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PHARM EXAM 2 > anticoagulants, antiplatelets, thrombolytics > Flashcards

anticoagulants, antiplatelets, thrombolytics Flashcards

1
Q

What is thrombosis?

A

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

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2
Q

What causes arterial blood clots?

A

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

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3
Q

What causes venous blood clots?

A

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

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4
Q

What are anticoagulants?

A

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

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5
Q

Who can anticoagulants be used for?

A

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

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6
Q

What can a blood clot in the heart cause?

A

It can go to the brain and cause a stroke.

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7
Q

What can a blood clot in the legs cause?

A

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

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8
Q

What are the anticoagulant medications?

A

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

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9
Q

How is heparin given?

A

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

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10
Q

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

A

Lovenox, Fragmin, Innohep - all given SQ.

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11
Q

How is enoxaparin (Lovenox) given specifically?

A

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

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12
Q

What is the mode of action of heparin?

A

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

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13
Q

What does heparin do to clotting time?

A

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

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14
Q

What is the pregnancy category of heparin?

A

Pregnancy category C.

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15
Q

How is heparin absorbed?

A

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

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16
Q

What are the indications of heparin?

A

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

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17
Q

What are the side effects of heparin?

A

Bruising, itching, and burning.

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18
Q

What are the adverse effects of heparin?

A

Bleeding, ecchymosis, thrombocytopenia, and hemorrhage.

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19
Q

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

A

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

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20
Q

What is the antidote for heparin?

A

Protamine sulfate.

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21
Q

What are the contraindications of heparin?

A

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

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22
Q

What are the drug interactions of heparin?

A

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

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23
Q

What is the half-life of heparin?

A

1-2 hours.

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24
Q

What are nursing considerations for heparin?

A

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

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25
Q

What are the indications of warfarin (Coumadin)?

A

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

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26
Q

How is Warfarin (Coumadin) given?

A

ONLY given PO.

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27
Q

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

A

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

28
Q

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

A

Within the next 3-5 days.

29
Q

What foods affect Warfarin (Coumadin)?

A

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

30
Q

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

A

2-3 days.

31
Q

What is the antidote for Warfarin (Coumadin)?

A

Vitamin K.

32
Q

Do you need an INR for novel anticoagulants?

A

No.

33
Q

What is the antidote for novel anticoagulants?

A

No antidote except for Pradaxa; the antidote is Praxibind.

34
Q

Who are novel anticoagulants indicated for?

A

Patients with AFIB, DVT, PE.

35
Q

Who can we not use novel anticoagulants on?

A

Patients with mechanical valves.

36
Q

What are the novel anticoagulants?

A

Xarelto, Eliquis, Pradaxa.

37
Q

What is the prototype for novel anticoagulants?

A

Dabigatran Etexilate (Pradaxa).

38
Q

What is Dabigatran Etexilate (Pradaxa) used for?

A

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

39
Q

How is Dabigatran Etexilate (Pradaxa) excreted?

A

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

40
Q

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

A

Bleeding, bruising, gastritis.

41
Q

What is the antidote for Dabigatran Etexilate (Pradaxa)?

A

Praxibind.

42
Q

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

A

Increases thrombotic events and CVA risk when discontinued prematurely.

43
Q

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

A

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

44
Q

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

A

Factor 10A/XA.

45
Q

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

A

Bleeding, bruising, gastritis, and anemia.

46
Q

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

A

Hemorrhage, hematoma, thrombocytopenia.

47
Q

Why are antiplatelets used?

A

To prevent PLT thrombosis by suppressing PLT aggregation.

48
Q

What are antiplatelet medications?

A

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

49
Q

What is Ticagrelor (Brilinta) specifically used for?

A

Patients with coronary stents.

50
Q

What is Clopidogrel (Plavix)?

A

An antiplatelet medication.

51
Q

What is the pregnancy category of Clopidogrel (Plavix)?

A

Pregnancy category B.

52
Q

What are the contraindications of Clopidogrel (Plavix)?

A

Intracranial hemorrhage, peptic ulcer.

53
Q

What are the side effects of Clopidogrel (Plavix)?

A

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

54
Q

What is the difference between antiplatelets and anticoagulants?

A

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

55
Q

What are thrombolytics known as?

A

Clot busters.

56
Q

Why are thrombolytics used?

A

To promote the fibrinolytic mechanism.

57
Q

How long after thrombolytic administration does the blood clot disintegrate?

A

Within 4 hours.

58
Q

What are the thrombolytic medications?

A

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

59
Q

What is Alteplase (tPA)?

A

A thrombolytic agent.

60
Q

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

A

5 minutes.

61
Q

What is the side effect of Alteplase (tPA)?

A

Bleeding.

62
Q

What are the adverse effects of Alteplase (tPA)?

A

Intracerebral hemorrhage, CVA, atrial/ventricular dysrhythmias.

63
Q

What are the contraindications of Alteplase (tPA)?

A

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

64
Q

What are the drug interactions of Alteplase (tPA)?

A

Increased bleeding when taken with oral anticoagulants, NSAIDs.

65
Q

dosing for plavix

A

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

66
Q

How is Alteplase (tPA) dosed?

A

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

PHARM EXAM 2 (10 decks)

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