Anticoagulants Flashcards

1
Q

What is the primary function of vitamin K?

A

Blood clotting

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2
Q

What is the drug class of warfarin (Coumadin)?

A

Vitamin K antagonist

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3
Q

Describe the MOA of warfarin (Coumadin)

A

Inhibits vitamin K synthesis

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4
Q

What is a normal INR?

A

1

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5
Q

What is a therapeutic INR?

A

2 - 3.5

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6
Q

What labs / monitoring are associated with warfarin (Coumadin)?

A

PT/INR

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7
Q

Anticoagulants help prevent ______ strokes

A

Ischemic

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8
Q

What is the primary side effect of warfarin (Coumadin)?

A

Ecchymosis

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9
Q

What are the adverse effects of warfarin (Coumadin)? (2)

A
  • Bleeding
  • Skin necrosis
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10
Q

Why are there so many drug interactions with warfarin (Coumadin)?

A

It is highly protein bound

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11
Q

What is the route of warfarin (Coumadin)?

A

PO

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12
Q

The onset of warfarin (Coumadin) is about ______

A

48 hours

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13
Q

Anticoagulation effects start ______ after administration of warfarin (Coumadin)

A

24 hours

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14
Q

When is warfarin (Coumadin) usually given?

A

In the evening

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15
Q

Why is warfarin (Coumadin) administration timing (in the evening) so important?

A

Allows for changes in dosage after obtaining lab results (decreases drug interactions)

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16
Q

Describe the most significant concern associated with warfarin toxicity

A

Change in mental status - indication of intercranial bleeding

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17
Q

What are the 2 antidotes / reversal agents for warfarin (Coumadin) toxicity?

A
  • Fresh frozen plasma
  • Vitamin K
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18
Q

Describe the reversal of warfarin (Coumadin) toxicity using vitamin K

A

10 mg IV –> reversal in 6 hours

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19
Q

What is bridge therapy?

A

Use of heparin / LMWH (short-acting anticoagulants) when warfarin therapy is interrupted

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20
Q

What is the purpose of bridge therapy?

A

Minimize the risk of blood clots while the patient is not fully anti-coagulated

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21
Q

What is the effect of vitamin K use for reversal of warfarin toxicity?

A

Warfarin resistance for up to 7 days

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22
Q

What is the primary nursing consideration associated with warfarin (Coumadin)?

A

Slow onset - use bridge therapy

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23
Q

What are the 2 possible types of bridge therapy that can be used for warfarin (Coumadin)?

A
  • IV heparin
  • LMWH
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24
Q

Why are anticoagulants used for non-valvular atrial fibrillation / atrial flutter?

A

Blood pooling - risk of clotting / stroke

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25
Q

What are the 2 types of direct oral anticoagulants?

A
  • dabigatran (Pradaxa)
  • rivaroxaban (Xarelto)
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26
Q

Describe the primary nursing consideration associated with direct oral anticoagulants

A

Excreted by the kidneys - dose adjustments made based on renal function

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27
Q

What is the primary side effect associated with direct oral anticoagulants?

A

Increased risk of GI bleed compared to warfarin

28
Q

What is the drug class of dabigatran (Pradaxa)?

A

Direct oral anticoagulant

29
Q

Dabigatran (Pradaxa) is activated in the ______

A

Liver

30
Q

Dabigatran (Pradaxa) must be stopped prior to ______

A

Planned surgical procedures

31
Q

What is the antidote / reversal agent for dabigatran (Pradaxa) toxicity?

A

Praxbind

32
Q

What is the drug class of rivaroxaban (Xarelto)?

A

Direct oral anticoagulant

33
Q

Describe the MOA of rivaroxaban (Xarelto)

A

Binds to factor Xa - inhibits thrombin

34
Q

What is the primary indication of rivaroxaban (Xarelto)?

A

Prophylaxis for knee / hip surgeries

35
Q

What is the black box warning for rivaroxaban (Xarelto)?

A

Spinal hematoma from epidural catheters

36
Q

Describe the MOA of heparin

A

Binds to antithrombin III - inhibits thrombin

37
Q

Heparin prevents clotting in ______

A

Central line catheters

38
Q

What is the primary side effect of heparin?

A

Heparin induced thrombocytopenia (HIT)

39
Q

Describe heparin induced thrombocytopenia (HIT)

A

Autoimmune reaction causing platelet aggregation

40
Q

What is the antidote / reversal agent for heparin toxicity?

A

Protamine sulfate

41
Q

What labs / monitoring are associated with heparin? (2)

A
  • aPTT
  • CBC - platelets
42
Q

What are the routes of heparin? (2)

A
  • IV
  • SQ
43
Q

What is the drug class of enoxaparin (Lovenox)?

A

Low molecular weight heparin (LMWH)

44
Q

What is the primary indication of enoxaparin (Lovenox)?

A

Bridge therapy

45
Q

Describe the primary nursing consideration associated with enoxaparin (Lovenox)

A

More predictable than heparin - aPTT not required

46
Q

What is the therapeutic dose of enoxaparin (Lovenox)?

A

1 mg / kg Q12 hrs

47
Q

What is the route of enoxaparin (Lovenox)?

A

SQ - teach self-injections

48
Q

What are the 2 types of antiplatelet agents?

A
  • aspirin (ASA)
  • clopidogrel (Plavix)
49
Q

What are the side effects of antiplatelet agents? (3)

A
  • Anemia
  • Bleeding
  • Thrombocytopenia
50
Q

What labs / monitoring are associated with antiplatelet agents?

A

CBCs - platelets

51
Q

What is the drug class of aspirin (ASA)?

A

Antiplatelet agent

52
Q

Describe the MOA of aspirin (ASA) (3)

A
  • Irreversible inhibition of COX enzymes in platelets
  • Decreased platelet aggregation
  • Vasoconstriction
53
Q

What is the lifespan of aspirin (ASA)?

A

7 days

54
Q

What are the contraindications of aspirin (ASA)? (2)

A
  • Reye’s syndrome
  • GI ulcers
55
Q

What are the routes of aspirin (ASA)? (2)

A
  • PO
  • Rectal
56
Q

What is the drug class of clopidogrel (Plavix)?

A

Antiplatelet agent

57
Q

What is the therapeutic dose of clopidogrel (Plavix)?

A

75 mg daily

58
Q

______ occurs with 300 mg doses of clopidogrel (Plavix)

A

Loading

59
Q

What is the route of clopidogrel (Plavix)?

A

PO

60
Q

What is the drug class of alteplace (Activase, tpa)?

A

Thrombolytic

61
Q

Describe the MOA of alteplace (Activase, tpa)

A

Conversion of plasminogen to plasmin - breakdown of clots

62
Q

What are the indications of alteplace (Activase, tpa)? (4)

A
  • Existing clots
  • Acute MI
  • Acute ischemic stroke
  • Occlusion of shunts / catheters
63
Q

Before administering alteplace (Activase, tpa), it is important to obtain a non-contrast CT showing ______

A

No hemorrhage

64
Q

Before administering alteplace (Activase, tpa), it is important to wait ______ after onset of ischemic stroke symptoms

A

3 - 4.5 hours

65
Q

Describe the primary nursing consideration of alteplace (Activase, tpa)

A

Short half-life - use bridge therapy

66
Q

What is the route of alteplace (Activase, tpa)?

A

IV