Anticoagulants (blood thinners)

Question 1

What are some medication options for DVT pulmonary embolisms?

Answer 1

warfarin, antithrombin, novel oral anticoagulants, and antiplatelet medications

Question 2

What is the name of the medication that can dissolve clots; it is a highly dangerous medication that destroys clots upon contact?

Answer 2

Alteplase (tPA)

Question 3

What is warfarin and how does it work?

Answer 3

it is an anticoagulant that is used to prevent/treat DVT, pulmonary embolisms, atrial fibrillation, and heart attacks.

It works by preventing vitamin K from being activated (several clotting factors depend on vitamin K)

Question 4

What are some high-yield concepts for warfarin?

Answer 4

Monitor warfarin using INR normal is 1 but patients on warfarin should be 2-3.
It takes 5 days for warfarin to reach a therapeutic effect
Has lots of drug interactions and is teratogenic (category X)

• it is important to know that increasing potassium intake can decrease INR, decreasing potassium and increase INR so it is important to have a consistent potassium diet

Question 5

What signs should patients assess for subtle bleeding when taking warfarin and what should they do?

Answer 5

Subtle signs of bleeding include rapid heart rate, decreased blood pressure, hematomas, coffee ground vomit, red/black stools, cloudy or discolored urine
They should use soft-bristled toothbrush and electric razors

Question 6

What is the antidote for warfarin overdose?

Answer 6

Vitamin K. Such as green leafy vegetables.

Question 7

what drug class do enoxaparin and heparin belong to and how do they work?

Answer 7

enoxaparin and heparin are antithrombins that inactivate clotting factors that are already in circulation and they work immediately

Question 8

What is important to know about enoxaparin and heparin?

Answer 8

They still have risk for bleeding, for labs we should monitor anti-Xa for enoxaparin (0.6-1.0) and aPTT for heparin (60-80)

Question 9

What is heparin-induced thrombocytopenia (HIT)

Answer 9

it is a fatal complication of heparin. This causes a strange combination of low platelet levels and blood clots which increases the risk of pulmonary embolism, heart attacks, and strokes. Clients are more at risk for this if they take heparin for more than 4 days. Medication should be stopped if the client has a severe rapid drop in platelets

Question 10

What is the antidote for enoxaparin and heparin?

Answer 10

protamine sulfate

Question 11

How should enoxaparin be administered?

Answer 11

Subcutaneously in the love handles, don’t remove air bubbles, when done press firmly on bottom of syringe to activate special guard lock

Question 12

What are some novel oral anticoagulants?

Answer 12

apixaban
dabigatran
rivaroxaban

Question 13

What is the mechanism of action of apixaban, dabigatran, and rivroxaban?

Answer 13

Apixaban and rivaroxaban work immediately by inhibiting clotting factor Xa. Dabigatran inhibits clotting factor II. These are approved for prevention and treatment of blood clots and prevention of atrial fibrillation

Question 14

What are some high-yield concepts for novel oral anticoagulants?

Answer 14

Clients are at a major risk for bleeding
Dabigatran and rivaroxaban are more likely to cause GI bleed than warfarin
Dabigatran must be kept moisture-free

Question 15

What medication is commonly prescribed for clients with a history of heart attack, ischemic stroke, and peripheral arterial disease?

Answer 15

Clopidogrel

Question 16

What medication is clopidogrel commonly prescribed with?

Answer 16

Aspirin but this also increases the risk of bleeding