before
Puritis
GI distress
Hepatotoxic 
Hyperglycemia
Hyperuricemia
82
Q

Niacin contraindications

A

Liver disease

Gout

83
Q

Niacin interactions

A

HMG-CoA (statin) causes Rhabdomyolysis

84
Q

Fibrates prototype drug

A

Gemfibrozil (Lopid)

85
Q

Gemfibrozil (Lopid) Fibrates indications

A

Decrease triglycerides - most effective drug for this

Increase HDL by 25%

86
Q

Gemfibrozil (Lopid) Fibrates adverse effects

A

GI distress are mild
gallstones
Myopathy-muscle pain
Hepatotoxicity

87
Q

Gemfibrozil (Lopid) Fibrates contraindications

A

Severe liver or kidney disease
Cirrhosis
Gallbladder disease

88
Q

Gemfibrozil (Lopid) Fibrates interactions

A

Oral anticoagulants increase risk of bleeding
Statin increase risk of rhabdomyosis
Take before eating

89
Q

Cholesterol Absorption Inhibitor prototype drug

A

Ezetimibe

90
Q

Cholesterol Absorption Inhibitor Ezetimibe general info

A

Inhibits absorption from the small intestine
Reduces total cholesterol, LDL & tri levels
Increases HDL
Clinical usefulness is currently questioned. New trials underway

91
Q

Cholesterol Absorption Inhibitor Ezetimibe nursing implications

A

Before therapy:
Assess lifestyle & history, contraindications & interactions
Get baseline level labs

Pharm Anticoagulant (1 decks)

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