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NUE 325: Pathopharm I > Coagulation Drugs > Flashcards

Coagulation Drugs Flashcards

1
Q

heparin MOA

A

activates antithrombin which indirectly inactivates thrombin (factor IIa) and factor Xa
inhibits fibrin formation

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2
Q

low molecular wt heparin MOA

A

inactivates factor Xa

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3
Q

heparin and low molecular wt heparin class

A

heparin

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4
Q

heparin route/dose

A

SQ or IV
- 5000 units 2-3x a day
- IV drip w bolus (wt based protocol–>kg)

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5
Q

heparin indication

A

conditions necessitating PROMPT anti activity
- stroke, PE, massive DVT
- open heart surgery or dialysis
- low dose therapy for prophylaxis against post op DVT
- treat disseminated intravascular coagulation

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6
Q

heparin nursing considerations

A
  • starts working vv quick (SQ, 20-30 mins, IV immediately)
  • use caution if pt has spinal or epidural anesthesia (typically wont even use)
  • high risk med, check w other RN
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7
Q

heparin antidote

A

protamine sulfate
- given slowly through IV to prevent bottoming out BP

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8
Q

how does antidote for heparin work

A

protamine binds to the heparin making a complex that stops the heparin from working

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9
Q

adverse effects of heparin

A
  • bleeding
  • hematoma
  • anemia
  • thrombocytopenia
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10
Q

signs of bleeding

A
  • change in vs
  • bruising
  • petechiae (red spots)
  • hematomas
  • black tarry stools
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11
Q

heparin induced thrombocytopenia (HIT)

A

low platelet count and inc development of thrombi cause by antibody development
- purple finger tip and toes

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12
Q

nursing consideration for HIT

A
  • monitor platelet counts
  • stop heparin if below 100,000
  • non heparin anticoags can be used instead
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13
Q

how do we dose IV heparin

A

clotting time labs
- anti Xa
- aPTT (activated partial thromboplastin time)
draw before and after heparin to determine if any changes in dose are needed

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14
Q

low molecular wt heparin medication

A

enoxaparin

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15
Q

enoxaparin moa

A

inhibits factor Xa
- large unfractionated molecules and cleaves them into smaller fragments which inc affinity for Xa and bioavailability, half life

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16
Q

enoxaparin route

A

SQ

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17
Q

enoxaparin indications

A

given prophylaxis and treatment
- can be given at home because already dosed out

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18
Q

enoxaparin adverse effects

A
  • bleeding
  • thrombocytopenia–> can also cause HIT
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19
Q

enoxaparin antidote

A

protamine

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20
Q

enoxaparin nursing consideration

A
  • dont give w heparin or other anticoags EXCEPT oral warfarin oral when treating PE/DVT
  • black box: potential spinal hematoma if pt has epidural catheter
  • given in pre filled syringe so easy to admin (at home too)
  • do not expel air bubble
  • slow onset of action bc longer half life
  • rotate injection site
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21
Q

warfarin moa

A

inhibit vitamin K dependent clotting factors
- prevents the synthesis of four coagulation factors (VII, IX, X, prothrombin)

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22
Q

warfarin indications

A

prevention of
- PE, DVT, VTE
- thrombotic events for pts w afib or heart valves
- reduce occurrence of TIA or MI

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23
Q

warfarin route

A
  • ONLY PO
  • usually at 5pm
  • onset not for 24 hrs
  • duration 2-5 days (the half life)
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24
Q

warfarin adverse effects

A
  • bleeding
  • lethargy
  • muscle pain
  • purple toes
  • teratogenic effects (no for breast feeding, pregnant)
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25
Q

warfarin antidote

A

vitamin K (IV)
- fresh frozen plasma or whole blood if vitamin k doesnt work

26
Q

warfarin nursing considerations

A
  • monitor and teach for signs of bleeding
  • HOLD before surgery
  • monitor labs –> prothrombin time, international normalized ratio (monitor monthly)
  • normal INR w/out warfarin: 1 or less
  • normal INR w warfarin: 2-3.5
  • many drug interactions (lots of abx)
  • food interactions
  • no alc
  • we med alert bracelet, use soft tissue toothbrush, electric toothbrush
27
Q

what foods to avoid if taking warfarin

A

foods with vitamin K will reduce warfarin ability to prevent clots
- kale, broccoli, brussell sprouts, cabbage, pickled cucumber, asparagus kiwi fruit, okra, green beans, lettuce

28
Q

apixaban and rivaroxaban moa

A

inhibit factor Xa

29
Q

apixaban and rivaroxaban indications

A
  • prevents strokes in pt w afib
  • post op thrombo-prophylaxis
  • treat DVT, PE
30
Q

apixaban and rivaroxaban adverse effects

A
  • bleeding
  • hematoma
  • dizziness
  • rash
  • gastrointestinal distress
  • peripheral edema
31
Q

apixaban and rivaroxaban black box warning

A
  • spinal hematomas if pts has epidural cath
  • risk of thrombosis if drug abruptly stops
32
Q

apixaban and rivaroxaban nursing consideration

A
  • drug interactions
    – dec effects of pheytonin, carbamazepine, rifampin, st johns wort
    – inc effects of CYP3A4 inihibitors, grapefruit
  • no routine monitoring
  • do not give w other anticoags
  • watch liver functions (ALT, AST, GGT)
33
Q

apixaban and rivaroxaban antidote

A

andexxa
- recombinant factor Xa, inactivated-zhzo)

34
Q

aspirin MOA

A

blocks prostaglandin synthesis through COX enzyme pathway
- blocks platelet aggregation and prevents platelets from clumping together

35
Q

aspirin indication

A
  • prevent or treat MI
  • prevent ischemic stroke
36
Q

aspirin route

A

PO
- if acute accident, chew baby aspirin (chew white)

37
Q

aspirin side effects

A
  • GI (N/V)
  • drowsiness/confusion
  • bleeding
38
Q

aspirin nursing considerations

A
  • dont crush enteric
  • OTC option but if need anti platelet then typically prescribed
  • no for children bc Reyes syndrome
39
Q

aspirin nursing considerations

A
  • thrombocytopenia
  • active bleeding
  • blood cancers
  • traumatic injury
  • GI ulcers
  • vitamin K deficiency
  • recent hemorrhagic stroke
40
Q

aspirin antidote

A

DDAVP (desmopressin)

41
Q

clopidogrel and ticagrelor moa

A

antiplatelet ADP inhibitor
- ADP works w/in the platelet adhesion/accumulation process
- alters platelet membrane so it doesn’t receive the signal to aggregate

42
Q

clopidogrel and ticagrelor indications

A
  • reduce risk of stroke
  • prophylaxis of TIAs
  • post MI
43
Q

clopidogrel and ticagrelor contraindications

A
  • thrombocytopenia
  • active bleeding
  • blood cancer
  • traumatic injuries
  • GI ulcers
  • vitamin K deficiency
  • recent hemorrhagic stroke
44
Q

clopidogrel and ticagrelor side effects

A
  • chest pain
  • edema
  • flu-like symptoms
  • abdominal pain
  • D/N
  • epistaxis (nose bleed)
  • rash
  • pruritus
45
Q

clopidogrel and ticagrelor route

A

PO

46
Q

clopidogrel black box

A
  • pt w certain genetic abnormalities
  • higher rate of CV events due to reduced conversion to its active metabolite
47
Q

clopidogrel nursing considerations

A

effectiveness reduced by amiodarone, Ca channel blockers, NSAIDS, PPIs

48
Q

ticagelor black box

A

inc bleeding risk w aspirin doses over 100 mg

49
Q

clopidogrel and ticagrelor antidote

A

DDAVP or platelet transfusion

50
Q

argatroban moa

A

inhibit thrombin (factor IIa)

51
Q

argatroban class

A

direct thrombin inhibitor

52
Q

argatroban indications

A

treat HIT
- pt undergoing procedures at high risk for HIT

53
Q

argatroban route

A

IV only

54
Q

argatroban adverse effects

A

bleeding

55
Q

argatroban nursing considerations

A
  • used for pts w hepatic dysfunction
  • monitor labs (anti Xa, h&h, platelets)
56
Q

glucocorticoid steroids often used

A
  • hydrocortisone
  • prednisone
  • dexamethasone
57
Q

acute side effects of glucocorticoids

A
  • inc ocular pressure (problem for ppl w glaucoma)
  • fluid retention
  • HTN
  • mood swings
  • wt gain in ab, face, back of neck –> hunger
58
Q

long term side effects of corticosteriods

A
  • clouded lens
  • high blood sugar
  • inc risk of infections
  • thinning bones
  • suppressed adrenal gland hormone production
  • thin skin, bruising, slow wound healing
59
Q

nursing implications for corticosteroids

A
  • must taper
  • take at same time
  • wear medical alert bracelet
  • monitor blood sugar and wt
60
Q

mineralcorticoid med

A

fludrocortisone

61
Q

fludrocortisone moa

A

mineralcorticoid replacement

62
Q

fludrocortisone info

A
  • may be needed with GCC replacement
  • salt wasting (unable to maintain Na levels, K levels remain high)

NUE 325: Pathopharm I (23 decks)

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