Anticoagulants

Question 1

Antiplatelets def

Answer 1

Prevent formation of clots after surgery

Prevent platelet aggregation

Question 2

Thrombolytics def

Answer 2

Clot busters

Attack and disolve clots that have already formed

Question 3

Heparin

Answer 3

Prevent clots, does not destroy them
Use in DVT,stroke,PE,MI

Routes:IV push,IV drip, subcut

Subcut to prevent DVT

Question 4

Monitoring effectiveness of heparin

Answer 4

APTT:activated partial thromboplastin time(check 4-6 hours after giving)

aPTT normal: 30-40 seconds
aPTT goal: 70 seconds(may vary, take into account BSA

Question 5

Heparin prototype

Answer 5

Anticoagulant
Contraindications: hemorrhagic stroke,peptic ulcer, bleeding disorders

SE: bleeding, HIT(heparin induced thrombocytopenia)

Monitor platelet counts and aPTT

Patients on heparin should NOT be given aspirin

Question 6

Low molecular weight heparin

Answer 6

Enoxaparin(lovenox)

Less bleeding
Longer half life
Can receive if pregnant

Heparin with antidote: protamine sulfate(given IV brings clotting time back to 2-4 hours

Question 7

Warfarin(Coumadin)

Oral anticoagulant

Answer 7

Monitor INR(2-3)
Has drug and herbal interactions
SE:bleeding
Inhibits production of vitamin K(vitamin K is antidote Takes 24-48 hours to become therapeutic)
Coumadin is therapeutic with in 12 hours to 3 days
Transition from heparin to Coumadin happens in hospital
Pregnancy category X

Question 8

Oral anticoagulant antagonist

Answer 8

Vitamin K
Takes 24-48 hours to be therapeutic
Subcut is preferred route
Be very cautious when giving IM or IV(do not give IV PUSH!)
Give blood as we wait for vitamin K to kick in

Question 9

Nursing process with heparin and Coumadin

Answer 9

Examine pt’s(mouth,nose, urine, and skin for bleeding)

Keep protamine sulfate for heparin and vitamin K for Coumadin

Question 10

Patient teaching on anticoagulants

Answer 10

Patient to inform dentist when on anticoagulant
Shave with electric razor

Check with HCP before taking OTC drugs
Aspirin should NOT be taken with warfarin
Control external hemorrhage(apply pressure 5-10 minutes)
Report frank or occult bleeding
Avoid excessive: green leafy veggies, caffeine, alcohol, herbs

Wear medic alert bracelet

Question 11

Dabigatron etexilate(prodaxa)

Answer 11

Anticoagulant approved for: preventing of blood clots of those with(AFIB) if it’s a valve problem

There are no blood tests needed or not good restrictions

BUT! If you need surgery and start to bleed there is not antidote

Acts on thrombin excreted through the kidneys

Question 12

Rivaroxaban(xarelto)

Answer 12

factor XA inhibitor
-prevention of clots for those undergoing joint replacement or history of AFIB

Need normal renal/liver function

Pregnancy Category C
No antidoteONR,aPTT,PTT not reliable

Question 13

Anti platelet drugs

Answer 13

Inhibit platelet aggregation
Used to prevent:stroke,TIA,MI

Asparin 81mg or 325 mg

Question 14

Clopidagrel(plavix)

Answer 14

Class:anti platelet
TE: to prevent reoccurrence of MI,stroke, to prevent vascular death

Can cause GI upset
Can take plavix and aspirin together

Question 15

Post-angioplasty

Answer 15

Reopro, integrillin

-helps prevent reoclussion of coronary arteries after angioplasty

Monitor for bleeding

Question 16

Thrombolytics

Answer 16

Medications that actually break down the blood clot

TPA(tissue plasminogen activator) activase

Thrombolytics must be given within 3 hours of onset of symptoms(when you last saw them normal)

Inactivator? Amino caloric acid(amicar)

Question 17

Extras

Answer 17

Do not make them bleed 
Use fall precautions 
Give foley before TPA
Soft bristle tooth brush
Electric razor

Question 18

Anticoagulants def

Answer 18

“Haparin” prevent blood clots