Anticoagulants, Antiplatelet drugs, Thrombolytic drugs

Question 1

heparin
mechanism

Answer 1

Enhances antithrombin
Reduce the formation of fibrin
Inhibits the synthesis and activity of clotting factors (binds them up)

Question 2

Heparin (Unfractionated) Uses

Answer 2

REMEMBER: He - Head, heart, hemodialysis
-DVT & Pulmonary embolism
-Stroke
-Open heart surgery
-Renal dialysis
(Both involve removing blood from the body)
Lose-dose postoperatively

Question 3

Signs/symptoms of pulmonary embolism

Answer 3

SOB
Chest pain
Cough
Panic
Rapid HR

Question 4

What laboratory parameter does one monitor when a patient is on heparin. Know the therapeutic range for this parameter.

Answer 4

Activated partial thromboplastin time (aPTT)
1.5-2.5 times the baseline value

Question 5

What is the antidote for heparin overdose?

Answer 5

protamine sulfate

Question 6

Would you be more cautious using heparin after certain surgeries or procedures?

Answer 6

Surgery of the eye, brain, or spinal cord

Question 7

What is heparin-induced thrombocytopenia? How would you recognize it? What would you do if it occurred in your patient?

Answer 7

-Dropping platelets, paradoxical clotting, DVT or PE while on heparin, ischemia of digits
-HIT should be suspected whenever platelet counts fall significantly or when thrombosis develops despite adequate anticoagulation
-Discontinue heparin

Question 8

Know the low molecular weight heparins (enoxaparin, dalteparin). What makes them different from unfractionated heparin? (consider bioavailability,dosing, and lab monitoring)?

Answer 8

No monitoring of aPTT
Dosage is based on body weight (easier, more standard dosing than unfractionated heparin)

Question 9

low molecular weight heparins (enoxaparin, dalteparin):
adverse effects

Answer 9

Bleeding (but less than unfractionated heparin)
Immune-mediated thrombocytopenia
Severe neurologic injury for patients undergoing spinal puncture of spinal epidural anesthesia

Question 10

Through which route and at which body site are heparin and LMWH administered?

Answer 10

Heparin: IV or sub Q
LMWH: subQ

Question 11

warfarin (Coumadin):
uses

Answer 11

Prevention of DVTs and pulmonary embolism
Prevention of thromboembolism in patients with prosthetic heart valves
Prevention of thrombosis during atrial fibrillation

Question 12

What laboratory parameter must be monitored for a patient on warfarin?

Answer 12

PT - Prothrombin time
INR - International normalized ratio (how long it takes to clot with warfarin vs. without)
Usually 2-3
Can do at home with finger stick

Question 13

What is the antidote for warfarin toxicity?

Answer 13

-Vitamin K
-Takes hours to work - so it’s given with fresh frozen plasma (FFP)

Question 14

What drugs increase warfarin levels?

Answer 14

Sulfonamides, acetaminophen, cimetidine
See I’m selface (selfish) to increase war cim = see im Sulf + ace = selfish To increase war !

Question 15

Which drugs decrease warfarin levels?

Answer 15

Antiepileptics, oral contraceptives, rifampin, bile-acid sequestrants

Question 16

Dabigatran:
Mechanism

Answer 16

Direct inhibition of thrombin

Question 17

Advantages of dabigatran:

Answer 17

Doesn’t require monitoring of anticoagulation
Same dose can be used for all patients (regardless of weight or age)

Question 18

Rivaroxaban:
Mechanism

Answer 18

Binds directly with factor Xa

Question 19

Rivaroxaban:
advantages

Answer 19

Oral
No lab monitoring

Question 20

aspirin:
mechanism

Answer 20

Inhibition of cyclooxygenase

Question 21

Aspirin:
Therapeutic uses

Answer 21

Ischemic stroke
TIA
Angina
Coronary stenting (prevents clotting in stent)
Acute MI

Question 22

Aspirin:
Adverse effect:

Answer 22

Bleeding
Risk for GI bleeding
Hemorrhagic stroke

Question 23

clopidogrel (Plavix):
Mechanism

Answer 23

ADP receptor antagonist

Question 24

clopidogrel (Plavix)
adverse effects compared to aspirin

Answer 24

Slightly less intracranial and GI bleeding than aspirin

Question 25

Recognize the _____ suffix, and know that drugs with this in the name, like ticagrelor, are antiplatelet drugs, and are often used for conditions for which aspirin might be used.

Answer 25

–grel

Question 26

How do the glycoprotein IIB/IIIA inhibitors work? In what situation would a nurse administer these drugs with aspirin and heparin?

Answer 26

-blocking the final step in platelet aggregation -“Super aspirins” (Abciximab) -Given with aspirin and heparin during percutaneous procedures (like a stent placement)

Question 27

Know the drug Alteplase (tPa).What is it used for?

Answer 27

Thrombolytic drug - break up clots -Ischemic stroke Massive pulmonary emboli MI (Given within 2 hours of acute MI)

Question 28

Alteplase (tPa) Major adverse effect:

Answer 28

bleeding - minor oozing to life-threatening effect

Question 29

Absolute contraindications of tPA

Answer 29

BRAIN PROBLEMS INTERNAL BLEEDING * Any prior intracranial hemorrhage * Known structural cerebral vascular lesion * Ischemic stroke within past 3 months except ischemic stroke within 4.5 hr * Brain tumor * Active internal bleeding (other than menses) * Suspected aortic dissection