Chapter 31

Question 1

clopidogrel (Plavix) thrombosis prevention

Answer 1

ADP receptor blocker

Inhibits platelet aggregation by directly inhibiting ADP binding to receptor. Permanently affects platelet.

Discontinue at least 5 days before surgery

Black box: Many Asians are poor metabolizers, less therapeutic effect

Question 2

Heparin patient education

Answer 2

NEVER MASSAGE AFTER SUBQ INJECT

NEVER IM INJECT

Never draw back syringe once needle has entered skin

Use weight based nomogram for 100% accuracy

Question 3

alteplase (Activase) for coagulation disorders

Answer 3

Thrombolytic

Convert plasminogen to plasmin-> dissolves clot

Begin therapy right after onset of symptoms

Must give 12hr within MI symptoms
3hr thrombotic stroke
Avoid parenteral injections

AE:
Intracranial bleeding
Other bleeding

Contraindications:
Hx of stroke or head injury w/in 3 months, HTN

Question 4

warfarin (Coumadin) for coagulation disorders

Answer 4

Vitamin K antagonist

Effects can take several days (way longer than heparin)

If life threatening bleeding happens then administer vitamin K to counteract

AE:
Abnormal bleeding
Black box: Can cause major or fatal bleeding, regular INR monitoring required. Instruct patients on prevention measures.