Chapter 55: Anticoagulant, Antiplatelet, and Thrombolytic Drugs Flashcards
1
Q
all drugs discussed in this chapter increase the risk of
A
patient bleeding
2
Q
before administration of any of these drugs careful assessment of _____ should be completed to asses for internal bleeding
A
mental status, blood pressure, heart rate, and mucous membranes
3
Q
henostasis stage 1
A
Formations of platelet plug
- platelet aggregation
4
Q
Homostasis stage 2
A
Coagulation
- intrinsic coagulation pathway
- extrinsic coagulation pathway
5
Q
what is a thrombosis
A
- blood clot formed within a blood vessel or within the heart
6
Q
artrial thrombosis
A
- involves platelet adhesion to an arterial wall that causes atrial occlusion
7
Q
Anticoagulants
A
- inhibit the action or formation of clotting factors
- prevent clot formation
8
Q
Antiplatelet drugs
A
- inhibit platelet aggregation
- prevent platelet plugs
9
Q
thrombolytic drugs
A
- Lyse (break down) existing clots
10
Q
hemostatic drugs are also called
A
antibibrinolytic drugs
11
Q
hemostatic drugs
A
- promote blood coagulation
12
Q
non-thrombolytic drugs include
A
- unfractioned heparin and low molecular weight heparins (LMWHs)
- warfarin [Coumadin]
- rivaroxiban [Xarelto], Edoxaban [lixiana]
- dabigatrin [Pradaxa]
- apixaban [eliquis]
13
Q
non thrombolytic drugs
A
prevent clot formation
- do not lyse clots
14
Q
non-thrombolytic drugs also aid in the prevention of
A
- stroke
- myocardial infraction
- deep vein thrombosis
- pulmonary embolism
15
Q
how do anticoagulants prevent clot formation
A
- reduce formation of fibrin
16
Q
anticoagulants are used to prevent clot formation in
A
- myocardial infraction
- unstable angina
- atrial fibrillation
- indwelling devices, such as mechanical heart valves
- major orthopedic surgery
17
Q
anticoagulants contradictions
A
- known drug allergy
- thrombocytopenia (low platelets)
18
Q
warfarin is contradicted in
A
pregnancy
19
Q
dabigatrin is contradicted in
A
nursing women
20
Q
rivaroxaban, edoxaban is contradicted in
A
pregnancy and nursing
21
Q
anticoagulants adverse events
A
- bleeding (risk increases with increased dosages; bleeding may be localized or systemic)
- nausea
- vomiting
- abdominal cramps
- thrombocytopenia
22
Q
Unfractioned heparin (heparin sodium)
A
highly polar polysaccharide chain molecule
23
Q
Unfractionated heparin MOA
A
enhances antithrombin
24
Q
Unfractionated heprin reversal agent
A
Protamine sulfate
25
unfractionated heparin therapeutic uses
- pulmonary embolism
- massive deep vein thrombosis
- open heart surgery
- renal dialysis
- low dose therapy postoperatively
- disseminated intravascular coagulation
- adjunct the thrombolytic therapy
- atrial fibrilation complications
26
what is the preffered anticoagulant during pregnancy
unfractionated heparin
27
what is the preferred anticoagulant when rapid anticoagulation is required
unfractionated heparin
28
unfractionated heparin adverse effects
- hemorrhage
- heparin induced thrombocytopenia
- hypersensitivity reactions
29
unfractionated heparin is contradicted in
- thrombocytopenia (low platelets)
- uncontrolled bleeding
- recent surgery of the eye, brain, or spinal cord trauma
30
unfractionated heparin reversal agent
protamine sulfate
31
unfractionated heparin levels are measured by
activated partial thromboplastin time (aPTT)
32
heparin dose is measured in
units
33
what is normal aPTT
40 seconds
34
what is aPTT with heparin
60-80 seconds
35
low molecular weight heparin examples
enoxaparin
36
how is low molecular weight heparin diffrent from unfractioned heparin
- more predictable anticoagulant response
- do not require frequent labratory monitoring
- thrombocytopenia is rare
37
low molecular weight heparin measurements
products are in both UNITs and mg, depending on agent
- use caution
38
LMW heparins reversal agent
protamine sulfate
39
LMW heparins therapeutic use
- prevention of DVT after surgury (replacement of hip, knee, colorectal, abdominal, and gynecological)
- treatment of established DVT
- prevention of ischemic complications (unstable angina, non-Q-wave myocardial infraction, ST elevation MI (STEMI)
40
LMW heparins adverse effects
bleeding
41
anoxaparin [Lovenox] contains a preservative that is associated with potentially fatal
"gasping syndrome" in newborns or premature infants
42
Nadroparin Nadroparin (9500iu/ml) is used for
prophylaxis of thronboembolic disorders (DVT and PE) in general and orthopaedic surgery, treatment of DVT, prevention of clooting during hemodialysis, treatment of unstable angina and not Q wave myocardial infraction
43
Nadroparin (19000iu/ml) is used for
treatment of DVT
44
nadroparin can be used interchangeably with
unfracioned heparin or other LMW heparins
45
Warfarin MOA
vitamin K antagonist
- blocks biosynthesis of factors VII, IX, and X and prothrombin
46
Warfarin onset
delayed
- long half life
47
Warfarin [Coumadin] therapeutic uses
long term prophylaxis od thrombosis
48
Warfarin is administered
orally
49
what should be monitored after Warfarin administration
prothrombin time (PT) and International normalized ratio (INR) (PT/INR)
50
what is normal international normalized ratio
1.0
51
warfarin international normalized ration
2-3.5
52
warfarin is bound to
99% protein bound
53
Warfarin [Coumadin] adverse effects
- severe bleeding, including heavier than normal menstrual cycle or gums after brushing
- red or brown urine
- black or bloody stool
- severe headache or stomach pain
- joint pain, discomfort or swelling, especially after injury
- easy brusing
- dizziness or weakness
54
warfarin [Coumadin] drug interactions
- drugs that increase anticoagulant effects
- drugs that promote bleeding
- drugs that decrease anticoagulant effects
55
what are warfarin herbal interactions
- capsicum pepper
- feverfew
- garlic
- ginger
- ginko
- ginseng
56
how long do warfarin's full therapeutic efects take
several days
57
what is the antidote to warfarin
vitamin K
58
what should nurses monitor for in a patient taking warfarin
bleeding or bruising
59
Direct thrombin inhibitors example
Dabigatran etexilate [pradaxa]
60
advantages of direct thrombin inhibitors
- rapid onset
- dont require monitoring of anticoagulation
- lower risk of adverse interactions
- few food drug interactions
- same dose can be used for all patients regardless of age or weight
61
Dabigatrin therapeutic uses
atrial fibrilation, VTE prophyaxis
62
Argatroban therapeutic uses
prevention of DVT in patients undergoing elective hip replacement surgury
63
Direct thrombin inhibitors adverse effects
- bleeding
- GERD, dyspepsia, nausea and vomiting, bloating)
64
reversal agent for dabigatrin
idarucizumab [praxiband]
65
Direct factor Xa inhibitors
rivaroxaban [xarelto]
- Apixaban [eliquis]
- edmoxaban [lixiana]
66
rivaroxaban [xarelto] should bu used in caution in
renal/hepatic impairment, pregancy
67
Direct factor Xa inhibitors use
- prevention of DVT and PE after total hip or knee replacement surgery
- prevention of stroke in patinets with atrial fibrillation
- treatment of DVT and PE unrelated to orthopedic surgury
68
Direct FActor Xa Inhibitors seide effects
- bleeding
- itching
69
Antiplatelet drugs example
Acetylsalicylic acid [asprin]
Clopidogrel [Plavix]
- Dipyridamole [Persentine}
70
Acetylsalicylic acid [asprin] MOA
inhibition of cyclooxygenase
71
Acetylsalicylic acid [asprin] adverse effects
- increases risk for bleeding, especially GI bleeding, hemorrhage stroke
72
Acetylsalicylic acid [asprin] therapeutic uses
- ischemic stroke
- transient ischemic attacks (TIA)
- chronic stable angina
- unstable angina
- coronary stenting
- acute MI
- primary prevention of MI
73
Clopidogrel [Plavix] should be used with caution in
combination with other drugs that promote bleeding
74
Dipyridamole [persantine] is used
after valve replacement
75
a combination of dipyridamole and asprin is used to
- prevent recurrent ischemic stroke in patients who had previous stroke or TIA
76
a combination of dipyridamole and asprin adverse effects
GI upset, bleeding, headache, dizziness
77
Thrombolytics example
Alteplase
- streptokinase [streptase]
- anisterplase [eminase]
- reteplase [retavase]
- tenecteplase [TNKase]
- drotrecogin alfa [Xigris]
78
Alteplase therapeutic uses
- myocardial infraction
- ischemic stroke
- massive pulmonary emboli
79
Alteplase contradictions
drug allergies, other drugs that alter clotting
80
Alteplase adverse effects
bleeding
81
Alteplase advantages
- does not cause allergic reactions
- does not induce hypotension
82
Antithrombolytic drugs MOA
prevent breakdown of fibrin by preventing the formation of plasmin
- used for uncontrolled bleeding in the mucous membrane of the mouth, nose and throat and dental extractions
83
Antithrombolytic drugs examples
- Aminocaproic acid
- tranexamic acid
84
tranexamic acid is used primary for
heavy menstrual bleeding
