Anticoagulants, Antiplatelets, Thrombolytics Flashcards

1
Q

in plasma

A

H2O and electrolytes (Sodium, magnesium, potassium), proteins (albumines, globulino, fibrogen), wastes, nutrients (vitamins, hormones), gases (O2, N2, CO2)

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2
Q

formed elements

A

platelets, red blood cells, white blood, cells

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3
Q

white blood cell types

A

neutrophils and monocytes are the 1st to site; eosinphils and basophils are for allergic reaction; lymphocytes - immunity

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4
Q

thrombus =

A

clot

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5
Q

Anticoagulants, Anti-platelets, Thrombolytics are used to treat

A

THROMBOTIC and THROMBOEMBOLC disorders

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6
Q

Embolus

A

traveling clot (so it breaks loose and travels)

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7
Q

THROMBI and EMBOLI that lodge in vital organs can cause

A

death

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8
Q

How Clotting Occurs

A

When injury to a blood vessel occurs, within seconds, PLATELETS travel to the site and within 1-2 minutes, form a platelet plug to stop the bleeding; • The platelet cell membrane immediately begins to disintegrate allowing contents to leak that cause VASOCONSTRICTION; and Release of THROMBOPLASTIN

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9
Q

THROMBOPLASTIN with calcium ions causes the conversion of PROTHROMBIN to **

A

THROMBIN

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10
Q

THROMBIN converts FIBRINOGEN to **

A

FIBRIN

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11
Q

After 24 hours, FIBRIN replaces

A

platelets at the site of the blood clot

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12
Q

so goal to prevent the release of thromboplastin so you would need

A

anticoagulant

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13
Q

anticoagulants DO NOT

A

DO NOT dissolve clots; DO NOT improve blood flow in the surrounding tissue of the clot; DO NOT prevent ischemic damage to tissues beyond the clot; DO NOT “thin” the blood

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14
Q

anticoagulants are given to

A

PREVENT CLOT EXTENSION AND FORMATION (so given to prevent clot formation)

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15
Q

“By definition, anticoagulants are drugs

A

that reduce formation of fibrin.”

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16
Q

2 TYPES OF ANTICOAGULANTS

A
  1. Parenteral Heparins 2. Oral warfarin (Coumadin)
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17
Q

anticoagulants are different than anti platelets by working on

A

clotting factors not the platelets

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18
Q

Parenteral Heparins inhibits **

A

thrombin, thus blocking conversion of fibrinogen to fibrin

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19
Q

Parenteral Heparins helps

A

antithrombin inactivate clotting factors, thrombin and factor Xa

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20
Q

now draw blood to check

A

anti Xa levels for people on heparin

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21
Q

all heparins are given

A

parenterally - subq or IV

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22
Q

Oral warfarin (Coumadin) blocks

A

the synthesis of vitamin k-dependent clotting factors

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23
Q

vitamin k

A

helps make clotting factors

24
Q

Oral warfarin (Coumadin) acts as

A

as a competitive antagonist to hepatic use of Vitamin K

25
Q

so if decrease vitamin k then

A

decrease clotting factors

26
Q

Heparin is great for

A

emergencies because it has a very short half life

27
Q

Heparin MOA

A

Inhibits thrombin–mediated conversion of fibrinogen to fibrin AND inhibits active factor X

28
Q

Heparin is metabolized and excreted by

A

Metabolized in liver, excreted by kidney

29
Q

half life of heparin

A

Half life of 1-2 hours; increases with increasing dosage

30
Q

heparin does not cross _______ and not secreted in ________

A

Does not cross placental barrier; not secreted in breast milk

31
Q

Heparin: Uses/Indications

A

Prophylaxis and treatment of clots; Maintains patency of catheters; Prevents clotting during surgery or vascular procedures; Prevents clotting around prosthetic heart valves

32
Q

Prophylaxis and treatment of clots with heparin

A

Deep vein thrombosis; pulmonary emboli; Atrial fibrillation with clots

33
Q

adverse effects of heparin

A

BLEEDING; Anemia, thrombocytopenia; Local pain or discomfort at subcutaneous injection site; Long term use: alopecia, osteoporosis

34
Q

so if any pt on heparin use what

A

bleeding precautions ex. apply pressure longer

35
Q

(interaction of heparin) Increased bleeding if used concurrently with:

A

anti-platelet drugs: aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs); clopidogrel (Plavix); quinidine, cephalosporins; thrombolytic drugs

36
Q

(interaction of heparin) • Anticoagulant effect may be INCREASED if heparin combined with:

A

digoxin, tetracyclines, nicotine and alcohol, antihistamines

37
Q

Contraindications- Do not use heparin if:

A

Active Bleeding; Gastrointestinal ulcers; Hemophilia, thrombocytopenia; Severe liver or kidney disease; Uncontrolled hypertension; Recent CNS surgery, spinal cord injury, brain surgery; Recent eye surgery

38
Q

Use Heparin Cautiously if:

A

Mild hypertension; Severe diabetes; Renal or hepatic disease; Alcoholism; Presence of drainage tubes; Malignancy; Last trimester of pregnancy or immediate

39
Q

with Heparin check pt’s history for

A

for bleeding disorders or any pre-existing condition that would increase risk for bleeding

40
Q

Check activated partial thromboplastin time (aPTT):

A

Normal value is 40 seconds. At therapeutic levels, heparin INCREASES the aPTT by a factor of 1.5 to 2 times

41
Q

On heparin therapy, the aPTT should be

A

60-80 seconds (prolonged aPTT

42
Q

If aPTT is too long (>80 seconds), the heparin dose should be

A

decreased (pt has too much heparin, put infusion on hold for a few hours and resume at a lower rate)

43
Q

If aPTT is 50 seconds, the heparin dose should be

A

increased (great risk for clotting so increase dose)

44
Q

If patient is bleeding excessively or aPTT is extremely prolonged

A

Stop the heparin; Administer Protamine sulfate: antidote or antagonist for heparin-neutralizes heparin activity

45
Q

for pt on heparin assess pt for

A

bleeding gums, nosebleeds, unusual bruising , hematuria, guaiac-positive stools, prolonged bleeding from needle puncture sites, or wounds.

46
Q

for pt on heparin avoid

A

needle sticks; apply pressure for 2 minutes for venous sticks; 5minutes for arterial sticks

47
Q

for pt on heparin monitor for low

A

hemoglobin hematocrit, platelet counts

48
Q

When administering SC heparin

A

use 25-26 gauge needles, administer 2 inches from umbilicus in abdomen, do not aspirate or apply pressure.

49
Q

pt teaching with heparin

A

Use soft bristled tooth brush, electric shavers only, protective gear with physical activity; Wear Medic Alert identification; Avoid vigorous activities leading to injury that might cause bleeding

50
Q

Low Molecular Weight Heparins

A

Lovenox (enoxaparin), Innohep

51
Q

Low Molecular Weight Heparins are

A

• Molecules shorter than regular heparin; have greater bioavailability and longer half-lives

52
Q

with Low Molecular Weight Heparins plasma levels are

A

predictable** for any given dose: do not require laboratory monitoring although will increase activated partial thromboplastin time

53
Q

Low Molecular Weight Heparins have less risk of

A

bleeding: safe for outpatient use

54
Q

Low Molecular Weight Heparins work mostly at inactivating

A

factor Xa rather than thrombin; response more stable and effect two to four times longer than that of heparin

55
Q

Low Molecular Weight Heparins cost

A

more than twice that of heparin

56
Q

Low Molecular Weight Heparin are the first line therapy for

A

prevention and treatment of deep vein thrombosis

57
Q

Low Molecular Weight Heparins can cause severe

A

neurologic injury (paralysis) when given to patients undergoing spinal puncture or epidural anesthesia