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
side effects of factor Xa
bleeding pain in limbs, headache, dizziness, abdominal pain
26
antiplatelet drug MOA
prevent platelets from sticking together to form a clot aspirin targets COX plavix(clopidogrel)/ticagrelor/pasugrel targetsP2Y12 dipyridamole: inhibit PDE
27
indications for antiplatelet drugs
angina a fib coronary artery disease PCI after stent placement stroke MI
28
side effects of anti platelet drugs
bleeding GI bleeding tinnitus thrombotic thrombocytopenia purpura
29
list thrombolytics
tPA reteplase tenecteplase streptokinase urokinase
30
thrombolytics MOA
activate conversion of plasminogen into plasmin to degrade fibrin in blood clot
31
indications of thrombolytics
acute MI acute stroke PE DVT
32
side effects of thrombolytics
bleeding allergic rxn reocculusion
33
PT consideration on anticoagulants
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