anticoagulants, antiplatelets, thrombolytics Flashcards
What is thrombosis?
The formation of a clot, there are 2 types: Arterial (WBC and RBC) and Venous (RBC and PLT).
What causes arterial blood clots?
Arterial blood clots are caused by blood stasis, platelet aggregation, and blood coagulation.
What causes venous blood clots?
Venous blood clots are caused by blood stasis of slow flow, occur rapidly, and can cause DVT and PE.
What are anticoagulants?
They prevent clot formation but do not break down existing clots.
Who can anticoagulants be used for?
Patients with clots or patients at risk of clot formation, such as those with DVT, PE, MI, artificial mechanical valves, and CVA.
What can a blood clot in the heart cause?
It can go to the brain and cause a stroke.
What can a blood clot in the legs cause?
It can go to the lungs and cause a pulmonary embolism.
What are the anticoagulant medications?
Heparin, Enoxaparin (Lovenox), Fragmin, Innohep, Coumadin/Warfarin.
How is heparin given?
SQ, IV for blood clots; not given IM due to pain and hematoma formation.
What are the low molecular weight heparins and how are they given?
Lovenox, Fragmin, Innohep - all given SQ.
How is enoxaparin (Lovenox) given specifically?
Given 2 inches away from the umbilicus. Maintain the air bubble to help seal in the enoxaparin.
What is the mode of action of heparin?
Combines with antithrombin 3, prevents thrombin formation, inhibits the conversion of fibrinogen to fibrin, prevents fibrin clot formation.
What does heparin do to clotting time?
Prolongs clotting time (PTT), decreasing the risk of clot formation.
What is the pregnancy category of heparin?
Pregnancy category C.
How is heparin absorbed?
Poorly absorbed through GI, destroyed by heparinase in the liver.
What are the indications of heparin?
Rapid acting and is out of the system in an hour; used for rapid anticoagulation for thrombosis such as DVT, PE, embolic CVA.
What are the side effects of heparin?
Bruising, itching, and burning.
What are the adverse effects of heparin?
Bleeding, ecchymosis, thrombocytopenia, and hemorrhage.
What should you check for if someone develops thrombocytopenia while on heparin?
Check if the patient has HIT (heparin induced thrombocytopenia).
What is the antidote for heparin?
Protamine sulfate.
What are the contraindications of heparin?
Any med that increases risk of bleeding: bleeding disorder, peptic ulcer, severe hepatic/renal disease, hemophilia, CVA (hemorrhagic).
What are the drug interactions of heparin?
Increased effect with aspirin, NSAIDs, thrombolytics, and probenecid; decreased effect with nitroglycerin and protamine.
What is the half-life of heparin?
1-2 hours.
What are nursing considerations for heparin?
Obtain history of possible abnormal clotting; PTT should be checked every 4 hours when changing the dose.
What are the indications of warfarin (Coumadin)?
Same as heparin - rapid anticoagulation for thrombosis such as DVT, PE, embolic CVA.
How is Warfarin (Coumadin) given?
ONLY given PO.
What are the therapeutic ranges for INR for Warfarin (Coumadin)?
AFIB: 2-3; DVT/PE/mechanical valves: 2.5-3.5.
When should you check the INR for a patient on antibiotics?
Within the next 3-5 days.
What foods affect Warfarin (Coumadin)?
Foods rich in vitamin K, such as dark leafy green vegetables, decrease the effectiveness of Warfarin.
How long does Warfarin (Coumadin) take to get out of the system?
2-3 days.
What is the antidote for Warfarin (Coumadin)?
Vitamin K.
Do you need an INR for novel anticoagulants?
No.
What is the antidote for novel anticoagulants?
No antidote except for Pradaxa; the antidote is Praxibind.
Who are novel anticoagulants indicated for?
Patients with AFIB, DVT, PE.
Who can we not use novel anticoagulants on?
Patients with mechanical valves.
What are the novel anticoagulants?
Xarelto, Eliquis, Pradaxa.
What is the prototype for novel anticoagulants?
Dabigatran Etexilate (Pradaxa).
What is Dabigatran Etexilate (Pradaxa) used for?
Thromboembolism (DVT/PE) treatment and stroke prophylaxis (nonvalvular AFIB).
How is Dabigatran Etexilate (Pradaxa) excreted?
Excreted by the kidneys; lower the dose in patients with CKD.
What are the side effects of Dabigatran Etexilate (Pradaxa)?
Bleeding, bruising, gastritis.
What is the antidote for Dabigatran Etexilate (Pradaxa)?
Praxibind.
What is the risk associated with Dabigatran Etexilate (Pradaxa)?
Increases thrombotic events and CVA risk when discontinued prematurely.
What are the indications for Apixaban (Eliquis) and Rivaroxaban (Xarelto)?
Thromboembolism (DVT/PE) treatment and stroke prophylaxis (nonvalvular AFIB).
What do Apixaban (Eliquis) and Rivaroxaban (Xarelto) selectively block?
Factor 10A/XA.
What are the side effects of Apixaban (Eliquis) and Rivaroxaban (Xarelto)?
Bleeding, bruising, gastritis, and anemia.
What are the adverse effects of Apixaban (Eliquis) and Rivaroxaban (Xarelto)?
Hemorrhage, hematoma, thrombocytopenia.
Why are antiplatelets used?
To prevent PLT thrombosis by suppressing PLT aggregation.
What are antiplatelet medications?
ASA, Ticagrelor (Brilinta), Prasugrel (Effient), Clopidogrel (Plavix), Pletal, Agrylin, Reopro, Integrilin.
What is Ticagrelor (Brilinta) specifically used for?
Patients with coronary stents.
What is Clopidogrel (Plavix)?
An antiplatelet medication.
What is the pregnancy category of Clopidogrel (Plavix)?
Pregnancy category B.
What are the contraindications of Clopidogrel (Plavix)?
Intracranial hemorrhage, peptic ulcer.
What are the side effects of Clopidogrel (Plavix)?
URI, flu-like symptoms, dizziness, HA, fatigue, CP, diarrhea, bruising, bleeding.
What is the difference between antiplatelets and anticoagulants?
Antiplatelets prevent PLT from sticking together; anticoagulants prevent clot formation.
What are thrombolytics known as?
Clot busters.
Why are thrombolytics used?
To promote the fibrinolytic mechanism.
How long after thrombolytic administration does the blood clot disintegrate?
Within 4 hours.
What are the thrombolytic medications?
Streptokinase, alteplase, reteplase (Retevase), Tenecteplase (THKnase).
What is Alteplase (tPA)?
A thrombolytic agent.
What is the half-life of Alteplase (tPA)?
5 minutes.
What is the side effect of Alteplase (tPA)?
Bleeding.
What are the adverse effects of Alteplase (tPA)?
Intracerebral hemorrhage, CVA, atrial/ventricular dysrhythmias.
What are the contraindications of Alteplase (tPA)?
Internal bleeding, bleeding disorders, recent CVA, surgery/trauma.
What are the drug interactions of Alteplase (tPA)?
Increased bleeding when taken with oral anticoagulants, NSAIDs.
dosing for plavix
loading dose: 300 mg and then 75 daily. Check P2Y12
How is Alteplase (tPA) dosed?
IV bolus 15mg, then 50 mg infused over 30 minutes, then 35 mg infused over 60 minutes (max 100mg)
