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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
warfarin antidote
vitamin K (IV) - fresh frozen plasma or whole blood if vitamin k doesnt work
26
warfarin nursing considerations
- 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
what foods to avoid if taking warfarin
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
apixaban and rivaroxaban moa
inhibit factor Xa
29
apixaban and rivaroxaban indications
- prevents strokes in pt w afib - post op thrombo-prophylaxis - treat DVT, PE
30
apixaban and rivaroxaban adverse effects
- bleeding - hematoma - dizziness - rash - gastrointestinal distress - peripheral edema
31
apixaban and rivaroxaban black box warning
- spinal hematomas if pts has epidural cath - risk of thrombosis if drug abruptly stops
32
apixaban and rivaroxaban nursing consideration
- 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
apixaban and rivaroxaban antidote
andexxa - recombinant factor Xa, inactivated-zhzo)
34
aspirin MOA
blocks prostaglandin synthesis through COX enzyme pathway - blocks platelet aggregation and prevents platelets from clumping together
35
aspirin indication
- prevent or treat MI - prevent ischemic stroke
36
aspirin route
PO - if acute accident, chew baby aspirin (chew white)
37
aspirin side effects
- GI (N/V) - drowsiness/confusion - bleeding
38
aspirin nursing considerations
- dont crush enteric - OTC option but if need anti platelet then typically prescribed - no for children bc Reyes syndrome
39
aspirin nursing considerations
- thrombocytopenia - active bleeding - blood cancers - traumatic injury - GI ulcers - vitamin K deficiency - recent hemorrhagic stroke
40
aspirin antidote
DDAVP (desmopressin)
41
clopidogrel and ticagrelor moa
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
clopidogrel and ticagrelor indications
- reduce risk of stroke - prophylaxis of TIAs - post MI
43
clopidogrel and ticagrelor contraindications
- thrombocytopenia - active bleeding - blood cancer - traumatic injuries - GI ulcers - vitamin K deficiency - recent hemorrhagic stroke
44
clopidogrel and ticagrelor side effects
- chest pain - edema - flu-like symptoms - abdominal pain - D/N - epistaxis (nose bleed) - rash - pruritus
45
clopidogrel and ticagrelor route
PO
46
clopidogrel black box
- pt w certain genetic abnormalities - higher rate of CV events due to reduced conversion to its active metabolite
47
clopidogrel nursing considerations
effectiveness reduced by amiodarone, Ca channel blockers, NSAIDS, PPIs
48
ticagelor black box
inc bleeding risk w aspirin doses over 100 mg
49
clopidogrel and ticagrelor antidote
DDAVP or platelet transfusion
50
argatroban moa
inhibit thrombin (factor IIa)
51
argatroban class
direct thrombin inhibitor
52
argatroban indications
treat HIT - pt undergoing procedures at high risk for HIT
53
argatroban route
IV only
54
argatroban adverse effects
bleeding
55
argatroban nursing considerations
- used for pts w hepatic dysfunction - monitor labs (anti Xa, h&h, platelets)
56
glucocorticoid steroids often used
- hydrocortisone - prednisone - dexamethasone
57
acute side effects of glucocorticoids
- inc ocular pressure (problem for ppl w glaucoma) - fluid retention - HTN - mood swings - wt gain in ab, face, back of neck --> hunger
58
long term side effects of corticosteriods
- clouded lens - high blood sugar - inc risk of infections - thinning bones - suppressed adrenal gland hormone production - thin skin, bruising, slow wound healing
59
nursing implications for corticosteroids
- must taper - take at same time - wear medical alert bracelet - monitor blood sugar and wt
60
mineralcorticoid med
fludrocortisone
61
fludrocortisone moa
mineralcorticoid replacement
62
fludrocortisone info
- 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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