Ch 32 Coagulation Flashcards
What does venous thrombosis Iead to?
PE
post phlebitic syndrome ( a syndrome occurring within 1 yr of a DVT with chronic, potentially disabling leg swelling, pain, venous dilation and skin induration.
What is arterial thrombosis the most common cause of
MI
Strike
Limb gangrene
Hemostasis
A series of events that occurs to prevent blood loss after a injury
Thrombolytics
Dissolve clots
Anticoagulants
Prevents clots only
Hemophilia
Uncontrollable bleeding
Where are most clotting factors produced
In the liver, therefor cirrhosis and hepatitis would prevent the synthesis of clotting factors
Are clotting factors active
They are inactive in the blood until a injury activates them
What does plasmin break down
Fibrin
Fibrinogen
And other plasma proteins
How is a arterial thrombus formed
It is formed under high flow conditions
How are venous thrombus’ formed
They are formed from stasis of the blood
What is a embolism
It is any dissolved matter carried in a blood or lymph vessel to another location where it lodges and occluded the vessel.
What does hyper coagulability result from
It results from either a increase in platelets or an increase in the activity of clotting factors or both.
Why does excessive bleeding occur
Because the body cannot form a stable clot in response to injury
Intrinsic factor
All the clotting factors already present in the blood
Vitamin k
Given as a injection for thin blood it helps with the viscosity of the blood
Where is vitamin k synthesized
In the colon bowels
What ration is heparin always given
1:1 ratio
What may continued use of heparin lead to
Osteoporosis
When administering Coumadin what labs should be monitored
PT which is an extrinsic factor
Coumadin is linked to what
Vitamin k
What is the treatment of a overdose of heparin
Protamine
Which is an intrinsic factor measure PTT
Can aspirin and warfarin be given together
Yes
What is the normal PT
11-16 seconds
What does vitamin k do
It helps clot the blood it is a fat soluble vitamin
What is clopidogrel ( plavix)
It is an anti platelet that decreases the ability of platelets to stick together. Severe neutropenia is a adverse effect
For clot formation what is needed
Fibrin
What is the shelf life of all blood products
4 hrs or less.
What are hemostatic drugs
It stops blood loss by enhancing blood coagulation( the goal is to form fibrin to stop blood loss) there are two types; systemic and topical.
What is parenteral heparin
It is an anticoagulant that interferes with the final steps in the clotting cascade
It rapidly promotes the inactivation of factor X which in turn prevents the conversion prothrombin to thrombin
What route is heparin given
IV
SC
Metabolized in the liver and excreted in the kidneys
What are adverse effects of heparin
Bleeding and thrombocytopenia
What lab should be monitored on heparin therapy
aPTT
What is the antidote for heparin
Protamine sulfate
What is warfarin used for
It is used prophylactically for ppl with long term risk for thrombus formation
What is the pharmacodynamics of warfarin
It competitively blocks vitamin k at its sites of action
What are adverse effects of Coumadin
Bleeding and HEMMORRHAGE
What should be monitored in a pt receiving warfarin
PT
INR
What is the antidote for warfarin
Vitamin k
phytonadione
What are low molecular weight heparin used for (LMWH)
Prevention of DVT
PE after surgical procedures known to increase the risk of such complications
The anticoagulant effect is increased by digitalis, tetracyclines, nicotine, and antihistamines
What are adverse effects of LMW
Life threatening bleeding
Anemia
Thrombocytopenia
Local pain or discomfort
What are contraindications to heparin and LMWH
Active HEMMORRHAGE GI ulcerations Hemophilia Thrombocytopenia Polycythemia Vera Severe liver or kidney disease HTN Recent brain, spinal cord injury, or hemorrhagic stroke Caution is exercised in ppl with diabetes, HTN, endocarditis,
Name LMWH
Dalteparin
Enoxaparin
Fondaparinux
Tinzaparin
What is the prototype anti platelet drug
Clopidogrel ( plavix). Aspirin
It is used to reduce atherosclerotic events
It is administered orally metabolized in the liver
What are adverse effects of anti platelet drugs
Bleeding
GI distress
Neutropenia
What are drug interactions of anti platelet drugs
Tamoxifen Tolbutamide Warfarin Torsemide Fluvastatin And many NSAIDS
Clopidogrel should be cautioned in children younger than what
18
What is the most serious adverse effect of clopidogrel
Neutropenia
What is the prototype Thrombolytic drug
Alteplase, recombinant ( activate, cathflo, activase)
What does Thrombolytic drugs do
Converts plasminogen to plasmin
It is used in thromboembolic conditions
Thrombolytic drugs are what type of drug
They are given in emergency situations and can have life threatening adverse effects the pt should be hooked to a cardiac monitor both during the treatment and afterwards
What pregnancy category is alteplase
C
What are clotting factors
They treat deficiencies of normal clotting factors replacement of theses factors is the treatment of choice
Prototype drug: anti hemophilia factor
It is essential for the conversion of prothrombin to thrombin.
What are adverse effects of the antihemophillic factor
Anaphylaxis, urticaria, nausea,,and chill
How should AHF be stored
It should be refrigerated until used before reconstitution, warm the concentrate and the diliuent to room temp… After dilution, administer within 3 hours to prevent bacterial growth
Instruct client to observer for bleeding gums, skin, urine, stool, or emesis.
What are hemostatic drugs
They stop blood loss by enhancing blood coagulation
What do systemic hemostatic drugs do
They interfere with the breakdown of clots
What do topical hemostatic agents do
They are used to control small amounts of bleeding for oozing, usually following surgery.
Prototype drug; aminocaproic acid ( Amicar)
What are adverse effects of aminocaproic acid ( hemostatic drug)
GI distress
Headache, dizziness, seizures, hypotension, arrhythmias, tinnitus, nasal congestion, vomiting, abdominal cramps, diarrhea, diuresis
What are drug interactions of hemostatic drugs
Oral contraceptives
Estrogen
How can one minimize adverse effects of hemostatic drugs
Monitor vital signs
Administer via IV pump
Monitor I&O neurological status
