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NURB 3150 > Coagulation Drugs > Flashcards

Coagulation Drugs Flashcards

1
Q

indication for anticoagulant therapy

A

prophylaxis for increased risk for clot formation

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2
Q

what does anticoagulants prevent

A
  • fibrin deposits
  • extension of thrombus
  • thromboembolic complications
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3
Q

anticoagulant MOA

A

decrease blood coagulability (not effective on existing thrombus)

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4
Q

routes of anticoagulants

A
  • parenteral

- oral

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5
Q

anticoagulant prototype

A

heparin

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6
Q

another name for heparin

A

unfractionated heparin

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7
Q

MOA of heparin

A

binds to antithrombin III and turns off the coagulation pathway to prevent clots from forming

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8
Q

indications of heparin

A
  • When there is a need for rapid anticoagulation
  • Surgery of heart and blood vessels
  • Hemodialysis
  • Sudden arterial occlusion
  • DVT/thrombophlebitis (prevent PE)
  • DVT prophylaxis
  • Disseminated Intravascular Coagulation (DIC)
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9
Q

contraindications of heparin

A
  • threatened abortion
  • cerebral or aortic aneurysm
  • ICB
  • severe HTN
  • hemophilia
  • thrombocytopenia
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10
Q

cautions of heparin

A
  • recent childbirth
  • severe trauma
  • active ulcer disease
  • liver disease
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11
Q

adverse effects of heparin

A
  • bleeding/hemorrhage

- HIT (heparin-induced thrombocytopenia)

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12
Q

implications before heparin IV infusion

A

check baseline aPTT, PT, CBC, platelets

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13
Q

implications 6 hours after start of heparin IV infusion

A

check lab (PTT) again in opposite arm of infusion….adjust dose according to protocol….repeat lab 6 hours later

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14
Q

normal/control PTT levels

A

25-35 sec

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15
Q

Therapeutic PTT

A

1.5-2.5 times normal… around 45-70 seconds

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16
Q

heparin subq onset

A

20-60 min

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17
Q

max? of heparin subq administration

A

5000 u q 6hr

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18
Q

implications for administering heparin subq

A
  • double check dose with another nurse
  • do not aspirate or rub site
  • rotate sites and document
  • hold in place for 3 seconds
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19
Q

herpain IV onset

A

immediate

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20
Q

heparin IV administration

A
  • loading dose (ex: 5000 u over atleast 1 minute)
  • continuous infusion on pump (ex: 1,000 u/hr)
  • provided constant blood level and less risk for complications
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21
Q

nursing implication

A

education

  • s/s of bleeding (blood in stool, hematuria, epistaxis)
  • avoid shaving with razor, use electric
  • use soft toothbrush
  • limit needle sticks

can precipitate HIT, so look for sudden decrease in platelets

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22
Q

antidote for heparin

A

protamine sulfate

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23
Q

administering protamine sulfate

A
  • give slowly, no faster than 50mg over 10 min

- check ACT

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24
Q

effects of rapid infusion of protamine sulfate

A
  • hypotension
  • bradycardia
  • flushing
25
Q

adverse effect of protamine sulfate

A
  • pulmonary edema

- anaphylaxis

26
Q

low molecular weight heparins function

A

similar to unfractionated heparin, but smaller and less protein-bound

27
Q

about low molecular weight heparins

A
  • longer half-life
  • more predictable anticoagulation response
  • more effective than subq heparin
  • often given until coumadin is effective
  • frequent lab monitoring not needed
28
Q

route of low molecular weight heparins

A
  • subq in abdomen 2 in from umbilicus

- occasionally IV with enoxaparin

29
Q

dalteparin (fragmin) class

A
  • low molecular weight heparins

- u/kg

30
Q

enoxaparin (lovenox) class

A

mg/kg

31
Q

tinxaparin (innohep) class

A

low molecular weigh heparin

32
Q

MOA of warfain (coumadin)

A
  • inhibits K synthesis
  • inhibits activation of several clotting factors in the liver
  • prevent clot formation and extension of formed clots
33
Q

Indication of warfarin

A
  • chronic atrial fibrillation
  • prophylaxis and treatment of DVT
  • mechanical heart valves
34
Q

dose life of warfarin

A
  • onset 2-3 days
  • duration 2-5 days
  • maximum effect 3-5 days
  • half life 0.5-3 days
35
Q

warfarin dosing

A
  • usually given at 1600 to ensure time to get lab results and adjust dose if need
  • monitor therapy
  • must get lab results daily at start of treatment
  • normal PT 11-13 sec
  • normal INR <1.0
36
Q

warfarin goals

A
  • DVT: INR- 2.0-3.0
  • A Fib: INR 2.0-3.0
  • Heart Valves INR 2.5-3.5 (3.0-4.5 per ATI)
37
Q

adverse effects of warfarin

A
  • bleeding/hemorrhage
  • N/V
  • abdominal pain
  • alopecia
  • joint/muscle
38
Q

drug interactions with warfarin that increase anticoagulant effect

A
  • ASA
  • NSAIDS
  • Aminodarone
  • Quinidine
  • Cimetidine
  • Macrolides
  • Furosemide, budensonide
  • glucocorticoids
39
Q

drug interactions with warfarin decrease anticoagulant effect

A
  • barbiturates
  • hormones
  • contraceptives
  • rifampin
  • vitamin K
  • phenytoin, tegretol
40
Q

food/drinks interactions with warfarin that increase anticoagulant effect

A
  • cranberry juice

- alcohol

41
Q

food/drinks interactions with warfarin that decrease anticoagulant effect

A
  • high in vitamin k

- green tea

42
Q

warfarin teachings

A
  • moderate green leafy vegetables
  • no prolonged sitting, standing, or crossing legs
  • no long car rides
  • monitor skin integrity
  • elevate limb when sitting/riding to decrease venous pulling
  • s/s of PE
  • may need to stop before procedures, check with MD
  • keep appt times for lab
  • hazards of prolonged clotting times
  • s/s of hemorrhage
43
Q

antidote for wawrfarin

A
  • vitamin K, mephyton, aquamephyton (po, im, sc, iv)

- FFP (fresh frozen plasma) in emergency

44
Q

argatroban (Acova) drug class

A

direct thrombin inhibitors

45
Q

dabigatran (Pradaxa) drug class

A

direct thrombin inhibitors

46
Q

argatroban use

A

used in place of heparin if HIT

47
Q

route of argatroban

A

IV only

48
Q

route of dabigratran

A

po alternative Coumadin

49
Q

dabigratran risk

A

stomach upset/GI bleed

50
Q

implications for dabigatran

A

doesn’t require frequent INR checks or food restrictions

51
Q

antidote for dabigratran

A
  • rucizumab (praxibind)

- wil reverse the effects

52
Q

Xa inhibitors

A

lower bleeding risk and “fewer” interactions than heparin

53
Q

fondaparinux (arixtra) drug class

A

Xa inhibitors

54
Q

fondaparainux

A
  • no antidote

- watch platelets

55
Q

route of fondaparainux

A

SQ

56
Q

rivaroxaban (Xarelto) drug class

A

Xa inhibitors

57
Q

rivaroxaban implications

A

monitor LFT

58
Q

rivaroxban route

A

Po

59
Q

things to monitor with all coagulants

A
  • bleeding
  • platelet leve
  • avoid current use of NSAIDs, ASA, etc/ if possible

NURB 3150 (6 decks)

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