anticoagulants, antiplatelets, thrombolytics

Question 1

What is thrombosis?

Answer 1

The formation of a clot, there are 2 types: Arterial (WBC and RBC) and Venous (RBC and PLT).

Question 2

What causes arterial blood clots?

Answer 2

Arterial blood clots are caused by blood stasis, platelet aggregation, and blood coagulation.

Question 3

What causes venous blood clots?

Answer 3

Venous blood clots are caused by blood stasis of slow flow, occur rapidly, and can cause DVT and PE.

Question 4

What are anticoagulants?

Answer 4

They prevent clot formation but do not break down existing clots.

Question 5

Who can anticoagulants be used for?

Answer 5

Patients with clots or patients at risk of clot formation, such as those with DVT, PE, MI, artificial mechanical valves, and CVA.

Question 6

What can a blood clot in the heart cause?

Answer 6

It can go to the brain and cause a stroke.

Question 7

What can a blood clot in the legs cause?

Answer 7

It can go to the lungs and cause a pulmonary embolism.

Question 8

What are the anticoagulant medications?

Answer 8

Heparin, Enoxaparin (Lovenox), Fragmin, Innohep, Coumadin/Warfarin.

Question 9

How is heparin given?

Answer 9

SQ, IV for blood clots; not given IM due to pain and hematoma formation.

Question 10

What are the low molecular weight heparins and how are they given?

Answer 10

Lovenox, Fragmin, Innohep - all given SQ.

Question 11

How is enoxaparin (Lovenox) given specifically?

Answer 11

Given 2 inches away from the umbilicus. Maintain the air bubble to help seal in the enoxaparin.

Question 12

What is the mode of action of heparin?

Answer 12

Combines with antithrombin 3, prevents thrombin formation, inhibits the conversion of fibrinogen to fibrin, prevents fibrin clot formation.

Question 13

What does heparin do to clotting time?

Answer 13

Prolongs clotting time (PTT), decreasing the risk of clot formation.

Question 14

What is the pregnancy category of heparin?

Answer 14

Pregnancy category C.

Question 15

How is heparin absorbed?

Answer 15

Poorly absorbed through GI, destroyed by heparinase in the liver.

Question 16

What are the indications of heparin?

Answer 16

Rapid acting and is out of the system in an hour; used for rapid anticoagulation for thrombosis such as DVT, PE, embolic CVA.

Question 17

What are the side effects of heparin?

Answer 17

Bruising, itching, and burning.

Question 18

What are the adverse effects of heparin?

Answer 18

Bleeding, ecchymosis, thrombocytopenia, and hemorrhage.

Question 19

What should you check for if someone develops thrombocytopenia while on heparin?

Answer 19

Check if the patient has HIT (heparin induced thrombocytopenia).

Question 20

What is the antidote for heparin?

Answer 20

Protamine sulfate.

Question 21

What are the contraindications of heparin?

Answer 21

Any med that increases risk of bleeding: bleeding disorder, peptic ulcer, severe hepatic/renal disease, hemophilia, CVA (hemorrhagic).

Question 22

What are the drug interactions of heparin?

Answer 22

Increased effect with aspirin, NSAIDs, thrombolytics, and probenecid; decreased effect with nitroglycerin and protamine.

Question 23

What is the half-life of heparin?

Answer 23

1-2 hours.

Question 24

What are nursing considerations for heparin?

Answer 24

Obtain history of possible abnormal clotting; PTT should be checked every 4 hours when changing the dose.

Question 25

What are the indications of warfarin (Coumadin)?

Answer 25

Same as heparin - rapid anticoagulation for thrombosis such as DVT, PE, embolic CVA.

Question 26

How is Warfarin (Coumadin) given?

Answer 26

ONLY given PO.

Question 27

What are the therapeutic ranges for INR for Warfarin (Coumadin)?

Answer 27

AFIB: 2-3; DVT/PE/mechanical valves: 2.5-3.5.

Question 28

When should you check the INR for a patient on antibiotics?

Answer 28

Within the next 3-5 days.

Question 29

What foods affect Warfarin (Coumadin)?

Answer 29

Foods rich in vitamin K, such as dark leafy green vegetables, decrease the effectiveness of Warfarin.

Question 30

How long does Warfarin (Coumadin) take to get out of the system?

Answer 30

2-3 days.

Question 31

What is the antidote for Warfarin (Coumadin)?

Answer 31

Vitamin K.

Question 32

Do you need an INR for novel anticoagulants?

Answer 32

No.

Question 33

What is the antidote for novel anticoagulants?

Answer 33

No antidote except for Pradaxa; the antidote is Praxibind.

Question 34

Who are novel anticoagulants indicated for?

Answer 34

Patients with AFIB, DVT, PE.

Question 35

Who can we not use novel anticoagulants on?

Answer 35

Patients with mechanical valves.

Question 36

What are the novel anticoagulants?

Answer 36

Xarelto, Eliquis, Pradaxa.

Question 37

What is the prototype for novel anticoagulants?

Answer 37

Dabigatran Etexilate (Pradaxa).

Question 38

What is Dabigatran Etexilate (Pradaxa) used for?

Answer 38

Thromboembolism (DVT/PE) treatment and stroke prophylaxis (nonvalvular AFIB).

Question 39

How is Dabigatran Etexilate (Pradaxa) excreted?

Answer 39

Excreted by the kidneys; lower the dose in patients with CKD.

Question 40

What are the side effects of Dabigatran Etexilate (Pradaxa)?

Answer 40

Bleeding, bruising, gastritis.

Question 41

What is the antidote for Dabigatran Etexilate (Pradaxa)?

Answer 41

Praxibind.

Question 42

What is the risk associated with Dabigatran Etexilate (Pradaxa)?

Answer 42

Increases thrombotic events and CVA risk when discontinued prematurely.

Question 43

What are the indications for Apixaban (Eliquis) and Rivaroxaban (Xarelto)?

Answer 43

Thromboembolism (DVT/PE) treatment and stroke prophylaxis (nonvalvular AFIB).

Question 44

What do Apixaban (Eliquis) and Rivaroxaban (Xarelto) selectively block?

Answer 44

Factor 10A/XA.

Question 45

What are the side effects of Apixaban (Eliquis) and Rivaroxaban (Xarelto)?

Answer 45

Bleeding, bruising, gastritis, and anemia.

Question 46

What are the adverse effects of Apixaban (Eliquis) and Rivaroxaban (Xarelto)?

Answer 46

Hemorrhage, hematoma, thrombocytopenia.

Question 47

Why are antiplatelets used?

Answer 47

To prevent PLT thrombosis by suppressing PLT aggregation.

Question 48

What are antiplatelet medications?

Answer 48

ASA, Ticagrelor (Brilinta), Prasugrel (Effient), Clopidogrel (Plavix), Pletal, Agrylin, Reopro, Integrilin.

Question 49

What is Ticagrelor (Brilinta) specifically used for?

Answer 49

Patients with coronary stents.

Question 50

What is Clopidogrel (Plavix)?

Answer 50

An antiplatelet medication.

Question 51

What is the pregnancy category of Clopidogrel (Plavix)?

Answer 51

Pregnancy category B.

Question 52

What are the contraindications of Clopidogrel (Plavix)?

Answer 52

Intracranial hemorrhage, peptic ulcer.

Question 53

What are the side effects of Clopidogrel (Plavix)?

Answer 53

URI, flu-like symptoms, dizziness, HA, fatigue, CP, diarrhea, bruising, bleeding.

Question 54

What is the difference between antiplatelets and anticoagulants?

Answer 54

Antiplatelets prevent PLT from sticking together; anticoagulants prevent clot formation.

Question 55

What are thrombolytics known as?

Answer 55

Clot busters.

Question 56

Why are thrombolytics used?

Answer 56

To promote the fibrinolytic mechanism.

Question 57

How long after thrombolytic administration does the blood clot disintegrate?

Answer 57

Within 4 hours.

Question 58

What are the thrombolytic medications?

Answer 58

Streptokinase, alteplase, reteplase (Retevase), Tenecteplase (THKnase).

Question 59

What is Alteplase (tPA)?

Answer 59

A thrombolytic agent.

Question 60

What is the half-life of Alteplase (tPA)?

Answer 60

5 minutes.

Question 61

What is the side effect of Alteplase (tPA)?

Answer 61

Bleeding.

Question 62

What are the adverse effects of Alteplase (tPA)?

Answer 62

Intracerebral hemorrhage, CVA, atrial/ventricular dysrhythmias.

Question 63

What are the contraindications of Alteplase (tPA)?

Answer 63

Internal bleeding, bleeding disorders, recent CVA, surgery/trauma.

Question 64

What are the drug interactions of Alteplase (tPA)?

Answer 64

Increased bleeding when taken with oral anticoagulants, NSAIDs.

Question 65

dosing for plavix

Answer 65

loading dose: 300 mg and then 75 daily. Check P2Y12

Question 66

How is Alteplase (tPA) dosed?

Answer 66

IV bolus 15mg, then 50 mg infused over 30 minutes, then 35 mg infused over 60 minutes (max 100mg)