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Pharm Exam 3 > Anticoagulants / Antiplatelets / Thrombolytics > Flashcards

Anticoagulants / Antiplatelets / Thrombolytics Flashcards

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

A

inhibits activation of vit K (factor X)

20
Q

anticoagulant enoxaparin side effect

A

stinging for a few minutes after injection

21
Q

anticoagulant enoxaparin labs?

A

no labs to monitor

22
Q

anticoagulant enoxaparin duration of action

A

12 hours

23
Q

anticoagulant enoxaparin reversal

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

anticoagulant warfarin route

A

enteral

- PO

25
Q

anticoagulant warfarin MOA

A

inhibits activation of vit K (factor X)

26
Q

anticoagulant warfarin nursing

A

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
Q

anticoagulant warfarin side effect

A

bleeding

28
Q

anticoagulant warfarin reversal

A
  • phytonadoine

- FFP transfusion

29
Q

anticoagulant warfarin drug interactions

A

ETOH b/c it increases the INR

30
Q

anticoagulant warfarin contraindication

A
  • pregnancy (use heparin instead)
  • thrombocytopenia
  • chronic liver disease
  • ETOH abuse
31
Q

antiplatelet aspirin, clpidogrel, and eptifibatide MOA

A

prevents platelet aggregation

32
Q

antiplatelet aspirin, clpidogrel, and eptifibatide indication

A

prophylactic for pts at high risk for thromboembolism

33
Q

antiplatelet aspirin, clpidogrel, and eptifibatide contraindication

A
  • pregnancy
  • history of bleeding disorders
  • retinal/cerebral hemorrhage
  • thrombocytopenia
  • PUD
  • aneurysm
  • uncontrolled HTN
34
Q

antiplatelet aspirin and clpidogrel route

A

PO

- 7 days to clear system

35
Q

antiplatelet aspirin and clpidogrel contraindication

A
  • NEVER to children under 19 yo
    = risk of Reye’s syndrome
  • NEVER while breastfeeding
36
Q

antiplatelet eptifibatide route and duration of action

A

IV

- duration of action: lasts 4 hours

37
Q

antiplatelet aspirin, clpidogrel, and eptifibatide nursing

A
  • 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
Q

antiplatelet aspirin, clpidogrel, and eptifibatide reversal agent

A

platelet transfusion

39
Q

thrombolytics: alteplase (tPA) MOA

A

dissolve the clots by fibrinolysis (only drug that does this!!)

naturally it takes 1-2wks

40
Q

thrombolytics: alteplase (tPA) indications

A
  • within 4 hours of the onset of MI or ischemic CVA s/s
  • PE
  • DVT
  • restore patency of IV catheters
41
Q

thrombolytics: alteplase (tPA) route

A

IV bolus followed by gtt for 60 min

- taper the dose!

42
Q

thrombolytics: alteplase (tPA) goal

A
  • resolution of s/s
  • half life of 35 min
  • given in ICU and ED
43
Q

thrombolytics: alteplase (tPA) drug interactions

A

avoid all AC and antiplatelet drugs until thrombolytic effects are cleared (3 hours)

44
Q

thrombolytics: alteplase (tPA) adverse reactions

A
  • bleeding
  • hemorrhagic CVA
  • spinal cord infarction
  • N/V
  • fever
  • angioedema
  • anaphylactic shock
    rhabdomyolysis
  • dysrhythmias
  • pulmonary edema
45
Q

thrombolytics: alteplase (tPA) reversal agent

A
  • aminocaproid acid (PO/IV)
  • FFP
  • PRBC
46
Q

thrombolytics: alteplase (tPA) contraindications

A
  • BP greater than 180/110
  • hemorrhagic diseases (PUD)
  • neoplasm
  • recent CNS trauma
  • aneurism
  • recent CVA
  • AC use
  • thrombocytopenia
  • ASA
  • NSAIDs
  • pregnancy
47
Q

thrombolytics: alteplase (tPA) nursing

A

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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