Chapter 7 - Coagulation Disorders Flashcards
1
Q
Heparin
A
Class: Heparins
- MOA: To inhibit specific clotting factors to prevent formation or enlargement of clots
- Use: DVT, pulmonary embolism, unstable angina, evolving MI, prevention of thrombosis in high risk patients
- AE: abnormal bleeding, HIT (Heparin induced thrombocytopenia)
- Admin: poorly absorbed GI tract – only subcutaneous of IV, weight based, never draw back plunger on syringe when giving subcutaneously or massage site
- Monitor: PTT (monitors Coumadin)
- Antidote: Protamine sulfate
- Other: Does not cross placental barriers, is not excreted in breast milk Ideal medication to give pregnant women (who are more susceptible to clots
2
Q
enoxaparin (Lovenox)
A
Class: Low Molecular Weight Heparins
- MOA: inactivates coagulation factor Xa (10a) and produces anticoagulation
- Uses: DVT prophylaxis, ACS, unstable angina, acute DVT
- Admin: peaks 3-5 hours/lasts 12 hours; subQ, air bubble needed, do not rub site after injection
- AE: injection site hematoma, nausea, peripheral edema
- Antidote: protamine sulfate
3
Q
warfarin (Coumadin)
A
Class: Vitamin K antagonists
- MOA: To inhibit specific clotting factors to prevent formation or enlargement of clots (Vitamin K)
- Use: prophylaxis of thrombosis, atrial fibrillation
- AE: bleeding, pregnancy category X
- Admin: take at same time of day (usually evening)
- Contra: GI bleed, ulcers, bleeding disorders, liver disease
- Antidote: vitamin K
- Monitoring: PT/INR
- ->Want INR to be 2.0 -3.0 (2-3 times normal to know they are getting anticoagulated)
4
Q
lepirudin (Refludan)
A
Class: Direct Thrombin Inhibitors (DTI)
- MOA: directly inhibits thrombin (doesn’t allow fibrinogen to convert to fibrin/platelet plug to form)
- Uses: acute coronary syndrome, HIT, prophylaxis in treatment of VTE (venous thrombolytic event), atrial fibrillation
- Admin: IV only (because it cannot be absorbed into Gi tract); onset within 30-90 minutes with duration of 24 hours
- AE: bleeding, injection site reaction, nausea/vomiting, GI upset, anemia, hematoma
- Antidote: No antidote (makes drug less desirable to patients – no way to reverse it)
5
Q
clopidogrel (Plavix)
A
Class: Antiplatelets
- MOA: to alter the plasma membrane of platelets so they cannot aggregate (clump up)
- Use: to prevent thrombi formation after a stroke or MI
- AE: abnormal bleeding, flu-like syndrome, headache, dizziness, rash, pruritus
- Negative factors: Takes about 5 days for it to leave system (at risk for developing clot), takes several days to start working
- NO ANTIDOTE/REVERSAL AGENT
- BBW: Decreased effects in patients who are reduced metabolizers – CYP enzyme – at risk for having an MI
- Give to patients who cannot tolerate Coumadin
6
Q
abciximab (ReoPro)
A
Class: Glycoprotein (GP) IIb/IIIa receptor antagonists
- MOA: cause reversible blockade of platelet GP IIb/IIIa receptors, thereby inhibiting final step in aggregation
- Uses: Acute coronary syndrome (ACS), percutaneous coronary intervention (PCI)
- AE: bleeding
- Admin: antiplatelet effects persistent for 24-48 hours after stopping infusion, IV only; $1200 single dose
7
Q
alteplase (Activase)
A
Class: Thrombolytics
- MOA: to convert plasminogen to plasmin, which digests fibrin and dissolves clot
- Uses: to dissolve existing clots, treat acute MI, deep vein thrombosis, treat cerebral vascular accident, pulmonary embolism, arterial thrombosis, to clear IV catheters
- AE: abnormal bleeding, contraindicated in patients with bleeding disorder or who have had recent trauma or surgery
- Admin: must be given within 12 hours of symptoms of MI and 3 hours of CVA
