bleeding drugs

Question 1

enoxaparin LMWH
heparin

Answer 1

inhibit IIa and Xa, activate antithrombin, stop fibrin formation
prompt anticoag (evolving stroke, PE, massive DVT, MI, adjunct for heart sx or dialysis, low dose - post op DVT; labs for dose: anti-Xa or aPTT (flush line and wait or peripheral stick)
HIT, stop if <100,000, weight based dose, high alert, check with another RN, work fast, antidote: protamine sulfate - give slow (hypotension),
E: only Xa, longer 1/2 life, slower onset; no labs, prophylaxis, prefilled syringe, black box: spinal hematoma w epidural; change injection sites, can give to pregnant, only SQ sometimes given with warfarin

Question 2

warfarin

Answer 2

inhibit vit K (II - pro, VII, IX, X)
prevent thombi in afib or heart valves, recurrence of TIA or MI - long term anticoag
purple toes
lots of interactions: meds, food (green!), OH thins blood, wear med alert bracelet, soft toothbrush, electric razor
2-3 weeks to see effect
antidote: vit K, fresh frozen plasma
no pregnant or breastfeeding, hold before Sx
labs: PT/INR, must monitor

Question 3

apixaban
rivaroxaban

Answer 3

selective Xa inhibitor
prevent stroke with afib, post op thrombo prophylaxis treat DVT and PE
SE: dizzy, rash, GI, bleeding, peripheral edema, black box: hematoma
interactions: decrease effects - phenytoin, rifampin, st johns wort; increase - CYP34Ai
dont give with other coags
watch liver function
antidote = andexxa

Question 4

aspirin

Answer 4

COX inhibitor, NSAID
antiplatelet, block prostaglandin synthesis via COX, block platelet aggregation
prevent/treat MI, stroke
contraindications: thrombocytopenia, active bleeding, blood cancer, traumatic injuries, GI ulcers, vit K, deficiency, recent hemorrhagic stroke PO
antidote: DDAVP (desmopressin)
baby aspirin if acute, Rx for platelet use, reye’s syndrome

Question 5

clopidogrel
ticagelor

Answer 5

aggregation inhibitor
antiplatelet, ADPi - alter platelet membrane X signal to aggregate
reduce risk of stroke, prophylaxis of TIAs and post MI
SE: chest pain, edema, flu like, abd pain, n/d, epistaxis, rash, pruritis, C: bb = genetic higher rate of CV; T: bb= increased bleeding over 100mg - baby aspirin
contraindications: thrombocytopenia, active bleeding, blood cancers, traumatic injuries, GI ulcers, vit K deficiency, recent hemorrhagic stroke
antidote: DDAVP or platelet transfusion

Question 6

argatroban
bivalrubin

Answer 6

direct thrombin i
treat HIT and pts undergoing procedures (PCI) at risk for HIT
IV only
Labs: anti Xa, H&H, platelets
A: careful with hepatic dysfunction