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Pharm Exam 3 > Anticoagulants / Antiplatelets / Thrombolytics > Flashcards

Anticoagulants / Antiplatelets / Thrombolytics Flashcards

(47 cards)

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1
Q

anticoagulants (3) and the reversal (3)

A
  1. heparin
  2. enoxaprin
    reversal: protamine sulfate
  3. warfarin
    reversal: vit K and FFP
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2
Q

antiplatelets (3) and reversal (1)

A
  1. ASA
  2. clopidogrel
  3. eptifibatide
    reversal: platelet infusion
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3
Q

thrombolytics (1) and reversal (1)

A
  1. alteplase

reversal: aminocaproic acid

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4
Q

thrombus/embolus risk factors

A
  1. dysrhythmia
  2. unstable plaque (atherosclerosis and HLD)
  3. blood pooling (bedrest) =>
  4. Deep Venous Thrombosis (DVT)
  5. Endocarditis (infectious/inflammatory)
  6. Invasive procedures, acute diseases, bedrest: perioperative, hemodialysis, angioplasty
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5
Q

thrombus/embolus can disrupt circulation and create what? (6)

A
  1. Angina
  2. myocardial infarction (MI)
  3. Cerebrovascular accident (CVA)
  4. Venous thromboembolism (VTE) => pulmonary embolism (PE)
  5. ischemic bowel
  6. intermittent claudication
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6
Q

anticoagulants (warfarin, enoxaprin, heparin) prevent…

A
  • prevent clot formation/enlargement
  • prophylactic to prevent thrombosis
  • therapeutic to prevent worsening (enlarged) of the present thrombosis

heparin, warfarin, and enoxaparin

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7
Q

antiplatelets (ASA, clopidogrel, eptifibatide) prevent…

A
  • prevent platelet aggregation
  • prophylactic to prevent thrombosis
  • therapeutic to prevent worsening (enlarged) of the present thrombosis

aspirin, clpidogrel, and eptifibatide

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8
Q

thrombolytics (alteplase) prevent…

A
  • clots, they dissolve blood clots

alteplae (tPA)

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9
Q

anticoagulant heparin route (2)

A

parenteral

  • IV
  • SubQ

measured in units

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10
Q

anticoagulant heparin MOA

A

inhibits activation of vit K (factor X)

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11
Q

anticoagulant heparin indication

A
  • prophylactic: pts at high risk for thromboembolism
  • therapeutic: prevents clot enlargement
  • while waiting for warfarin onset of action; therapeutic INR
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12
Q

anticoagulant warfarin onset of action

A

3-5 days

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13
Q

risks of all anticoagulants

A

risk of bleeding with fall and injuries

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14
Q

anticoagulant heparin onset of action and duration of action

A

20 minutes

duration: 8 hrs

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15
Q

anticoagulant heparin labs to monitor (nursing)

A
  • aPTT

- platelet count for thrombocytopenia (HIT)

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16
Q

anticoagulant heparin reversal

A
  • FFP
  • protamine sulfate IV
  • or wait 6-8 hours
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17
Q

anticoagulant heparin adverse effects

A
  • heparin-induced thrombocytopenia (HIT)

- bleeding w/ OD

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18
Q

anticoagulant enoxaparin route

A

parenteral
- SubQ only in prefilled syringes, measured in mg

avoid massaging the area

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19
Q

anticoagulant enoxaparin MOA

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A

inhibits activation of vit K (factor X)

20
Q

anticoagulant enoxaparin side effect

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A

stinging for a few minutes after injection

21
Q

anticoagulant enoxaparin labs?

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A

no labs to monitor

22
Q

anticoagulant enoxaparin duration of action

23
Q

anticoagulant enoxaparin reversal

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A
  • FFP
  • protamine sulfate IV
  • or wait 12-24 hours
24
Q

anticoagulant warfarin route

25
anticoagulant warfarin MOA
inhibits activation of vit K (factor X)
26
anticoagulant warfarin nursing
monitor: - PT (therapeutic 18-24 sec[not important]) - INR (therapeutic 2-3 days) - takes 3-5 for therapeutic effects, bridging w/ heparin - long half life = takes 5 days for INR to return to normal after discontinuing the drug education: - consistent amount of green leafy vegetables in the diet - frequent PT/INR monitoring; keep a diet/dose log
27
anticoagulant warfarin side effect
bleeding
28
anticoagulant warfarin reversal
- phytonadoine | - FFP transfusion
29
anticoagulant warfarin drug interactions
ETOH b/c it increases the INR
30
anticoagulant warfarin contraindication
- pregnancy (use heparin instead) - thrombocytopenia - chronic liver disease - ETOH abuse
31
antiplatelet aspirin, clpidogrel, and eptifibatide MOA
prevents platelet aggregation
32
antiplatelet aspirin, clpidogrel, and eptifibatide indication
prophylactic for pts at high risk for thromboembolism
33
antiplatelet aspirin, clpidogrel, and eptifibatide contraindication
- pregnancy - history of bleeding disorders - retinal/cerebral hemorrhage - thrombocytopenia - PUD - aneurysm - uncontrolled HTN
34
antiplatelet aspirin and clpidogrel route
PO | - 7 days to clear system
35
antiplatelet aspirin and clpidogrel contraindication
- NEVER to children under 19 yo = risk of Reye's syndrome - NEVER while breastfeeding
36
antiplatelet eptifibatide route and duration of action
IV | - duration of action: lasts 4 hours
37
antiplatelet aspirin, clpidogrel, and eptifibatide nursing
- Take with food to minimize GI upset/ GIB - for Hx. of GIB, PUD: - Enteric-coated aspirin!! don’t crush - Buffered aspirin!! (mixed with calcium carbonate) - Avoid NSAIDs (increased risk of GI bleed) - Avoid alcohol (increased risk of GI bleed) - Monitor for adverse reactions: - Hemorrhage: (see code phrases), particularly GI bleed!!
38
antiplatelet aspirin, clpidogrel, and eptifibatide reversal agent
platelet transfusion
39
thrombolytics: alteplase (tPA) MOA
dissolve the clots by fibrinolysis (*only drug that does this!!*) naturally it takes 1-2wks
40
thrombolytics: alteplase (tPA) indications
- within 4 hours of the onset of MI or ischemic CVA s/s - PE - DVT - restore patency of IV catheters
41
thrombolytics: alteplase (tPA) route
IV bolus followed by gtt for 60 min | - taper the dose!
42
thrombolytics: alteplase (tPA) goal
- resolution of s/s - half life of 35 min - given in ICU and ED
43
thrombolytics: alteplase (tPA) drug interactions
avoid all AC and antiplatelet drugs until thrombolytic effects are cleared (3 hours)
44
thrombolytics: alteplase (tPA) adverse reactions
- bleeding - hemorrhagic CVA - spinal cord infarction - N/V - fever - angioedema - anaphylactic shock rhabdomyolysis - dysrhythmias - pulmonary edema
45
thrombolytics: alteplase (tPA) reversal agent
- aminocaproid acid (PO/IV) - FFP - PRBC
46
thrombolytics: alteplase (tPA) contraindications
- BP greater than 180/110 - hemorrhagic diseases (PUD) - neoplasm - recent CNS trauma - aneurism - recent CVA - AC use - thrombocytopenia - ASA - NSAIDs - pregnancy
47
thrombolytics: alteplase (tPA) nursing
Monitor: - trend of VS and assessment (q 15 min) - resolution of symptoms (CP, neurological deficit) - active bleeding, allergic reaction (hives, angioedema, & dyspnea, anaphylaxis) cardiac monitoring (risk of *reperfusion dysrhythmia* treated with beta-blockers) Avoid venipuncture/arterial sticks, injections (SubQ/IM) as possible - hold pressure for 30 min

Pharm Exam 3 (9 decks)

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