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Pharmacology > anticoagulants, antiplatelets, and thrombolytic medications > Flashcards

anticoagulants, antiplatelets, and thrombolytic medications Flashcards

1
Q

antiplatelets

A

alter the formation of the platelet plug

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1
Q

anticoagulants

A

interfere with clotting cascade and thrombin formation

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2
Q

thrombolytics

A

break down the thrombus by stimulating the plasmin system

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3
Q

anti-platelet examples

A

aspirin
clopidogrel
abciximad

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4
Q

anticoagulant examples

A

heparin
enoxaprin
warfarin
dabigatran

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5
Q

thrombolytic example

A

tPA

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6
Q

aspirin action

A

-suppress platelet aggregation
-primarily in arteries

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7
Q

aspirin indications

A

-primary & secondary prevention of MI
-prevention of stroke in pts with hx of TIAs
-anti-inflammatory & anti-febrile

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8
Q

aspirin precaution

A

IRREVERSIBLE ACTION
-single dose of aspirin persists fro the life of a platelet (7-10 days)

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9
Q

if someone taking aspirin was having an elective surgery, when would you tell them to stop taking the aspirin?

A

7 days prior to surgery

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10
Q

adverse effects of aspirin

A

-GI upset & bleeding
-hemorrhagic stroke
-salicylate toxicity

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11
Q

what does salicylate toxicity look like?

A

-agitation
-confusion
-tachycardia
-fever
-ringing in ears

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12
Q

should you recommend someone take aspirin with food?

A

yes

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13
Q

aspirin contraindications

A

-peptic ulcer
-thrombocytopenia

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14
Q

aspirin teaching

A

-bleeding
-GI upset
-overuse

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15
Q

clopidogrel indications

A

-reduces risk of thrombotic events in patients with CAD
-prior to or after cardiac procedures (Cath/stent)

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16
Q

what type of medication is clopidogrel?

A

anti platelet

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17
Q

clopidogrel adverse effects

A

-bleeding
-TTP (big flat bruising)

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18
Q

clopidogrel teaching

A

-monitor for GI side effects
-look for blood in stool and urine
-look for bruising
-take with or without food

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19
Q

what cannot be taken with clopidogrel?

A

PPI

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20
Q

What are the most effective anti platelet drugs??

A

-super aspirins
-Abciximab
-tirofiban

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21
Q

abciximab / tirofiban indications

A

-prevent ischemic events due to acute coronary syndromes and those undergoing percutaneous coronary intervention (PCI)

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22
Q

abciximab / tirofiban adverse effects

A

-monitor for Brady cardia & hypotension
-bleeding

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23
Q

what do anticoagulants do?

A

-prevent blood clots from forming or extending
-interfere with the clotting cascade & thrombin formation

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24
Q

do anticoagulants break down existing clots?

A

no

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25
Q

heparin method od action

A

activates antithrombin thus indirectly inactivating thrombin & factor Xa which inhibits fibrin formation

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26
Q

heparin indication

A

-treat PE, DVT, stroke, when prompt anticoagulant activity is needed
-low dose for prophylaxis for surgery
-treatment of DIC

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27
Q

heparin contraindications

A

-thrombocytopenia
-Pts with high risk of bleeding (peptic ulcer disease, severe hypertension)
-post-op surgeries on the brain, eye, or spinal cord, lumbar puncture

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28
Q

people with what type of chronic illnesses should not take heparin?

A

-peptic ulcer disease
-severe hypertension

29
Q

people with what type of surgery should not take heparin?

A

-eye
-brain
-spinal cord
-lumbar puncture

30
Q

where would you administer a heparin injection?

A

SQ
2 inches below umbilicus

31
Q

can heparin be a drip?

A

yes

32
Q

monitoring for heparin

A

-frequent monitoring and titration of drip rate based upon aPTT

33
Q

what are therapeutic aPTT values for someone on heparin?

A

-1.5-2 times the control

34
Q

heparin most common adverse effects

A

-hemorrhage
-heparin-induced thrombocytopenia
-hypersensitivity reaction

35
Q

heparin antidote

A

protamine sulfate

36
Q

heparin teaching

A

-avoid aspirin
-report bleeding, bruising, dark tray stool

37
Q

enoxaparin mechanism of action

A

-activates antithrombin thus indirectly inactivating factor Xa which inhibits fibrin formation

38
Q

enoxaparin indications

A

-prevent DVT post-op
-treat DVT & PE
-prevents complications of MI

39
Q

enoxaparin contraindications

A

-thrombocytopenia
-pts with a high risk of bleeding (peptic ulcer disease, severe hypertension
-post-op surgeries on brain, spinal cord, eye or lumbar puncture

40
Q

where do you give enoxaparin injections?

A

SQ at anterior or posterolateral sites

41
Q

monitoring for enoxaparin

A

-predictable pharm-kinetics: does not require PTT monitoring
-weight based
-monitor CBC

42
Q

adverse effects of enoxaparin

A

bleeding

43
Q

antidote for enoxaparin

A

protamine sulfate

44
Q

warfarin mechanism of action

A

antagonizes vitamin K which prevents formation of coagulation factors

45
Q

indications for warfarin

A

-prevent DVT & PE
-prevent thrombosis in fib or prosthetic heart valve
-reduce risk for recurrent TIA/CVA or MI

46
Q

warfarin contraindications

A

-pts with high risk of bleeding, post-op brain/eye/spinal cord surgery
-liver disorders & alcohol use disorders

47
Q

warfarin most common side effect

A

bleeding

48
Q

warfarin assessment

A

MONITOR FOR BLEEDING
-watch INR
-PT should be 1.5-2 times patient’s baseline value
-INR level is 1.1 or lower, desired therapeutic range of 2-3

49
Q

warfarin antidote

A

Vitamin K

50
Q

general teaching points for heparin, enoxaparin, & warfarin

A

-avoid aspirin
-electric razors & soft toothbrushes
-report bruising, dark tarry stools, fatigue, dizziness, palpations
-stay away from foods high in vitamin K

51
Q

foods high in vitamin K

A

spinach, green leafy veggies, broccoli, kale

52
Q

indication for thrombin inhibitors

A

-DVT
-PE
-CVA with afib

53
Q

dabigatran antidote

A

Praxbind

54
Q

direct thrombin inhibitors administration

A

-oral
-short acting

55
Q

direct thrombin inhibitors contraindications

A

-pts with high risk of bleeding or active bleeding
-liver disorders & alcohol use disorders (higher risk for bleeding)

56
Q

direct thrombin inhibitors precautions

A

-aspirin
-NSAIDS
-other anticoagulants
-hepatic of renal impairment
-pregnancy category C

57
Q

rivaroxavan/apiaxban antagonist

A

andexanet alfa

58
Q

why would an antidote to a direct thrombin inhibitor be given?

A

-in the event of an emergency surgery
-urgent procedure
-life-threatening or uncontrolled bleeding

59
Q

risks of dabigatran

A

-surgery or dental work bleeding concerns
-spinal or epidural blood clots leading to paralysis

60
Q

biggest concern about dabigatran

A

no reliable lab test to identify overdose

61
Q

teaching for dabigatran

A

-monitor for bleeding signs
-soft tooth brush, electric razor
-avoid over the counter meds like feverfew, garlic, ginger, gingko biloba, saw palmetto

62
Q

alteplASE action

A

-breaks down formed clots
-can interfere with new clot formation

63
Q

alteplASE indications

A

-evolving MR or CVA
-massive PE
-extensive DVT
-arterial thrombosis
-open clotted paths

64
Q

alteplASE administration

A

-IV, time is priority

65
Q

alteplASE contraindications

A

-intracranial hemorrhage
-active internal bleeding
-ischemic stroke within past 3 months
-cautious with uncontrolled hypertension

66
Q

alteplASE adverse effects

A

-bleeding
-hypotension
-fever

67
Q

management of bleeding with thrombolytics (alteplASE)

A

-use whole blood, FFP if bleeding is excessive

68
Q

what to use if blood products don’t work to fix bleeding with thrombolytics?

A

aminocoproic

69
Q

management of bleeding

A

-minimize physical manipulations of patient
-avoid sub Q or Im injections
-minimize invasive proceures
-manual BP no automated cuff
-minimize concurrent use of anticoagulants and anti-platelet drugs
-monitor aPTT, INR
-monitor CDC: H&H
-no foley Cath

70
Q

complementary therapies that suppress platelet aggregation

A

-feverfew
-ginger root
-glucosamine
-garlic
-ginko biloba

Pharmacology (60 decks)

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