Ch 44 Anticoagulation, Antiplatelet, and Thrombolytic Drug

Question 1

hemostatsis

Answer 1

stage 1- formation of platelet plug (platelet aggregation)

stage 2- coagulation (intrinsic coagulation pathway, extrinsic coagulation pathway)

Question 2

3 drug groups for thromboembolic disorders

Answer 2

1. anticoagulations
2. antiplatelets
3. thrombolytics

Question 3

anticoagulants

Answer 3

disrupt the coagulation cascade, thereby suppressing the production of fibrin

Question 4

antiplatelets

Answer 4

inhibit platelet aggregation

Question 5

thrombolytics

Answer 5

promote lysis of fibrin, causing dissolution of thrombi

Question 6

anticoagulants mechanism of of action (2)

Answer 6

1. inhibit synthesis of clotting factors

2. inhibit activity of clotting factors

Question 7

heparin (unfractionated)

Answer 7

enhances antithrombin

rapid acting anticoagulant

by IV or subQ only

Question 8

heparin (unfractionated) therapeutic uses

Answer 8

Preferred anticoagulant during pregnancy and when rapid anticoagulation is required
Pulmonary embolism (PE)
Stroke evolving
Massive deep vein thrombosis (DVT)
Open heart surgery
Renal dialysis
Low-dose therapy postoperatively
Disseminated intravascular coagulation (DIC)
Adjunct to thrombolytic therapy

Question 9

heparin (unfractionated) adverse effects

Answer 9

hemorrhage
HIT
hypersensitivity reactions

Question 10

heparin (unfractionated) contraindications

Answer 10

thrombocytopenia
uncontrollable bleeding
during and immediately after surgery of the eye, brain, or spinal cord

Question 11

antidote for heparin (unfractionated) overdose

Answer 11

protamine sulfate

Question 12

lab for heparin (unfractionated)

Answer 12

activated partial thromboplastin time (aPTT)

Question 13

LMW heparin

Answer 13

heparin preparations composed of molecules that are shorter than those found in unfractionated heparin

Question 14

LMW heparin therapeutic uses

Answer 14

Prevention of DVT after surgery
(Including replacement of hip, knee)
Treatment of established DVT
Prevention of ischemic complications
Patients with unstable (angina, non–Q-wave myocardial infarction (MI), and ST-elevation MI (STEMI) )

Question 15

LMW heparin administration route

Answer 15

subcutaneous

Question 16

LMW heparin dosage

Answer 16

based on body weight

Question 17

LMW heparin antidote for toxicity

Answer 17

protamine sulfate

Question 18

LMW heparin adverse effects

Answer 18

bleeding (less than with unfractionated heparin)
immune mediated thrombocytopenia
severe neurologic injury for pts undergoing spinal puncture or spinal epidural anesthesia

Question 19

three LMW heparins available in US

Answer 19

1. Enoxaparin
2. dalteparin
3. tinzaparin

Question 20

warfarin clinical use

Answer 20

PO anticoagulant with delayed onset
vitamin K antagonist
blocks biosynthesis of factors VII, IX, X, and prothrombin

Question 21

warfarin blocks biosynthesis of what factors

Answer 21

factors 2, 7, 9, 10

although power point says factors VII, IX, X, and prothrombin

Question 22

warfarin therapeutic uses

Answer 22

long term prophlaxis of thrombosis

• venous thrombosis and associated PE
• thromboembolism (in patients with prosthetic heart valves)
• a fib`

Question 23

warfarin monitoring treatmet with what

Answer 23

Prothrombin time- PT

International normalized ratio- INR

Question 24

Warfarin adverse effects

Answer 24

Hemorrhage (vitamin K for toxicity)
Fetal hemorrhage and teratogenesis from use during pregnancy
Use during lactation
Other adverse effects

Question 25

warfarin drug interactions

Answer 25

Drugs that increase anticoagulant effects Drugs that promote bleeding Drugs that decrease anticoagulant effects Heparin Aspirin Acetaminophen

Question 26

warfarin OD

Answer 26

Vitamin K

Question 27

dietary vitamin K

Answer 27

nayonnaise, canola oil, soybean oil, and green leafy vegetables