Chapter 46: anticoagulants And Antiplatelet Drugs

Question 1

3 types of blood thinners

Answer 1

Anticoagulants, antiplatelets, trombolytics

Question 2

Anticoagulants

Answer 2

Used to inhibit clot formation
Used with thromboembolism treatment or thromboembolism prophylaxis

Venous
Deep vein thrombosis (DVT)
Pulmonary embolism (PE)

Arterial
Coronary thrombus (MI) -Lead to MI
Presence of artificial heart valves
Stroke

Question 3

3 classes of anticoagulants

Answer 3

Drugs that Activate Antithrombin
Need thrombin to create clot
Heparin
Enoxaparin (Lovenox)

Vitamin K Antagonist
Warfarin

Factor Xa Inhibitors
Rivaroxaban (Xarelto)
Apixiban (Eliquis)
Tabigatrin is a factor 10a inhibitor but is not used as frequently, not as effective

Question 4

Unfractionated heparin MOA

Answer 4

Rapid acting AC that Inactivates thrombin. Prevent further clot formation.

Question 5

Heparin use

Answer 5

Indicated for rapid anticoagulant effect for thromboembolism treatment or prophylaxis
Introduced in 1938

Question 6

Heparin route

Answer 6

IV or Sub Q (injection ONLY)

Question 7

Heparin SE

Answer 7

Bleeding, HI thrombocytopenia, prolonged clotting time

HIT potentially fatal, immune mediated disorder. Characterized by decrease plt. Monitor plt on heparin, if plt drops d/c hep. If pt still needs anticoagulant therapy, give non-heparin anti-coagulant –typically gatroban. HIT can occur in ~5% of pt who are on hep for >4 days.
Normal aPTT 35 sec. Therapeutic aPTT is 70 sec

Question 8

Heparin Ssaftey and monitoring

Answer 8

Monitor PTT (Partial thromboplastin time) OR aPTT (activated partial thromboplastin time) . Therapeutic value is 2X normal
Safe in pregnancy

Question 9

Heparin antagonist

Answer 9

Protamine Sulfate

Question 10

Heparin d/c

Answer 10

When discontinued, oral AC is started

Question 11

LMWH

Answer 11

Enoxaparin sodium (Lovenox)
This is a heparin prep. Prep with shorter molecules than what heparin has. Just as effective as unfractionated heparin
More convenient, can be admin at home, les SE -1st line tx for DVT prevention

Question 12

LMWH MOA

Answer 12

Binds to AT III to inactivate thrombin

Question 13

LMWH use

Answer 13

DVT prophylaxis, DVT/PE, Prevention of ischemia for angina unstable and MIs

More convenient, can be admin at home, les SE -1st line tx for DVT prevention

Question 14

LMWH route

Answer 14

*SC only. Dosage based on body weight and administered BID

Question 15

LMWH SE

Answer 15

bleeding, thrombocytopenia

Can cause HIT, but less than UFH

Question 16

LMWH safety and monitoring

Answer 16

May be given at home, monitor platelets
Contraindicated in clients with hem strokes, peptic ulcers. Not given after eye, brain or spinal surgery

Cautious in pt with RF, pretty much contraindicated in pt with renal probs

Question 17

Warfarin MOA

Answer 17

Inhibit synthesis of vitamin K

Question 18

Warfarin use

Answer 18

DVT/PE, VTE prophylaxis, atrial fib/flutter, ischemic stroke

Delayed onset –not appro for emergency

Question 19

Warfarin route

Answer 19

PO

Question 20

Warfarin labs

Answer 20

Monitor PT prothrombin time and INR international normalized ratio
Desired INR when on warfarin is 2x normal

PT/INK –in order to get INR, need PT first. Normal INR is 1-1.5, therapeutic is going to be 2-3. Toxic is over 3 -> bleed.

Question 21

Warfarin SE

Answer 21

Bleeding is a major side effect (Monitor for signs of bleeding)
Petechiae
Ecchymosis
Hematemesis, occult stool, hematuria, epistaxis
Bleeding gums

Question 22

Warfarin safety and monitoring

Answer 22

Antidote is vitamin K

Does not work immediately =, often will give with FFP (has clotting factors in it)

Diet education is necessary
green leafy veg, keep intake consistent
Want to avoid fluctuations

Many drug interactions

Question 23

DOAC: factor Xa inhibitors

Answer 23

rivaroxaban (Xarelto)
apixiban (Eliquis)

Question 24

DOAC MOA

Answer 24

Selectively blocks Factor Xa (factor Xa inhibitor)

Question 25

DOAC use

Answer 25

DVT/PE, VTE, atrial fib/flutter treatment, DVT and stroke prophylaxis. Convienent –no dietary restrictions, no routine monitoring

Question 26

DOAC SE

Answer 26

Bleeding

Question 27

DOAC safety and monitoring

Answer 27

Routine coagulation monitoring not required
Reversal agents are available now
Expensive reversal agents, can give FFP
Not safe in preg

Question 28

Antiplatelet MOA

Answer 28

Used to prevent thrombosis in the arteries by suppressing platelet aggregation

Question 29

antiplatelet use

Answer 29

Prevention of thrombosis in arteries. Indications:
Prevention of MI or stroke in patient with family history or high risk factors.
Prevention for a repeat MI or stroke
Prevention of a stroke in patients having TIAs.
TIA pt will have stroke within 6 Mon
Angina- To reduce the risk of death
Coronary stenting- To prevent occlusion

Question 30

Antiplatelet ASA

Answer 30

ASA can greatly reduce morbidity and mortality for Mis, stores, TIAs, angina. If pt needs ASA and gets GI upset, add PPI

81 mg, or 325 mg/day

ASA SE: GI Bleed and hemorrhagic stroke.

Question 31

Anti platelet clopidogrel (Plavix)

Answer 31

Use: ASA allergy. Prevents stenosis of coronary stents
SE: Bleeding, TTP

Question 32

Antiplatelet cilostazol (Pletal)

Answer 32

Use: Antiplatelet; Claudication
Inhibits platelet aggregation and is a vasodilator. Indicated for PVD and intermittent claudication
Works better than ASA for PVD

Question 33

Antiplatelet naturals

Answer 33

Garlic, ginkgo, ginger increase bleeding especially when taken with anticoagulants
Increase bleeding time

Question 34

Anti-platelet contraindications

Answer 34

Contraindicated if someone is purposely bleeding. Hold prior to sx, no routine mentoring, use caution with other meds that promote bleeding like NSAIDs, ASA + nticoag, may see ASA and plt is together for stent