Coagulation Disorders Flashcards

1
Q

steps of blood clotting in normal physiologic process

A
  1. vasoconstriction: reduce blood loss when injury occurs
  2. form platelet plug: platelets adhere to open areas and stick together
  3. coagulation cascade activates to convert plasma protein fibrinogen into fibrin
  4. clot retraction/repair: reduce size of clot, approximate edges of wound, fibroblasts proliferate to lay down collagen fibers
  5. fibrinolysis: clot remove by plasminogen, which is activated into plasmin which dissolves clot
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2
Q

regulation of coagulation

A

anticoagulants: antithrombin, protein C
tissue factor pathway inhibitor: inhibit extrinsic pathway
fibrinolysis: removal of clots

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3
Q

drug classess for anticoagulation

A

thrombolytics
anticoagulants
antithrombotics/antiplatelet

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4
Q

indications for anticoagulants

A

DVT
PE
A fib
MI
arteriosclerosis
acute coronary syndrome
stroke
artificial heart valve
hemodialysis
chronic renal failure
CABG

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5
Q

adverse effects of anticoagulants

A

increased/excess bleeding

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6
Q

list anticoagulant drugs

A

warfarin: vitamin K antagonist
heparin
LMWH
dabigatran: direct thrombin inhibitor
Factor Xa inhibitors: fondaparinux

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7
Q

list anti thrombotics

A

aspirin: COX inhibitor
Plavix: ADP receptor inhibitors
tirofiban, abciximab: glycoprotein inhibitors

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8
Q

list thrombolytics

A

tPA
reteplase
tenectplase

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9
Q

hemostatic drugs function

A

promote clot stability
prevent excess bleeding
includes tranexamic acid, aminocaproid acid

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10
Q

vitamin K function

A

antidote to warfarin overdose/excess anticoagulation

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11
Q

warfarin MOA

A

vitamin K antagonist
antagonise liver synthesis of vitamin K dependent clotting factors

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12
Q

indications for warfarin

A

if pt will be on anticoagulation long term
VTE
acute Afib

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13
Q

side effects of warfarin

A

hemorrhage
fetotoxic
many drug interactions

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14
Q

INR

A

normal: 1
target in anticoagulation differs: 2.5-3.5

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15
Q

PT considerations on warfarin

A

bruising
risk of bleeding
fall risk
INR monitoring

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16
Q

heparin MOA

A

increase antithrombin factor activity to decrease blood clotting protease activity

17
Q

clinical indications for heparin

A

DVT
PE
pts going into surgery
acute coronary syndrome/MI!

18
Q

side effects of heparin

A

bleeding
thrombocytopenia
osteoporosis
hypersensitivity

19
Q

PT implications of heparin

A

bleeding
drug interactions and interactions with deep heat that can increase risk of bleeding
pt education on bleeding

20
Q

direct thrombin inhibitor MOA

A

inhibit activity of thrombin in coagulation cascade to reduce blood clotting

21
Q

indications for direct thrombin inhibitors

A

prevent stroke
treat/prevent DVT
anticoagulate pts who have thrombocytopenia from heparin use
during PCI procedure

22
Q

side effects of direct thrombin inhibitors

A

bleeding
GI effects

23
Q

factor Xa inhibitors MOA

A

inhibit Xa in coagulation cascade, prevent conversion to thrombin

24
Q

indications for factor Xa inhibitors

A

prevent/treat DVT, PE
prevent stroke or embolism

25
Q

side effects of factor Xa

A

bleeding
pain in limbs,
headache,
dizziness,
abdominal pain

26
Q

antiplatelet drug MOA

A

prevent platelets from sticking together to form a clot
aspirin targets COX
plavix(clopidogrel)/ticagrelor/pasugrel targetsP2Y12
dipyridamole: inhibit PDE

27
Q

indications for antiplatelet drugs

A

angina
a fib
coronary artery disease
PCI after stent placement
stroke
MI

28
Q

side effects of anti platelet drugs

A

bleeding
GI bleeding
tinnitus
thrombotic thrombocytopenia purpura

29
Q

list thrombolytics

A

tPA
reteplase
tenecteplase
streptokinase
urokinase

30
Q

thrombolytics MOA

A

activate conversion of plasminogen into plasmin to degrade fibrin in blood clot

31
Q

indications of thrombolytics

A

acute MI
acute stroke
PE
DVT

32
Q

side effects of thrombolytics

A

bleeding
allergic rxn
reocculusion

33
Q

PT consideration on anticoagulants

A

increased bruising risk
increased risk of post op bleeding
monitor for internal bleeding
dry needling, electroacupuncture, deep tissue mobilization could icnrease hematoma risk, inspect area if using manual technique
monitor for DVT and consider prophylaxis
caution with high intensity exercise
schedule interventions when meds at moderate level of effect
fall prevention