Anticoagulants, antiplatelets, & thrombolytics

Question 1

Prevent the formation of clots that inhibit circulation

Answer 1

Anticoagulants

Question 2

Prevent platelet aggregation, clumping together of clots platelets to form a clot

Answer 2

Antiplatelets

Question 3

Anticoagulant used to for preventing or treating blood clots
(VTEs or PEs, stroke, a fib, clot prevention with certain surgeries)

Prolongs clotting time; requires aPTT (titrated drip based on this)

High risk med w/ strict protocol

Answer 3

Heparin

Question 4

Heparin side effects

Answer 4

excessive bleeding, heparin-induced thrombocytopenia
(HIT), osteoporosis

Antidote for hemorrhage: protamine sulfate

Question 5

Low molecular weight heparin (LMWH) anticoagulant that does not require aPTT

Answer 5

enoxaparin (Lovenox)

Question 6

Oral anticoagulant that prolongs clotting time (monitored by prothrombin time) by inhibiting synthesis of Vitamin K; Dosage is based on INR lab test

Used mainly to prevent thromboembolic conditions (thrombophlebitis, PE, and embolism formation caused by a fib, which can lead to stroke)

Answer 6

warfarin (Coumadin)

Question 7

Side effects of warfarin

Answer 7

bleeding (monitor for signs of bleeding- petechiae, ecchymosis, GI bleeding, ocular hemorrhage, hematuria)

Question 8

Adverse effects of warfarin

Answer 8

hemorrhage (rare, possibly life-threatening), warfarin induced skin necrosis

Antidote is Vitamin K

Question 9

True or False

Garlic is a blood thinner

Answer 9

True

Question 10

Warfarin INR lab test parameters

Answer 10

 Normal INR is 1.1 or below
 Patients on warfarin therapy are maintained at 2.0 to 3.0
 INR value greater than 3 puts patient at risk of bleeding

Question 11

Warfarin pt teaching points

Answer 11

 Medical follow-up to check INR and adjust dosage
 Consume consistent amounts of vitamin K-rich foods (no alterations)
 Do not take aspirin-containing products without consulting prescriber
 Do not drink alcohol
 Manage home safety

Question 12

Used to prevent thrombosis in the arteries by suppressing platelet aggregation

 Prophylactic use in:
 Prevention of myocardial infarction or stroke for patients with familial history
 Prevention of a repeat myocardial infarction or stroke
 Prevention of a stroke for patients having transient ischemic attacks

Answer 12

Antiplatelet drugs

Ex: aspirin and clopidrogel

Question 13

Inhibit COX enzyme to reduce platelet aggregation

• prevent/treat MI & thromboembolism
• stroke
  -TIA
  -Maintain vascular grafts

Side effects: prolonged bleedings time, GI effects

Answer 13

aspirin

Question 14

Antiplatelet drug used frequently after MI or stroke to prevent a second event

Side effects: epistaxis, headaches, hematoma, GI distress, purpura, rash, pruritis

Adverse effects: bleeding, peptic ulcers, intracranial bleeding

Answer 14

clopidogrel (Plavix)

Question 15

It is important for patients to read labels of OTC medications when taking antiplatelet drugs. Why?

Answer 15

They need to avoid products with aspirin and NSAIDs.

Question 16

DISSOLVE existing clots! Nicknamed “clot busters”; Promotes conversion of plasminogen to plasmin, which destroys the fibrin in the blood clot

Used to treat MI, thrombotic stroke, PE, & DVT

Answer 16

Thrombolytic drugs

Ex: alteplase t-PA (Activase)*

Question 17

For thrombotic stroke, thrombolytic drugs should be administered within 3 hours. Can these types of drugs be used for hemorrhagic stroke?

Answer 17

No! Must get CT beforehand to determine type of stroke.

Question 18

Side effects & adverse effects of thrombolytic drugs

Answer 18

Side effects – bleeding! Oozing from cuts, gums, wounds, injection sites

Adverse effects – allergic reaction, life-threatening hemorrhage

Question 19

Used to promote the formation of clots

Prevent fibrin from dissolving

Used to treat excessive bleeding from surgical sites

May cause hypercoagulation w/concurrent use of estrogen/oral contraceptives

Answer 19

hemostatic agents

Question 20

Anti-hyperlipidemia that inhibits the enzyme HMG CoA reductase in cholesterol biosynthesis; slows the production of cholesterol

Increases the ability of the liver to remove LDL from blood; No effect on HDL

Answer 20

HMG CoA reductase inhibitors (statins)

Ex: atorvastatin calcium (Lipitor)

Question 21

Side effects & adverse effects of statins

Answer 21

Side effects: constipation, peptic ulcers, muscle ache

Adverse effects: hepatic/renal failure, vision changes (cataract development), Rhabdo

Question 22

Nursing interventions for statins

Answer 22

-Monitor pt’s blood lipid levels
-Monitor lab values for liver function
-May take several weeks for blood lipid levels to decline
-Pts must have annual eye exams & report any vision changes
-Instruct pt to take at bedtime
-Teach pt to report any unexplained muscle tenderness weakness, fever, and malaise

Question 23

Antiplatelet that causes peripheral vasodilation. Used to treat intermittent claudication.

Side effects: Dizziness, headache, peripheral edema, GI distress, orthostatic hypotension

Adverse effects: tachycardia, palpitations, dysrhythmias

Answer 23

Peripheral vasodilators

Ex: cilostazol (Pletal)

Question 24

Cilostazol must knows

Answer 24

-therapeutic response may take 1.5 to 3 months
-No smoking or drinking alcohol
-change position slowly