Chapter 28- Coagulation Modifier drugs Flashcards
Anticoagulant/ Mech of Action
A substance that prevents or delays coagulation of the blood.
Varies depending on drug. Do not lyse existing clots. Ex) heparin and low-weight-molecular heparins (LWMHs)-Turn off coagulation pathway and prevent clot formation. Warfarin (Coumadin)
Antifibrinolytic drug
A drug that promotes the formation of clots through prevention of the lysis of fibrin. Prevention and treatment of excessive bleeding. Hardly ever used.
ex) desmopression (DDAVP), similar to antidiuretic hormone (ADH), also used in the treatment of diabetes insipidus.
Antiplatelet drug
A drug that prevents platelet plugs from forming; this effect can help prevent cardiovascular disease such as MI and strokes
Ex) acetylicyclic acid (Aspirin), clopidogrel (Plavix), eptifibatide (Integrillin)
Antithrombin III (AT-III)
A substance that inactivates three major activating factors of the clotting cascade; activated II(thrombin), activated X, and activated IX
B-Hemolytic streptococci (group A)
The pyogenic streptococci of group A that cause hemolysis of RBC in blood agar in the lab setting
Clot
Insoluble solid elements of blood (cells, fibrin, threads) that have chemically separated from the liquid (plasma) component of the blood.
Coagulation
The sequential process by which the multiple coagulation factors of the blood interact in the coagulation cascade, ultimately forming an insoluble fibrin clot.
Coagulation cascade
The series of steps beginning with the intrinsic or extrinsic pathways of coagulation and proceeding through the formation of a fibrin clot.
Deep Vein Thrombosis (DVT)
The formation of a thrombus in one of the deep veins in the body, most commonly the iliac and femoral veins.
Embolus
A blood clot (thrombus) that has been dislodged from the wall of a blood vessel and is travelling throughout the bloodstream.
Fibrin
A stringy, insoluble protein produced by the action of thrombin on fibrinogen during the clotting process; a major component of blood clots or thrombi
Fibrinogen
A plasma protein that is converted into fibrin by thrombin in the presence of calcium ions
Fibrinolysis
The continual process of fibrin decomposition produced by the actions of the enzymatic protein fibronlysin.
Fibrinlytic system
An area of the circulatory system undergoing fibrinolysis
Fibrin-specificity
Property of newer thrombolytic drugs to activate plasminogen to plasmin in the presence of established clots having fibrin threads
Hemorheological drug
A drug that alters the function of platelets without compromising their blood-clotting properties.
Hemostasis
The process that halts bleeding after injury to a blood vessel
Hemostatic
A procedure, device, or substance that arrests the flow of blood
Plasmin
The enzymatic protein that breaks down fibrin into fibrin degradation products; it is derived from plasminogen
Plasminogen
A plasma protein that is converted to plasmin
Pulmonary embolus (PE)
The blockage of a pulmonary artery by foreign matter such as fat, air, tumour, or a thrombus that usually arises from a peripheral vein.
Stoke
Occlusion of the blood vessels of the brain by an embolus, thrombus, or cerebrovascular hemorrhage, resulting in schema of the brain tissue.
Thromboembolic event
An event in which a blood vessel is blocked by an embolus carried in the bloodstream from the site of its formation
Thrombolytic drug/ Mech of Action
Drugs that break down, or lyse, preformed clots.
ex) Tissue plasminogen activator, APSAC, alteplase (t-PA, Activase) & tenecteplase (TNKase)
Activate the fibrinolytic system to break down the clot in the blood vessel quickly. Activate plasminogen, which digests fibrin. Re-establish blood flow to heart muscle.
Thrombus
Technical term for blood clot (plural: thrombi); an aggregation of platelets, fibrin, clotting factors, and the cellular elements of the blood that is attached to the interior wall of a vein or artery, sometimes occluding the lumen of the vessel.
Tissue plasminogen activator
A naturally occurring plasminogen activator secreted by vascular endothelial cells in the walls of the blood vessels. Thrombolytic drugs are based on this component.
Substances promoting coagulation
Platelets, Von Willebrand factor, Activated clotting factors, tissue thromboplastin
Anticoagulants Indications
Atrial fibrillation, mechanical heart valves, major orthopaedic surgery (because of immobility)
Anticoagulants Contraindications
Acute bleeding process, Thrombocytopenia (low platelets), warfarin is strongly contraindicated in pregnancy
Anticoagulants adverse effects
Bleeding, N/V, Abdo cramps, Thrombocytopenia
Anticoagulants Interactions
Coumadin interacts with lots!
Heparin
Lovenox
Monitored by activated partial thromboplastin times (aPTTs), available in parenteral form, short half life (1-2hrs), antidote= protamine sulphate.
Lovenox is a low-weight-molecular heparin used in pregnancy
Warfarin (Coumadin)
Given orally only. Monitored by prothrombin time (PT) and INR. Antidote= Vitamin K
Antiplatelet Indications
Antithrombotic effects-reduce risk of fatal and nonfatal strokes
Antiplatelet Adverse effects
Bleeding
Antiplatelet Contraindications
Allergy, Thrombocytopenia, GI ulcer, Vitamin K deficiency, Recent Stroke
Antiplatelet interactions
NSAIDS like ibuprofen. Produces additive antiplatelet activity and increased bleeding potential
Antifibrinolytic Indications
Prevention and treatment of excessive bleeding
Antifibrinolytic Contraindications
Disseminated intravascular coagulation (DIC)
Antifibrinolytic Adverse Effects
Many including death
Antifibrinolytic Interactions
Estrogens or oral contraceptives. Lithium
Thrombolytic Indications
MI, occlusion of shunts or catheters, stroke
Thrombolytic Contraindications
Drug allergy
Thrombolytic Adverse Effects
Bleeding, N/V, hypotension, anaphylactoid reactions, cardiac dysrhythmias
Thrombolytic Interactions
Increased bleeding tendency with concurrent use of anticoagulant, antiplatelet
Heparin: Nursing Implications
IV doses-double check with another nurse.
SubQ given SubQ and given in areas of deep subcutaneous fat and site should be rotated. Do not give SubQ doses within 5cm of umbilicus and do not aspirate or massage injection site.
Protamine sulphate given as antidote
LWMHs: Nursing Implications
SubQ in Abdomen
Rotate Injection sites
Protamine sulphate given as antidote
Warfarin: Nursing Implications
May be started while the PT is still on heparin until PT/INR levels indicate adequate anticoagulation “bridging”.
Vitamin K is antidote
Increased bleeding may occur with Garlic, Ginger, Gingko, Ginseng, Feverfew and Capsicum pepper
Thrombolytic: Nursing Implications
Montior IV sites for bleeding, redness, pain.
Observe for signs of internal bleeding (decreased BP, restlessness, increased pulse, confused)
Nursing Implications
Monitor for signs of excessive bleeding ex)nosebleeds
Monitor for adverse effects
