Anticoagulants, Antiplatelets, Thrombolytics 2

Question 1

Warfarin (Coumadin) blocks

Answer 1

the liver from making vitamin k –dependent clotting factors (II, VII, IX, X)

Question 2

Warfarin (Coumadin) is structurally similar to

Answer 2

vitamin K

Question 3

Warfarin (Coumadin) has no effect on

Answer 3

circulating clotting factors or on platelet function-will take 3-5 days to take effect

Question 4

Why do you know Warfarin (Coumadin) has multiple drug interactions

Answer 4

because its a highly protein bound; Half-life of 0.5 to 3 days

Question 5

Warfarin (Coumadin) indications

Answer 5

Long-term prevention or treatment of deep vein thrombosis; Pulmonary embolism; Atrial fibrillation with embolization; Management of myocardial infarction

Question 6

Warfarin (Coumadin) adverse effects

Answer 6

bleeding

Question 7

Warfarin (Coumadin) contraindicated in

Answer 7

pregnancy, GI ulcers, Severe hypertension, liver, or kidney disease, Recent surgery of the eye, spinal cord, or brain

Question 8

Drugs that decrease Coumadin’s effect:

Answer 8

estrogens, oral contraceptives, phenytoin (Dilantin), diet or nutritional supplements high in Vitamin K

Question 9

Drugs that increase Coumadin’s effect:

Answer 9

anti-platelet drugs (aspirin, NSAIDs, plavix), cephalosporins, thrombolytics

Question 10

coumadin’s antidote:

Answer 10

a vitamin k injection

Question 11

coumadin is begun while

Answer 11

heparin is still being administered, overlapping 3-5 days to maintain therapeutic control of clotting.

Question 12

assess pt on coumadin for

Answer 12

s/s of bleeding

Question 13

for pt on coumadin monitor

Answer 13

Prothrombin Time or INR (International Normalized Ratio) during therapy to determine appropriate Coumadin level

Question 14

Prothrombin Time is especially sensitive to

Answer 14

alterations in vitamin K-dependent factors. Without Coumadin, Prothrombin Time is 12 seconds

Question 15

Goal of Coumadin therapy:

Answer 15

a Prothrombin Time 1.3 to 1.5 times the control

Question 16

International Normalized Ratio

Answer 16

ensures that results from different labs are comparable; determined by using a correction factor specific to the particular thrombolplastin preparation employed for the test

Question 17

Goal is for International Normalized Ratio to be

Answer 17

2-3 if on coumadin

Question 18

Teach w/ Coumadin

Answer 18

Take Coumadin same time each day; Do not double dose, if a dose is missed; Keep diet consistent: Avoid foods high in Vitamin K (greens, asparagus, broccoli, cabbage, green tea); will decrease action of Coumadin; Medic Alert; Avoid alcohol

Question 19

anti-amemics

Answer 19

Epogen (erythopoieten)

Question 20

Epogen (erythopoieten) stimulates

Answer 20

RBC production; used to treat anemia

Question 21

with Epogen (erythopoieten) there is increased risk of

Answer 21

seizures greatest during first 3 months of therapy

Question 22

Epogen (erythopoieten) is given

Answer 22

subq or IV; do not shake vial; refrigerate multi-dose vial

Question 23

with Epogen (erythopoieten) monitor

Answer 23

Hgb & Hct

Question 24

Thrombolytics:

Answer 24

Activase (alteplase-tPA), Streptokinase

Question 25

Thrombolytics MOA

Answer 25

dissolve thrombi; stimulate conversion of plasminogen to plasmin that degrades fibrin in clots

Question 26

Thrombolytics used in treatment of

Answer 26

of MI (lysis of clots in coronary arteries) treatment of CVA

Question 27

For those with MI, results are best when

Answer 27

thrombolytic therapy is started within 4-6 hrs

Question 28

Thrombolytics adverse effects

Answer 28

bleeding

Question 29

Anti-platelets:

Answer 29

aspirin, ticlopidine (Ticlid), clopidogrel (Plavix)

Question 30

Anti-platelets MOA

Answer 30

present platelet aggregation and interfere with the initial phase of blood coagulation

Question 31

aspirin causes irreversible ***

Answer 31

inhibition of cyclooxygenase, an enzyme necessary for synthesis of thromboxane A2 which is necessary for platelet activation

Question 32

Anti-platelets are used to

Answer 32

prevent MI, stroke, thromboembolism in clients with prosthetic heart valves

Question 33

Anti-platelets adverse effects

Answer 33

bleeding, GI bleeding/ulcers, hemorrhagic stroke

Question 34

If GI bleeding occurs,

Answer 34

a proton pump inhibitor (pantoprazole/protonix) can reduce gastric acidity and help prevent gastric ulcers