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NURS 212A > Coagulation Drugs > Flashcards

Coagulation Drugs Flashcards

1
Q

hemostasis

A
  • any process that STOPS bleeding
  • COAGULATION: physiologic clotting of blood
  • relations b/w substances that PROMOTE CLOT FORMATION or INHIBIT COAGULATION or DISSOLVE CLOTS
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2
Q

coagulation system

A
  • considered a CASCADE
  • these factors when ACTIVATED serve as CATALYSTS for the next reaction
  • creates FIBRIN; clot-forming substance
  • has either an INTRINSIC or EXTRINSIC PATHWAY
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3
Q

fibrinolytic system

A

causes the BREAKDOWN of CLOTS and serves to BALANCE the CLOTTING PROCESS

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4
Q

fibrinolysis

A

the mechanism where formed THROMBI are LYSED
this helps to prevent EXCESSIVE CLOT FORMATION & BV BLOCKAGES

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5
Q

what does FIBRIN bind to?

A

binds to this protein PLASMINOGEN (will then convert to PLASMIN)

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6
Q

what is PLASMIN?

A

an ENZYMATIC PROTEIN that breaks down the FIBRIN THROMBUS into its end products; keeps the THROMBUS LOCALIZED so it doesn’t get detached from the BV

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7
Q

reminder

A
  • coagulation drugs are VERY DANGEROUS if not used correctly
  • is affected by many factors!
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8
Q

anticoagulants/antithrombotic drugs

A
  • inhibits the ACTION or FORMATION of CLOTTING FACTORS
  • prevents CLOT FORMATION by preventing INTRVASCULAR THROMBOSIS (this decreases coagulability)
    *does not have a DIRECT EFFECT on the already formed BLOOD CLOT
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9
Q

antiplatelets

A
  • inhibits PLATELET AGGREGATION
  • prevents PLATELET PLUGS
  • platelets continue normal flow WITHOUT ADHESION to injury/tissues *typically college from damage makes them stick on!
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10
Q

hemorheologic drugs

A

alters PLATELET FUNCTION and prevents PLATELETS from working

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11
Q

thrombolytic drugs

A

they LYSE or BREAK DOWN existing clots

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12
Q

antifibrinolytic or hemostatic drugs

A

helps PROMOTE BLOOD COAGULATION

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13
Q

thromboembolic events

A
  • MI (embolus in coronary artery)
  • STROKE (embolus in brain vessel)
  • PE (embolus in pulmonary circulation)
  • DVT (embolus in leg vein)
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14
Q

heparins work by?

A

work by INHIBITING CLOTTING FACTORS (thrombin) and factor Xa

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15
Q

common labs for hepatin to assess

A
  • aPTT; assessing bleeding times
  • assessing every 6 hours until therapeutic effects are seen
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16
Q

catheter flush for heparin

A
  • no monitoring is needed
  • 10 - 100 units/mL
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17
Q

describe LOW MOLECULAR WEIGHT HEPARINS (LMWH)

A
  • enoxaparin (lovenox)
  • dalteparin (fragmin)
  • has a more SYNTHETIC SMALLER MOLECULAR STRUCTURE
  • is more PREDICTABLE in response
  • does not need as much lab monitoring
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18
Q

coumarins

A

Inhibits VITAMIN K–important for clotting factors II, VII, IX, and X

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19
Q

warfarin (coumadin)

A
  • works by INHIBITING VITAMIN K SYNTHESIS in the GI tract
  • inhibits PRODUCTION of VITAMIN K (important for clotting factors II, VII, IX, and X)
    overall effect = prevention of clot formation
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20
Q

fondaparinux (arixtra)

A

factor Xa inhibitor

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21
Q

what are our DIRECT ORAL ANTICOAGULANTS?

A

Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Edoxaban (Savaysa)
Betrixaban (Bevyxxa)

**all end in ban - works by inhibiting thrombosis / factor Xa

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22
Q

what are our DIRECT THROMBIN INHIBITORS?

A
  • These work by inhibiting THROMBIN (factor IIa) *very important enzyme for blood clotting
  • have NATURAL or SYNTHETIC

natural:
human antithrombin III (thrombate)

synthetic
Lepirudin (Refludan)
Argatroban (Argatroban)
Bivalirudin (Angiomax)
Dabigatran (Pradaxa) (oral)

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23
Q

anticoagulants - contraindications

A
  • DA
  • acute bleeding
  • CONTRAINDICATED for PREGNANCY - warfarin
  • LMWH - indwelling epidural catheters *can increase risk of EPIDURAL HEMATOMA
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24
Q

anticoagulants - adverse effects

A
  • BLEEDING
  • HEPARIN-INDUCED THROMBOCYTOPENIA
  • N/V, abd. cramps
  • **warfarin - skin necrosis/purple toes syndrome
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25
type I heparin-induced thrombocytopenia
- gradual REDUCTION in platelets - can still continue heparin therapy
26
type II HIT
- have an ACUTE FALL in platelets (50% reduction from baseline) - DISCONTINUE heparin
27
what is the treatment for HIT
- have to use an ALTERNATIVE ANTICOAGULANT - ex. THROMBIN INHIBITORS - lepirudin & argatroban
28
heparin - toxic effects
- hematuria - melena - petechiae - gum or MM bleeding **must stop drug immediately
29
how to reverse HEPARIN TOXICITY?
- IV PROTAMINE SULFATE 1 mg - reverses effects of 100 units of HEPARIN!
30
warfarin - toxic effects (how to treat)
- *can take a bit for resynthesization of clotting factors (36 - 42 hours) - administer VITAMIN K1 - to return to normal coagulation - increases doses of VITAMIN K (around 10 mg) = can reverse anticoagulation in 6 HOURS
31
reminders for WARFARIN
- *vitamin K - causes warfarin resistence for up to 7 days - can cause SEVERE BLEEDING - if there is SEVERE BLEEDING; admin KCENTRA and PROFILINE - for IV vitamin K- potential for allergic rxn (should dilute/give over 30 min)
32
idarucizumab (praxbind)
- specific ANTIDOTE for dabigatron (synthetic thrombin inhibitor) - reverses EFFECTS for emergency surgery for uncontrolled bleeding
33
andexxa
specific ANTIDOTE for FACTOR Xa INHIBITOR - contains RIVAROXABAN (XARELTO) + APIXABAN (ELIQUIS) - used for uncontrolled bleeding - BBW for THROMBOEMBOLIC EVENTS
34
anticoagulants - drug interactions
- can have ENZYME INHIBITION of METABOLISM - displacement of drug from INACTIVE PROTEIN-BINDING SITES - can have DECREASE in VITAMIN K ABSORPTION - alterations in platelet count
35
what happens if two anticoagulants are ordered?
- should always question; this can increase risk for bleeding or complications - EXCEPTION: BRIDGE THERAPY with HEPARIN or ENOXAPRIN and PO WARFARIN
36
argatroban
- SYNTHETIC direct thrombin inhibitor - for active HIT and percut. CORONARY interventions for HIT risk patients - given IV
37
dabigatran (pradaxa)
- FIRST ORAL DIRECT THROMBIN INHIBITOR for preventing STROKES & THROMBOSIS with non-val Afib - is a PRODRUG activated in LIVER - assess RENAL FXN - can cause adv effects of; bleeding/GI - does not need coagulation monitoring
38
enoxaparin (Lovenox)
- type of PROTOTYPICAL LMWH - greater affinity for factor Xa vs. factor lia - has increased BIOAVAILABILITY & LONGER ELIMINATION/HALF-LIFE - injectable - used for prophylaxis & treatment
39
fondaparinux (arixtra)
- selective inhibitor of FACTOR XA - treats DVT or PE - should NOT be given for at leat 6 - 8 hours AFTER SURGERY - caution with WARFARIN - given via subq injections
40
fondaparinux adverse effects
- BLEEDING - most common - anemia - wound drainage - hematoma - confusion, UTI, hypotension, dizziness, HYPOKALEMIA - THROMBOCYTOPENIA
41
where is HEPARIN produced ? How much is given for DVT prophylaxis?
- is a NATURAL ANTICOAGULANT from the lungs or intest. mucosa of PIGS - DVT PROPHYLAXIS; given around 5000 units subq 2 - 3 times a day *no monitoring needed for prophylaxis can give up to 10 - 40,000 units/mL
42
rivaroxaban
- first ORAL FACTOR XA inhibitor - prevents STROKES in a-fib patients, is POST-OP THROMBOPROPHYLAXIS, DVT or PE
43
rivaroxaban adv reactions
- peripheral edema - dizziness - headaches - diarrhea - hemauria or bleeding
44
warfarin (coumadin) - description; normal INR levels?
- most common anticoagulant - assess PT/INR normal INR levels (w/o warfarin) around 1.0 normal INR levels (w/ warfarin) around 2 - 3.5 *depending on indication
45
list of antiplatelet drugs
Aspirin Cilostazol (Pletal) Clopidogrel (Plavix) Prasugrel (Effient) Ticagrelor (Brilinta) Treprostinil (Remodulin) Abciximab (ReoPro) Eptifibatide (Integrilin) Tirofiban (Aggrastat) Anagrelide (Agrylin) Dipyridamole (Persantine) Vorapaxar (Zontivity) >:( too many
46
aspirin
- seen in many combos - is CONTRAINDICATED with FLULIKE SYMPTOMS in KIDS/TEENS *can cause REYES SYNDROME (sudden damage to brain and liver)
47
clopidogrel (plavix)
- the most widely used ADP inhibitor - oral - PRASUGREL/TICAGRELOR - work similarly to this drug - has many DRUG INTERACTIONS
48
eptifibatide (integrilin)
- type of GLYCOPROTEIN lin/iiia inhibitor (prevents blood clots by blocking ability to bind to FIBRINOGEN) - seen in the ICU/CARDIAC LAB - IV
49
what are our CURRENT THROMBOLYTIC DRUGS?
t-plasminogen activators (tPa) Alteplase (Activase, Cathflo Activase) Tenecteplase (TNKase)
50
thrombolytic drugs - MOA
- activates the FIBRINOLYTIC SYSTEM - activates PLASMINOGEN > conversion into PLASMIN *digests firbin - reestablishes BF to heart muscle via CORONARY ARTERIES
51
indications - thrombolytic drugs
- acute MI - arterial thrombolysis - DVT - occulsion of shunts/caths - PE - strokes
52
advese effects - thrombolytic
= bleeding (internally, intracranial, superficial) can cause N/V, decreased BP, cardiac dysrthy
53
alterplase (activase)
- type of T-Pa - is FIBRIN SPECIFIC - is natural in the body - super short half-life *5 min - used for MI or strokes
54
what are our ANTIFIBRINOLYTIC DRUGS?
Aminocaproic acid (Amicar) Tranexamic acid (Cyklokapron) Desmopressin (DDAVP)
55
what are ANTIFIBRINOLYTIC DRUGS INDICATED FOR?
** these remember PROMOTE BLOOD CLOT FORMATION - helps to treat or prevent EXCESSIVE BLEEDING - treats HEMOPHILIA or VON WILLEBRANDS DZ
56
antifibrinolytic drugs - adverse effects
- more UNCOMMON and MILD - can include; dysrhy, bradycardia, headaches, fatigue, N/V, abd. cramps
57
aminocaproic acid
- oral or parenteral - prevents excessive bleeding from surgery or overactivation of fibrinolytic sys
58
desmopressin (DDAVP)
- synthetic POLYPEPTIDE - works similar to VASOPRESSIN *antidiuretic hormone - for DM insipidus, HEMOPHILIA - can be a NASAL SPRAY for noc. enuresis
59
tranexamic acid
- antifib drug - creates REVERSIBLE COMPLEX; displaces plasminogen from fibrin *this inhibits FIBRINOLYSIS - via IV before surgery - adv effect: HYPOTENSION with RAPID IV INJECTION
60
nursing implications - heparin
- typically double check with IV dosing - ensure SUBQ is given through correctly (do not given around umbilicus, wounds/incisions/drains) - do NOT ASPIRATE *can cause HEMATOMAS - assess aPTT levels DAILY *antidote - protamine sulfate
61
nursing implications - LWMHs
- give subQ in abdomen - rotate injection sites
62
warfarin - nursing implications
- can have BRIDGE THERAPY with HEPARIN until PT/INR levels deem proper anticoagulation - can take a couple days for proper therapeutic effect - ANTIDOTE - VITAMIN K

NURS 212A (32 decks)

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