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HLST220: Pharmacology > Chapter 55: Anticoagulant, Antiplatelet, and Thrombolytic Drugs > Flashcards

Chapter 55: Anticoagulant, Antiplatelet, and Thrombolytic Drugs Flashcards

1
Q

all drugs discussed in this chapter increase the risk of

A

patient bleeding

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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

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3
Q

henostasis stage 1

A

Formations of platelet plug
- platelet aggregation

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4
Q

Homostasis stage 2

A

Coagulation
- intrinsic coagulation pathway
- extrinsic coagulation pathway

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5
Q

what is a thrombosis

A
  • blood clot formed within a blood vessel or within the heart
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6
Q

artrial thrombosis

A
  • involves platelet adhesion to an arterial wall that causes atrial occlusion
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7
Q

Anticoagulants

A
  • inhibit the action or formation of clotting factors
  • prevent clot formation
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8
Q

Antiplatelet drugs

A
  • inhibit platelet aggregation
  • prevent platelet plugs
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9
Q

thrombolytic drugs

A
  • Lyse (break down) existing clots
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10
Q

hemostatic drugs are also called

A

antibibrinolytic drugs

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11
Q

hemostatic drugs

A
  • promote blood coagulation
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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]
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13
Q

non thrombolytic drugs

A

prevent clot formation
- do not lyse clots

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14
Q

non-thrombolytic drugs also aid in the prevention of

A
  • stroke
  • myocardial infraction
  • deep vein thrombosis
  • pulmonary embolism
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15
Q

how do anticoagulants prevent clot formation

A
  • reduce formation of fibrin
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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
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17
Q

anticoagulants contradictions

A
  • known drug allergy
  • thrombocytopenia (low platelets)
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18
Q

warfarin is contradicted in

A

pregnancy

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19
Q

dabigatrin is contradicted in

A

nursing women

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20
Q

rivaroxaban, edoxaban is contradicted in

A

pregnancy and nursing

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21
Q

anticoagulants adverse events

A
  • bleeding (risk increases with increased dosages; bleeding may be localized or systemic)
  • nausea
  • vomiting
  • abdominal cramps
  • thrombocytopenia
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22
Q

Unfractioned heparin (heparin sodium)

A

highly polar polysaccharide chain molecule

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23
Q

Unfractionated heparin MOA

A

enhances antithrombin

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24
Q

Unfractionated heprin reversal agent

A

Protamine sulfate

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25
Q

unfractionated heparin therapeutic uses

A
  • 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
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26
Q

what is the preffered anticoagulant during pregnancy

A

unfractionated heparin

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27
Q

what is the preferred anticoagulant when rapid anticoagulation is required

A

unfractionated heparin

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28
Q

unfractionated heparin adverse effects

A
  • hemorrhage
  • heparin induced thrombocytopenia
  • hypersensitivity reactions
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29
Q

unfractionated heparin is contradicted in

A
  • thrombocytopenia (low platelets)
  • uncontrolled bleeding
  • recent surgery of the eye, brain, or spinal cord trauma
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30
Q

unfractionated heparin reversal agent

A

protamine sulfate

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31
Q

unfractionated heparin levels are measured by

A

activated partial thromboplastin time (aPTT)

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32
Q

heparin dose is measured in

A

units

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33
Q

what is normal aPTT

A

40 seconds

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34
Q

what is aPTT with heparin

A

60-80 seconds

35
Q

low molecular weight heparin examples

A

enoxaparin

36
Q

how is low molecular weight heparin diffrent from unfractioned heparin

A
  • more predictable anticoagulant response
  • do not require frequent labratory monitoring
  • thrombocytopenia is rare
37
Q

low molecular weight heparin measurements

A

products are in both UNITs and mg, depending on agent
- use caution

38
Q

LMW heparins reversal agent

A

protamine sulfate

39
Q

LMW heparins therapeutic use

A
  • 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
Q

LMW heparins adverse effects

A

bleeding

41
Q

anoxaparin [Lovenox] contains a preservative that is associated with potentially fatal

A

“gasping syndrome” in newborns or premature infants

42
Q

Nadroparin Nadroparin (9500iu/ml) is used for

A

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
Q

Nadroparin (19000iu/ml) is used for

A

treatment of DVT

44
Q

nadroparin can be used interchangeably with

A

unfracioned heparin or other LMW heparins

45
Q

Warfarin MOA

A

vitamin K antagonist
- blocks biosynthesis of factors VII, IX, and X and prothrombin

46
Q

Warfarin onset

A

delayed
- long half life

47
Q

Warfarin [Coumadin] therapeutic uses

A

long term prophylaxis od thrombosis

48
Q

Warfarin is administered

A

orally

49
Q

what should be monitored after Warfarin administration

A

prothrombin time (PT) and International normalized ratio (INR) (PT/INR)

50
Q

what is normal international normalized ratio

A

1.0

51
Q

warfarin international normalized ration

A

2-3.5

52
Q

warfarin is bound to

A

99% protein bound

53
Q

Warfarin [Coumadin] adverse effects

A
  • 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
Q

warfarin [Coumadin] drug interactions

A
  • drugs that increase anticoagulant effects
  • drugs that promote bleeding
  • drugs that decrease anticoagulant effects
55
Q

what are warfarin herbal interactions

A
  • capsicum pepper
  • feverfew
  • garlic
  • ginger
  • ginko
  • ginseng
56
Q

how long do warfarin’s full therapeutic efects take

A

several days

57
Q

what is the antidote to warfarin

A

vitamin K

58
Q

what should nurses monitor for in a patient taking warfarin

A

bleeding or bruising

59
Q

Direct thrombin inhibitors example

A

Dabigatran etexilate [pradaxa]

60
Q

advantages of direct thrombin inhibitors

A
  • 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
Q

Dabigatrin therapeutic uses

A

atrial fibrilation, VTE prophyaxis

62
Q

Argatroban therapeutic uses

A

prevention of DVT in patients undergoing elective hip replacement surgury

63
Q

Direct thrombin inhibitors adverse effects

A
  • bleeding
  • GERD, dyspepsia, nausea and vomiting, bloating)
64
Q

reversal agent for dabigatrin

A

idarucizumab [praxiband]

65
Q

Direct factor Xa inhibitors

A

rivaroxaban [xarelto]
- Apixaban [eliquis]
- edmoxaban [lixiana]

66
Q

rivaroxaban [xarelto] should bu used in caution in

A

renal/hepatic impairment, pregancy

67
Q

Direct factor Xa inhibitors use

A
  • 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
Q

Direct FActor Xa Inhibitors seide effects

A
  • bleeding
  • itching
69
Q

Antiplatelet drugs example

A

Acetylsalicylic acid [asprin]
Clopidogrel [Plavix]
- Dipyridamole [Persentine}

70
Q

Acetylsalicylic acid [asprin] MOA

A

inhibition of cyclooxygenase

71
Q

Acetylsalicylic acid [asprin] adverse effects

A
  • increases risk for bleeding, especially GI bleeding, hemorrhage stroke
72
Q

Acetylsalicylic acid [asprin] therapeutic uses

A
  • ischemic stroke
  • transient ischemic attacks (TIA)
  • chronic stable angina
  • unstable angina
  • coronary stenting
  • acute MI
  • primary prevention of MI
73
Q

Clopidogrel [Plavix] should be used with caution in

A

combination with other drugs that promote bleeding

74
Q

Dipyridamole [persantine] is used

A

after valve replacement

75
Q

a combination of dipyridamole and asprin is used to

A
  • prevent recurrent ischemic stroke in patients who had previous stroke or TIA
76
Q

a combination of dipyridamole and asprin adverse effects

A

GI upset, bleeding, headache, dizziness

77
Q

Thrombolytics example

A

Alteplase
- streptokinase [streptase]
- anisterplase [eminase]
- reteplase [retavase]
- tenecteplase [TNKase]
- drotrecogin alfa [Xigris]

78
Q

Alteplase therapeutic uses

A
  • myocardial infraction
  • ischemic stroke
  • massive pulmonary emboli
79
Q

Alteplase contradictions

A

drug allergies, other drugs that alter clotting

80
Q

Alteplase adverse effects

A

bleeding

81
Q

Alteplase advantages

A
  • does not cause allergic reactions
  • does not induce hypotension
82
Q

Antithrombolytic drugs MOA

A

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
Q

Antithrombolytic drugs examples

A
  • Aminocaproic acid
  • tranexamic acid
84
Q

tranexamic acid is used primary for

A

heavy menstrual bleeding

HLST220: Pharmacology (46 decks)

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