Coagulation Drugs Flashcards
1
Q
anticoagulant therapy
A
- primarily prophylactic, used when likelihood of clot formation is high
- prevents: fibrin deposits, extension of thrombus, thromboembolic complications
- action: delays blood coagulability
2
Q
heparin moa
A
- binds to antithrombin III and turn off the coagulation pathway to prevent clots from forming
- doesn’t dissolve clots, just prevents new one from forming
3
Q
heparin indications
A
- when there is a need for rapid anticoagulation
- surgery of heart and blood vessels
- hemodilaysis
- sudden arterial prophylaxis
- DVT/thrombophlebitis
- DVT prophylaxis
- Disseminated intravascular coagulation (DIC)
4
Q
heparin contraindications/caution
A
- preexisting conditions that would be life-threatening if bleeding occurred
- caution use in conditions with increased risk of bleeding
5
Q
heparin adverse effects
A
- bleeding/hemorrhage
- HIT (heparin induced thrombocytopenia)
6
Q
heparin coagulation studies
A
- prior to initiation obain baseline aPTT, PT, CBC, platelets
- dose based on weight
- 6 hours after start of infusion: check lab (ptt) again in opposite arm of infusion, adjust dose according to protocol repeat lab 6 hours later
7
Q
normal PTT
A
25-35 seconds
8
Q
therapeutic PTT
A
1.5 times normal… around 45-70 seconds
9
Q
administering heparin subq
A
- onset 20-60 min, 5000u every 6 hrs
- dont aspirate or rub site
- hold in place for 3 seconds
- double check dose with another nurse
10
Q
admin heparin iv
A
- onset immediate
- loading dose
- continuous infusion on pump; provided constant blood level and less risk for complications
11
Q
heparin implications
A
- watch for s/s of bleeding
- avoid shaving with razor, use electric
- limit needle sticks
- can precipitate HIT so look for sudden decrease in platelets
12
Q
heparin antidote
A
- protamine sulfate
- give slowly, no faster than 50mg over 10 minutes
- rapid infusion may cause hypotension, bradycardia, flushing
- may cause pulmonary edema and anaphylaxis
- check ACTs
13
Q
low molecular weight heparin drugs
A
- dalteparin
- enoxaparin
- tinxaparin
14
Q
low molecular weight heparin
A
- works similar to heparin but smaller and less protein-bound
- much more predictable anticoag response
- frequent lab monitoring not needed
- given subq only in abdomen, 2 inches from umbilicus
- often given is coumadin is effective
15
Q
warfarin moa
A
- inhibits vit. k synthesis, inhibites activation of several clotting factors in the liver, prevents clot formation, prevent
- prevents extension of formed clots and formation of new clots
16
Q
warfarin indications
A
- chronic a. fib
- prophylaxis and treatment of DVT
- mechanical heart valves
17
Q
warfarin pharm
A
- highly protein bound
- metabolized in liver, excreted in kidneys
- onset: 2-3 days
- duration: 2-5 days
- max effect in 3-5 days
- half life: 0.5-3days
18
Q
warfarin dosing
A
- load 5-10mg x ___ days then 2-4 mg/day
- usually given at 1600 to ensure time to get lab results and adjust dose if needed
- monitor therapy
- normal PT: 11-13 (increased in liver disease)
- INR: <1.0
- must get labs results daily at start of treatment
19
Q
warfarin goals
A
- DVT, INR: 2-3
- A fib, INR: 2-3
- Heart valves, INR 2.5-3.5 (3.0-4.5 per ATI)
20
Q
warfarin ae
A
- bleeding/hemorrhage
- n/v
- abdominal pain
- alopecia
- joint/muscle pain
21
Q
drugs that increase anticoag effect
A
- ASA
- nsaids
- amiodarone
- quindine, cimetidine
- macrolides
- furosemide, budensonide
- glucocorticoids
22
Q
drugs that decrease anticoag effect
A
- baribituates
- hormones
- contraceptives
- rifampin
- vit. k
- phenytoin, tegretol
23
Q
drinks that increase anticoag effects
A
- etoh
- cranberry juice
24
Q
food/drink that decrease anticoag
A
- foods high in vit. k (green vegetables)
- greent tea
25
warfarin teaching
- moderate green leafy vegetables
- dont change diet suddenly
- no prolonged sitting, standing, or crossing legs
- elevation of lim when sitting/riding to decrease venous pooling
- s/s of PE
- may need to stop med before procedures, check with MD
- keep appt time for labs
- monitor skin
- s/s of hemorrhage
26
warfarin antidote
- vit. k, mephyton, aquamephyton
| - ffp in emergency
27
direct thrombin inhibitor drugs
- argatroban
| - dabigatran
28
argatroban
- used in place of heparin if HIT occurs
| - iv only
29
dabigatran
- po alternative to coumadin
- doesn't require frequent INR checks or food restrictions
- much fewer drug interactions
- more risk for upset stomach/gi upset
- antidote: rucizumab, will reverse effects
30
xa inhibitor drugs
- lower bleeding risk and fewer interactions than heparin
- rivaroxaban (po, monitor lfts)
- apixaban (po)
- fondaparinux (subq, no antidote, monitor platelets)
31
antiplatelet moa
-prevents platelet aggregation at the site of blood vessel injury
32
antiplatelet indications
- CAD (mi prevention)
- cva/tia prevention
- heart valves
33
asa
- low doses 325mg- often used during initial acute phase of MI
- very low does 81 mg (baby asa)
- never give ASA to children/teens with flu-like sx
- can cause gi distress/bleeding, may take ec forms
- careful taking with NSAIDS, can increase bleeding
34
clopidogrel
- antithrobotic and platelet aggregation inhibitor
- most widely used currently
- often taken with asa
- given po every day
35
clopidogrel side effects
- gi distress
- arthralgia
- back pain
- headache
36
clopidogrel ae
-bleeding
-chest pain
-purpura/rash/pruritis
0uri
37
clopidogrel interactions
-nsaids
38
gp lib/llla inhibitors
- iv infusion only, only used in icu and cardiac cath labs
| - need baseline coag studies
39
gp lib/llla inhibitors indications
-prevnetion of thrombi in unstable angina and MI, s/s stents, angioplasty
40
gp lib/llla inhibitors ae
- bleeding
| - bradycardia
41
gp lib/llla inhibitors drugs
- abciximab
- eptifibatide
- tirafiban
42
implication for anti-platelet drugs
- avoid nsaid, asa
- no herbs (4 Gs)
- no invasive procedures unless necessary
- ngt, central lines, im injections
- dont leave auto bp cuff on arm
- can cause cva, esp. with increased inr
- monitor for bleeding
