CH 31: Drugs for Coagulation Disorders Flashcards
Drugs for Coagulation Disorders
Anticoagulants
Antiplatelet
Thrombolytics
Hemostatic
Clotting Factor Concentrates
hemostasis
to stop blood flow
protects the body from external and internal injury
without it any bleeding would lead to death
too much hemostasis (clotting) is dangerous too
Causes of alterations of hemostasis
MI
Stroke
Venous or arterial thrombosis
Sepsis
Cancer
How do we achieve Hemostasis
Requires clotting factors in sequential steps
The clotting process needs platelets, thrombin, thromboxane, platelet receptor sites (glycoprotein IIb/IIa), von Willebrand’s factor, fibrin strands
this results in coagulation,
fibrin threads create a meshwork, traps the cells and then
the formation of a clot
the liver needs ____ to make several of the clotting factors
Vitamin K
The most common bleeding disorder in women is:
von Willebrand’s disease (vWD)
women with vWd are at risk for:
anemia, menstrual pain, and limitations in activities of daily living.
Clot removal =
fibrinolysis – usually starts within 24 to 48 hours of clot formation
steps to removing a clot
- blood vessel cells secrete enzyme tissue plasminogen activator (TPA)
- TPA converts the inactive protein plasminogen to its active enzymatic form, plasmin
- Plasmin then digests the fibrin strands to remove the clot
diagnostics for hemostasis
lab tests that measure coagulation
PT prothrombin time
aPTT activated partial thromboplastin time
Platelet count
what happens with thromboembolic disorders
the body forms undesirable clots – they can break away with bad consequences
what happens with coagulation disorders
body experiences too much clotting – usually caused by decreased platelets and deficiencies in clotting factors
deficiency of platelets
thrombocytopenia
possible causes of thrombocytopenia
condition that suppresses bone marrow function
immunosuppressant drugs
and most of the medications used for cancer chemotherapy.
Other common causes of decreased platelet production are folic acid or vitamin B12 deficiencies and liver failure.
deficiency of clotting factors may:
May prolong coagulation and lead to excess bleeding
deficiency of one clotting factor
hemophilia
inhibit specific clotting factors in the coagulation cascade.
Anticoagulants
act by inhibiting the clotting action of platelets.
antiplatelet medication
remove clots quickly and used for life-threatening clots
Thrombolytics
administration of anticoagulants
Can have a rapid onset of action and given IV or subcutaneously in an emergency – then usually switched to oral anticoagulant therapy
heparin (anticoagulant) therapeutic effects
-Prevention of coagulation
-Inactivates thrombin
-Slows the formation and enlargement of fibrin clots
-Used to prevent clots and treat clots that have formed
heparin (anticoagulant) adverse effects
Nausea,
vomiting,
transient thrombocytopenia (heparin),
anemia (fondaparinux)
Hemorrhage,
anaphylaxis,
heparin-induced thrombocytopenia
heparin (anticoagulant) what to monitor for
-aPTT closely!
-Hematocrit
-Monitor platelet count every 2 to 3 days HIT may develop on day 8
-Heparin-induced thrombocytopenia (HIT_
-Signs and symptoms of bleeding!*
heparin (anticoagulant) safety precautions
-Interacts with warfarin lead to serious bleeding
-Do not take with aspirin or ibuprofen and other “blood
thinning” meds
-Protamine sulfate is the antidote
warfarin (Vitamin K antagonists) therapeutic effects
-Inhibits the action of vitamin K and suppresses coagulation
factors
-Prevention of thrombotic events – by preventing thrombus formation
-Prevention of stroke, MI, DVT, PE post surgery
-Management of MI – decreases risk of death, another MI
warfarin (Vit K antagonists) adverse effects
Abnormal bleeding
fatal bleeding
warfarin (Vit K antagonists) what to monitor
-PT and INR!!!
-*Signs and symptoms of bleeding
-Keep close watch of INR when new medications are
added or d/c’d
warfarin (Vit K Antagonists) safety precautions
-Takes several days to have max effect
-DO NOT double doses if pt misses a dose
-NO alcohol
-Pt needs Med ID
-Overlap heparin with warfarin 2 to 3 days
-Vitamin K in antidote for overdose
-Anticoagulant effect can last up to 10 days after the drug is discontinued
-Increased effect with alcohol, NSAIDs, diuretics, SSRI, steroids, antibiotics,
-No OTC meds without provider approval
-Do not change diet to more vitamin K-rich foods
enoxaparin (Low molecular weight heparins (LMWHS) therapeutic effects
-prevention of coagulation – thrombus formation
-Inhibition of factor x
-Slows the formation and enlargement of fibrin clots
-Last 2 to 4 times longer than heparin
-More stable response
-Can be given by caregivers or patient
-Less likely to cause thrombocytopenia
enoxaparin (Low molecular weight heparins (LMWHS) adverse effects
Minor bleeding,
nausea,
vomiting,
hematoma,
local pain,
fever
Hemorrhage,
thrombocytopenia,
pancytopenia,
anaphylaxis
enoxaparin (Low molecular weight heparins (LMWHS) what to monitor
-Monitor for bleeding, thrombo-cytopenia
-CBC, platelet, stools for occult blood
enoxaparin (Low molecular weight heparins (LMWHS) safety precautions
-Risk of bleeding increased with concurrent use of drugs that affect platelet aggregation
-Protamine sulfate for overdose
dabigatran (direct thrombin inhibitors) therapeutic effects
-Prevent the formation of fibrin clots
-Prevent thrombocytopenia induced by heparin therapy
-Reduce the risk of stroke or embolism for patients with a fib
-Given after IV heparin
dabigatran (direct thrombin inhibitor) adverse effects
Fever,
nausea,
allergic skin reactions,
hepatic impairment,
minor bleeding,
back pain (bivalirudin)
Serious internal hemorrhage,
hemoptysis,
hematuria,
sepsis
heart failure
dabigatran (direct thrombin inhibitor) what to monitor
-Assess for stroke
-aPTT NOT INR
-sign and symptoms of bleeding
-hyper-sensitivity reactions
-angioedema
dabigatran (direct thrombin inhibitor) safety precautions
Can interact with other anticoagulants
Take same time each day
apixaban (factor Xa inhibitors) therapeutic effects
-Inhibit factor Xa
-Prevention of DVT following surgery, reduction of chance for stroke, and embolism associated with a fib
-Do not require INR monitoring
-Fewer interactions
apixaban (factor Xa inhibitors) adverse effects
Minor bleeding,
rash
Major bleeding,
including stroke;
hypersensitivity reactions
apixaban (factor Xa inhibitors) what to monitor
hypersensitivity reactions
stroke,
DVT,
PE,
bleeding
apixaban (factor Xa inhibitors) safety precautions
-DO NOT D/C abruptly
-Can interact with other anticoagulants
-No not double missed doses
signs of bleeding
bleeding gums,
nosebleed,
unusual bruising,
black tarry stools,
hematurea,
fall in hemacrit or BP
aspirin (antiplatelet) therapeutic effects
Interfere with platelet aggregation
aspirin (antiplatelet) adverse effects
nausea
vomiting,
diarrhea,
abdominal pain,
headache (anagrelide)
Increased clotting time,
GI bleeding (aspirin),
central nervous system (CNS)
effects (dipyridamole)
anaphylaxis (aspirin),
cardiac toxicity (anagrelide)
aspirin (antiplatelet) what to monitor
GI bleeding
Allergic reactions
Tinnitus
aspirin (antiplatelet) safety precautions
-Take after meals or with food
-Report tinnitus
-Caution with alcohol
-Avoid acetaminophen or NSAIDs
clopidogrel (ADP receptor blockers) therapeutic effects
-Prevent thrombi formation in patients with the recent event
(stroke or MI)
-Prevent DVT
-Given with aspirin
clopidogrel (ADP receptor blockers) adverse effects
Minor bleeding,
dyspepsia,
abdominal pain,
dizziness,
headache
Increased clotting time,
GI bleeding,
blood dyscrasias,
angina
clopidogrel (ADP receptor blockers) what to monitor
Monitor for bleeding.
cbc with diff (anemia) and platelet count
thrombocytopenia
Monitor for GI bleeding
Test effectiveness for Asian patients
clopidogrel admin precautions
Do not crush or split tablets
Avoid other antiplatelet drugs such as NSAIDs
