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NURS 1064 - Pharm > Chapter 32 & 10 (Learning Outcomes) > Flashcards

Chapter 32 & 10 (Learning Outcomes) Flashcards

1
Q

Define anticoagulant

A

Prevent new thrombus formation and the extension of existing thrombi

  • keep blood from clotting
  • exist naturally
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2
Q

Define anticoagulant

A

Prevent thrombus formation and the extension of existing thrombi

  • keep blood from clotting
  • exist naturally
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3
Q

What are two types of anticoagulants?

A
  1. Heparin (parenteral)

2. Warfarin (oral)

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4
Q

What is the action of thrombolytics (how is it different than anticoagulants)?

A

Dissolves EXISTING clots

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5
Q

What is the action of antiplatelet therapy?

A

Decreases the ability of platelets to stick together

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6
Q

What are the areas of the body that produces heparin naturally?

A
  • Lungs

- Liver

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7
Q

What drug is used to prevent the extension of a blood clot, particularly in patients with DVT or PE?

A

Heparin

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8
Q

What is the route of administration for Heparin?

A

Parenterally
IV: onset immediate
SC: onset 20-60 minutes

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9
Q

Describe the pharmacodynamics of heparin

A

Heparin (along with antithrombin) rapidly promotes the inactivation of factor X
- prevents the conversion of prothrombin to thrombin

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10
Q

True or False:

Heparin has no effect on blood clots that have already been formed

A

True

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11
Q

When is Heparin contraindicated?

A
  • Thrombocytopenia
  • Bleeding disorders
  • Active bleeding (other than DIC)
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12
Q

What is the most common adverse effect of heparin?

A

Bleeding

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13
Q

What is administered if a patient receives an overdose of heparin?

A

Protamine sulfate
- a strong base that reacts with heparin (a strong acid) to forma a stable salt, thereby neutralizing the anticoagulant effects of heparin

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14
Q

What core patient variables should be assessed prior to giving heparin?

A
  • pre-existing prolonged bleeding time
  • aPTT
  • platelet count
  • renal function
  • hematocrit
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15
Q

What core patient variables should be assessed prior to giving heparin?

A
  • pre-existing prolonged bleeding time
  • aPTT
  • platelet count
  • renal function
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16
Q

How do you determine the therapeutic range for heparin?

A

Multiply the control by 1.5 and then by 2
- therapeutic range is between these two numbers
(Ex: Control time = 30 seconds. Therapeutic range = 45 - 60 seconds)

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17
Q

To minimize the risk of heparin-induced thrombocytopenia (HIT), when does the platelet count have to be monitored?

A

Every day for 14 days

  • or until heparin is discontinued
  • whichever comes first
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18
Q

How long should a patient be given heparin for to reduce the risk of developing a DVT or PE?

A

Low risk = 3 months
High risk = 6 months to indefinitely
- initially treatment begins with heparin for 5 days, but then continues with oral anticoagulant afterwards

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19
Q

What is the patient education for heparin?

A 
Report any blood in:
- urine
- stools
Bleeding from:
- gums
- nose
- vagina
- wounds
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20
Q

What are the important education points for patients administering Enoxaparin themselves?

A
  • locating appropriate injection site and rotating injection sites
  • performing SC injections using appropriate technique
  • disposing of syringes and needles appropriately
  • PATIENTS may RECAP their own needle
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21
Q

What are the important education points for patients administering Enoxaparin themselves?

A
  • reason for therapy
  • taking it on time
  • having follow-up blood analyses done as recommended
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22
Q

What are the names of the drugs that are in the class of direct thrombin inhibitors (3)?

A
  1. Argatroban
  2. Bivalirudin
  3. Lepirudin
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23
Q

How are direct thrombin inhibitors different than heparin?

A

Bind to active thrombin site and inhibit both free and clot-bound thrombin

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24
Q

What is the prototype drug for oral anticoagulants?

A

Warfarin (Coumadin)

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25
Q

What is measured to determine therapeutic levels of warfarin?

A

INR

  • international normalized ratio
  • compares patient prothrombin time to standard prothrombin time
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26
Q

For treatment or prophylaxis of a thrombus or embolus, what should the INR be equal to?

A

2 - 3

- patient’s prothrombin time should be 1.4 - 1.6 times the control time

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27
Q

Describe the pharmacodynamics of warfarin

A

Works by competitively blocking vitamin K at its sites of action

  • thus it prevents the activation of factors II, VII, IX, and X
  • has not effect on factors that have already been activated
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28
Q

True or False:

Full therapeutic response of warfarin cannot be measured until 3 days after therapy begins

A

True

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29
Q

When is warfarin contraindicated?

A
  • active bleeding
  • open wounds
  • ulcerations of the GI tract
  • hemophilia
  • thrombocytopenia
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30
Q

What is most frequent adverse effect of warfarin?

A
  • Bleeding
  • Hemorrhage
  • N/V
  • diarrhea
31
Q

When can heparin be discontinued when warfarin has been started?

A

Once INR is between 2-3 for 2 days in a row

32
Q

Why is it safe to use heparin and warfarin at the same time?

A

They affect different clotting factors

33
Q

What is the antidote for warfarin?

A

High levels of vitamin K

- competes with warfarin for binding sites

34
Q

What is another example (other than warfarin) that is an oral anticoagulant?

A

Anisindione (Miradon)

35
Q

What is the function of antiplatelet drugs?

A

Prevent platelet aggregation

- prolongs bleeding time

36
Q

What class of drugs does Clopidogrel fall into and what does it do?

A

Antiplatelet

- reduces the occurence of atherosclerotic events (MI, stroke, vascular death)

37
Q

What are the adverse effects of using Clopidogrel?

A
  • GI distress
  • Abdominal pain
  • Indigestion
  • Diarrhea
  • Nausea
38
Q

What test should be performed prior to administering Clopidogrel?

A

Complete baseline blood count with differential

- to determine platelet functioning

39
Q

What drug class is Aspirin close to?

A

Antiplatelet

- used prophylactically against thromboembolic complications (MI and TIA)

40
Q

What is the function of hemorhelogic drugs?

A

Act on RBCs to reduce blood viscosity and increase the flexibility of RBCs

41
Q

What is the function of thrombolytic drugs?

A

Assist in breaking down FORMED blood clots

42
Q

What is the prototype drug for thrombolytic drugs?

A

Alteplase, recombinant (Activase)

43
Q

Since Alteplase, recombinant has the potential for serious side effects, what is the recommended use limited to?

A

CONFIRMED PE or DVT

44
Q

Describe the pharmacodynamics of Alteplase recombinant

A

It is an enzyme that, when fibrin is present, converts pasminogen to plasmin

  • binds to the fibrin in a clot and converts the trapped plasminogen to plasmin
  • fibrinolysis (breakdown of the clot) then occurs
45
Q

What is the most frequent adverse effect of Alteplase, recombinant?

A

BLEEDING!

  • internal (GI, GU, respiratory tracts or retroperitoneal, or intracranial areas)
  • surface or superficial bleeding (punctures, incision sites)
46
Q

What are the two drug classes used to treat hypocoagulation?

A
  1. Clotting factors

2. Hemostatic agents

47
Q

If a patient is deficient in blood clotting factors, what is that associated with?

A

Prolonged bleeding and clot formation time

48
Q

What is the prototype for clotting factor?

A

Antihemophilic factor (AHF)

49
Q

What is anti-hemophilic factor (AHF) used for?

Is the effect long term or short term?

A

To prevent and control excessive bleeding

- effect is short term because the factor is used up in the clotting process

50
Q

What is the administration route for anti-hemophilic factor?

A

Intravenously

- rapidly removed from plasma because it is used in the clotting process

51
Q

True or False:

Antihemophilic Factor temporarily meets the needs for clotting factor to prevent or stop bleeding

A

True

52
Q

What is the function of hemostatic drugs?

A

Stop blood loss by enhancing blood coagulation

53
Q

What are the two types of hemostatic drugs?

A
  1. Systemic

2 Topical

54
Q

What is the prototype systemic hemostatic drug?

A

Aminocaproic acid (Amicar)

55
Q

Describe the pharmacodymanics of Aminocaproic acid (Amicar)

A

Prevents fibrinolysis in two ways:

  1. Blocks the action of plasminogen activators (thus interfering with the formation of active plasmin
  2. Interferes with the binding of active plasma to fibrin (thus preventing the breakdown of fibrin
56
Q

What is the end result of Aminocaproic acid (Amicar)

A

Stabilization of a blood clot and control of bleeding

57
Q

True or False:

Anticoagulants break down existing clots and prevent clots from forming

A

False

- Anticoagulants DO NOT break down existing clots but DO help prevent clots from forming

58
Q

True of False:

Antiplatelet drugs prevent platelet aggregation and thereby prevent thrombus formation

A

True

59
Q

True or False:

Hemorheologic agents break down existing clots

A

False

- Hemorheologic agents promote the flexibility of the RBCs and decrease blood viscosity to prevent thrombus formation

60
Q

True or Flase:

Thrombolytic drugs break down existing clots

A

True

61
Q

True or False:
In general, disorders of hypercoagulability result from either an increase in platelets or an increase in the activity of the clotting system (or both)

A

True

62
Q

What is the benefit of a well-balanced diet?

A

May prevent chronic illness and therefore indirectly decrease the need for drug therapy

63
Q

True or False:
If a patient has low dietary proteins levels, this could increase the concentration of FREE (unbound) drug in their system

A

True
- Diminished protein status results in lower amounts of plasma proteins and can substantially increase the concentration of free drug available

64
Q

What is the most important blood protein that is involved in drug binding/action?

A

Albumin

65
Q

True or False:
Distribution of fat-soluable drugs is decreased in obese and the elderly because of the decreased proportion of adipose tissue to lean body mass

A

FALSE
- Distribution of fat-soluable drugs is INCREASED in obese and the elderly because of the INCREASED proportion of adipose tissue to lean body mass

66
Q

What is there a risk of when a patient is obese or elderly, and are taking fat-soluable drugs

A

Risk for an increase in adverse effects

67
Q

Most protein binding by drugs occurs with which blood protein?

A

Albumin

68
Q

What food affects the first-pass drug metabolism of many drugs?

A

Grapefruit

69
Q

What can happen if you eat grapefruit while taking certain medications?

A

Can increase the bioavailability and corresponding increases in serum drug levels
(not affected as much by first-pass effect, therefore, more active drug is available)

70
Q

What are some examples of foods that induce chemical oxidation when added to the diet and increase drug metabolism?

A

Cruciferous vegetables

  • broccoli
  • brussels
  • sprouts
  • cabbage
  • cauliflower
  • rutabaga
  • turnips
71
Q

What happens if you induce/increase drug metabolism?

A

Results in a LOWER serum concentration of the drug

72
Q

What vitamin is important in the clotting process?

A

Vitamin K

73
Q

State the core patient variables that can influence drug-nutrient interactions

A
  • Abnormal dietary intake

- Use of herbs and nutritional supplements

NURS 1064 - Pharm (9 decks)

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