Coagulation & Hyperlipidemia Flashcards
Blood coagulation required to prevent excessive hemorrhaging from damaged blood vessels is referred to as..?
Hemostasis
Thrombus formation as a result of overactive clotting is referred to as..?
Thrombogenesis
Treatment for thrombus formation (3)
Anticoagulants & Antiplatelets (prevent clot formation)
Fibrinolytics (remove clots)
To prevent atherosclerosis, plasma lipid levels are _____
Decreased
Tissue Plasminogen Activator (t-PA)
Breaks down a clot - Converts plasminogen to plasmin (fibrinolysin) to initiate break down of fibrin mesh
Drugs used to control the synthesis and function of clotting factors. Used to prevent clot formation in venous system
Anticoagulants
Inhibit abnormal platelet activity by preventing thrombus formation in arteries that could lead to MI or ischemic CVA
Antiplatelets
Facilitate destruction of clots which re-establishes blood flow through vessels
Fibrinolytics
Primary drug in initial treatment of venous thrombosis. Effects seen almost immediately. Administered 2x/day parenterally (IV)
Heparin (Anticoagulants)
Low molecular weight heparin
Ending “-parin” or Lovenox
Administered 1x/day subcutaneously into fat tissue
Used in patients having surgery or at risk for DVTs
Primary drug used in long-term prevention of venous thrombosis
Warfarin (Coumadin)
Mechanism of Warfarin
Interferes with Vitamin K metabolism in liver & impairs hepatic synthesis of clotting factors
Acceptable clotting INR range for long-term Warfarin (Coumadin) use?
2-3
Adverse effects of Anticoagulants
Hemorrhage, thrombocytopenia - severe autoimmune situation, GI distress, skin reactions
Drugs primarily used to prevent formation of arterial clots
Antiplatelets - Aspirin, ADP blockers, Glycoprotein IIb-IIIa blockers
Effective dose of Aspirin
75-325 mg/day
Mechanism of Aspirin on Platelets
Irreversible effect - Inhibits platelet for remainder of life (7-8 days)
Suppresses natural platelet aggregation
Assists in preventing ischemic strokes, but may increase risk of hemorrhagic stroke
ADP Receptor Blockers (Plavix)
Blocks the chemical ADP that increases platelet activity and clotting – Results in reductions in clotting
Primary use: Prevent thrombosis in pts at risk of MI or ischemic stroke
Glycoprotein IIb-IIIa Receptor Blockers
Inhibit ability of fibrinogen to activate platelets by blocking receptor cite on platelet membrane
MOST POWERFUL inhibitors of platelet activity
Used in patients undergoing angioplasty or other interventions
Adverse effects of Anti-platelet drugs
Increased risk of bleeding, hypotension, GI distress, gastric irritation (aspirin)
Fibrinolytics
Essential in treating MI – Reestablishes blood flow at onset of MI
Also used for peripheral artery clot dissolving, PEs, and occluded shunt/bypass grafts
Effective window of fibrinolytics post-MI
12 hours after onset
Decreases morbidity and mortality by 50% if used within 1 hour of onset
Adverse effects of fibrinolytics
Intracranial hemorrhage or additional bleeding due to stimulation of clot breakdown
Itching, Nausea, HA, allergic reactions/anaphylaxis
Fibrinolytic CONTRAINDICATIONS
History of hemorrhagic stroke, active internal bleeding, other factors predisposing to hemorrhaging
Clotting disorder characterized by the inability to synthesize adequate amounts of clotting factors. Causes joint problems due to intra-articular bleeding
Hemophilia
Which vitamin may be responsible for inadequate clotting factor production by the liver?
Vitamin K
Why do newborns require Vitamin K?
To prevent hemorrhaging - If they don’t have vitamin K they will not survive the first 5-8 days after birth
Hyperlipidemia
Abnormally high concentration of lipids in blood – Causes atherosclerosis & cardiovascular disease
What is the primary cause of cardiovascular disease?
Hyperlipidemia
Primary treatment - Statins
Treatment of hyperlipidmia focuses on..?
Increasing HDL and decreasing LDL
Statin Drugs (Lipitor, Crestor)
Reduce cholesterol production in liver cells. Cause breakdown of LDL and decreases triglycerides while increasing HDL
Fibric Acids
Decrease triglyceride levels, produce increases in HDL, and help lower LDL levels
Adverse effects of Lipid lowering drugs
GI distress, liver dysfunction, gallstones, pancreatitis, cardiovascular problems, neuromuscular problems (myopathy)
Can progress to rhabdomyolosis
What should be done if rhabdomyolosis presents while on lipid lowering drugs?
Discontinue statin drug and rest for 4-6 weeks
