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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
adverse effect of protamine sulfate
- pulmonary edema | - anaphylaxis
26
low molecular weight heparins function
similar to unfractionated heparin, but smaller and less protein-bound
27
about low molecular weight heparins
- longer half-life - more predictable anticoagulation response - more effective than subq heparin - often given until coumadin is effective - frequent lab monitoring not needed
28
route of low molecular weight heparins
- subq in abdomen 2 in from umbilicus | - occasionally IV with enoxaparin
29
dalteparin (fragmin) class
- low molecular weight heparins | - u/kg
30
enoxaparin (lovenox) class
mg/kg
31
tinxaparin (innohep) class
low molecular weigh heparin
32
MOA of warfain (coumadin)
- inhibits K synthesis - inhibits activation of several clotting factors in the liver - prevent clot formation and extension of formed clots
33
Indication of warfarin
- chronic atrial fibrillation - prophylaxis and treatment of DVT - mechanical heart valves
34
dose life of warfarin
- onset 2-3 days - duration 2-5 days - maximum effect 3-5 days - half life 0.5-3 days
35
warfarin dosing
- 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
warfarin goals
- 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
adverse effects of warfarin
- bleeding/hemorrhage - N/V - abdominal pain - alopecia - joint/muscle
38
drug interactions with warfarin that increase anticoagulant effect
- ASA - NSAIDS - Aminodarone - Quinidine - Cimetidine - Macrolides - Furosemide, budensonide - glucocorticoids
39
drug interactions with warfarin decrease anticoagulant effect
- barbiturates - hormones - contraceptives - rifampin - vitamin K - phenytoin, tegretol
40
food/drinks interactions with warfarin that increase anticoagulant effect
- cranberry juice | - alcohol
41
food/drinks interactions with warfarin that decrease anticoagulant effect
- high in vitamin k | - green tea
42
warfarin teachings
- 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
antidote for wawrfarin
- vitamin K, mephyton, aquamephyton (po, im, sc, iv) | - FFP (fresh frozen plasma) in emergency
44
argatroban (Acova) drug class
direct thrombin inhibitors
45
dabigatran (Pradaxa) drug class
direct thrombin inhibitors
46
argatroban use
used in place of heparin if HIT
47
route of argatroban
IV only
48
route of dabigratran
po alternative Coumadin
49
dabigratran risk
stomach upset/GI bleed
50
implications for dabigatran
doesn't require frequent INR checks or food restrictions
51
antidote for dabigratran
- rucizumab (praxibind) | - wil reverse the effects
52
Xa inhibitors
lower bleeding risk and "fewer" interactions than heparin
53
fondaparinux (arixtra) drug class
Xa inhibitors
54
fondaparainux
- no antidote | - watch platelets
55
route of fondaparainux
SQ
56
rivaroxaban (Xarelto) drug class
Xa inhibitors
57
rivaroxaban implications
monitor LFT
58
rivaroxban route
Po
59
things to monitor with all coagulants
- bleeding - platelet leve - avoid current use of NSAIDs, ASA, etc/ if possible

NURB 3150 (6 decks)

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