Chapter 26: Coagulation Modifier Drugs Flashcards
anticoagulants
used prophylactically to prevent the formation of clot or thrombus
antiplatelet drugs
inhibit platelet function and prevent platelet aggregation at the site of injury. (platelet aggregation is what can cause atherosclerosis)
thrombolytic drugs
lyse (break down) existing clots. (increases bleeding, can be dangerous)
antifibrinolytic
prevents lysis of fibrin and promotes clot formation
Anticoagulants are also known as
antithrombotic drugs.
are high alert drugs!
embolus
dislodged clot
Anticoagulants have no direct effect on
a blood clot that is already formed
What are the selected anticoagulants?
- warfarin sodium (coumadin)
- enoxaparin (lovenox)
- heparin
- dalteparin (fragmin)
- dabigatran (pradaxa)
- argatroban
- bivalirudin (angiomax)
- fondaparinux (arixta)
- rivaroxaban (xarelto)
- apixaban (eliquis)
The ability of anticoagulants to prevent clot formation is of benefit in certain settings in which there is a high likelyhood of clot formation, these indications include:
- MI
- unstable angina
- atrial fibrilation
- indwelling services such as mechanical heart valves
- major orthopedic surgery
- prolonged immobilization
What are the adverse effects of anticoagulants?
- bleeding (esp. w/ increased dosages. may be localized or systemic)
- may also cause: heparin-induced thrombocytopenia (HIT); thrombocytopenia, purple toes (warfarin); hematoma.
Heparin
- monitored by activated partial thromboplastin times (aPTTs)
- parenteral
- short half-life (1-2 hours)
the effects of heparin are reversed by
protamine sulfate
Enoxaparin and dalteparin
(low-molecular-weight heparins)
- do not require laboratory monitoring
- given subcutaneously
- do NOT rub after administration
Warfarin
- given orally
- monitor prothrombin time and INR: (PT-INR)
the effects of warfarin are reversed by
vitamin k
Antiplatelet drugs
work to prevent platelet adhesion at the site of blood vessel injury, which occurs before the clotting cascade
What are the selected antiplatelet drugs?
- aspirin
- clopidogrel (plavix)
- glycoprotein Ilb/Ilb inhibitors: eptifibatide (integrilin)
Indications of antiplatelet drugs
- reduce risk of fatal and nonfatal strokes
- acute unstable angina and MI
What are the adverse effects of antiplatelet drugs?
- thrombocytopenia
- anemia
- bleeding
- GI symptoms
What are the main categories of coagulation modifier drugs?
- anticoagulants
- antiplatelet drugs
- hemorheologic drugs
- thrombolytic drugs
- antifibrinolytic drugs
What are the selected thrombolytic drugs?
- streptokinase and urokinase
- alteplase (activase)
What is the mechanism of action for thrombolytic drugs?
- activate the fibrinolytic system to break down the clot in the blood vessel
- activate plasminogen and convert it to plasmin, which can digest fibrin
- reestablish blood flow to the heart muscle via coronary arteries, preventing tissue distruction
Indications of thrombolytic drugs
- acute MI
- arterial thrombosis
- DVT
- occlusion of shunts or catheters
- pulmonary embolus
- acute ischemic stroke
What are the adverse effects of thrombolytic drugs?
-bleeding: internal, intracranial, superficial
-other effects include:
nausea, vomiting, hypotension, anaphylactoid rx’s
cardiac dysrhythmias (can be dangerous)
What is the selected antifibrinolytic drug?
aminocarroic accid (amicar)
What is an indication for antifibrinolytic drugs?
excessive bleeding
Discuss the nursing process focus on patient-centered care pgs 426-433.
Assessment, Nursing Diagnosis, Planning, Implementation, Evaluation
partial thromboplastin times (aPTTs)
a blood test that measures the time it takes your blood to clot.
can be used to check for bleeding problems.
International normalized ratio
based on the ratio of the patient’s prothrombin time and the normal mean prothrombin time.
prothrombin time (PT)
- blood test that measures how long it takes blood to clot
- also used to check whether medicine to prevent blood clots is working.
