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NUR 325 Patho > Coagulation Meds > Flashcards

Coagulation Meds Flashcards

1
Q

What is the biggest concern in anti-coagulant medications

A

most common S/E is bleeding

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2
Q

What 3 things do nurses want to monitor for bleeding

A

Hemoglobin
hematocrit
Vital Signs

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3
Q

what 2 considerations should nurses know about their patient on anti-coagulant medications

A

Know why your patient is on an anti-coagulant

know what sites they may be at risk for bleeding

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4
Q

What are the 2 types of coagulation drugs

A

Anticoagulants

Anti platelet

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5
Q

What are anticoagulants

A

Inhibit the action or formation of the clotting factors

PREVENT clots

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6
Q

What are antiplatelets

A

Prevent platelet plugs from forming by inhibiting platelet aggregation

Best for preventing heart attacks and stroke

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7
Q

MOA of heparin

A

Prevents clotting by activating ANTITHROMBIN -> indirectly inactivates thrombin & factor Xa

Inhibits FIBRIN formation

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8
Q

What is the MOA of Enoxaparin or Low molecular weight heparin

A

Prevents clotting by activating ANTITHROMBIN

ONLY inactivates factor Xa (not thrombin)

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9
Q

What is the first sign of fluid volume deficit ?

A

tachycardia

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10
Q

Signs of internal bleeding

A

tachycardia
skin pallor
low BP
respiration Increasing

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11
Q

T/F Bruising can be a late sign of internal bleeding?

A

True

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12
Q

What is the class for Heparin and LMWH (Enoxaparin)

A

Heparins

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13
Q

Route of Heparin

A

Only given parental (IV or SQ)

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14
Q

Indications for Heparin

A

conditions necessitating PROMPT anticoagulant activity

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15
Q

Examples of when to give Heparin (4)

A

Evolving stroke, PE, massive DVT

Adjunct for patients having open heart surgery or dialysis

Low-dose therapy for prophylaxis against post-op DVT

Treat disseminated intravascular coagulation

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16
Q

What amount and frequency can Heparin be given

A

5000u injection 2-3x a day or as an IV drip with a bolus

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17
Q

what protocol is heparin given

A

weight-based in kg

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18
Q

When Does IV heparin start working

A

Immediately

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19
Q

when does SQ heparin start working

A

20-30 minutes

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20
Q

what is the anti-dote for Heparin

A

Protamine Sulfate

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21
Q

how is protamine given

A

IV
slowly
pushing can drop BP

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22
Q

What patients do we use caution when giving Heparin

A

patients with spinal or epidural anesthesia

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23
Q

T/F Heparin is a HIGH-RISK MED

A

True - must double check with other RN prior to rate changes and boluses

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24
Q

Adverse effects of Heparin (4)

A

bleeding
hematoma
anemia
thrombocytopenia

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25
Q

What 5 things do we monitor for when giving heparin

A

vital signs,
bruising,
petechiae,
hematomas,
black tarry stools

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26
Q

What is Heparin induced thrombocytopenia (HIT)

A

Low platelet count and increased development of thrombi

caused by antibody development

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27
Q

What are the nursing consideratoins for Heparin induced thrombocytopenia (HIT)

A

Monitor platelet counts

Stop heparin immediately if platelet count <100,000/mm3

Non-heparin anticoagulants can be used as substitute if anticoagulation still needed

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28
Q

What 2 labs do we monitor with Heparin

A

Anti-Xa OR aPTT (activated partial thromboplastin time)

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29
Q

How do we dose IV heparin

A

based on clotting time labs

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30
Q

What is Enoxaparin (Lovenox)

A

Low-molecular weight heparin

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31
Q

What route is Enoxaparin available

A

SQ injectable

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32
Q

Are labs necessary for Enoxaparin

A

No

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33
Q

What are the indications for Enoxaparin

A

given prophylaxis & treatment

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34
Q

What is the advantage of Enoxaparin

A

can be given at home

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35
Q

what are the adverse effects on enoxaparin

A

bleeding
thromboxytopenia
Can also cause HIT

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36
Q

What is the antidote for Enoxaparin

A

protamine

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37
Q

what patients do we use caution when giving enoxaparin

A

patients with spinal or epidural anesthesia

38
Q

Reason for low molecular weight heparin

A

takes large unfractionated heparin moleculaes and cleaves them into smaller fragments and this makes them have greater affinity to factor X-a making them bioavailable and have a longer half life

39
Q

Can you give Enoxaparin and heparin together

A

No

40
Q

what is the black box warning for Enoxaparin

A

potential spinal hematoma if patient has epidural catheter

41
Q

5 Nursing considerations for Enoxaparin

A

Don’t give with really any other anticoagulants except oral warfarin when treating PE or DVT

Given in pre-filled syringes easy to administer and teach to give at home

Do not expel the air bubble: will remain in plunger to ensure whole dose is given

Slower onset of action
compared to heparin but LONGER half-life

Rotate injection sites

42
Q

MOA of warfarin

A

Vitamin-K inhibitor
-prevents the synthesis of four coagulation factors (VII, IX, X, prothrombin)

43
Q

indications of Warfarin (3)

A

prevention VTE/DVT/PE,

thrombotic events for patients with afib or heart valves,

reduce recurrence of TIA or MI

44
Q

route of Warfarin

A

only given PO, Once daily

45
Q

What is the onset of warfarin

A

24 hrs

46
Q

what is the duration of warfarin

A

2-5 days

47
Q

Adverse effects of Warfarin

A

bleeding
lethargy
muscle pain
purple toes

48
Q

Antidote of warfarin

A

Vitamin K (IV)

If that doesn’t work
Fresh frozen plasma or whole blood

49
Q

Can you give warfarin to pregnant women or breastfeeding

A

NO

50
Q

Warfarin nursing considerations

A

Monitor and teach signs of bleeding

hold before surgeries

monitor labs

MANY drug interactions

Food interactions

Avoid alcohol

Weat medic alert bracelet, use soft toothbrush,

51
Q

What Labs do we monitor for Warfarin

A

PT- prothrombin time
INR- International normalize ratio

52
Q

Normal INR value without warfarin

A

about 1

53
Q

Therapeutic value with warfarin

A

2-3.5

54
Q

How frequently do we monitor patients on warfarin for therapeutic effect

A

MONTHLY

55
Q

What foods should be monitored when taking warfarin

A

Avoid foods High in Vitamin K

green, leafy vegetables

56
Q

MOA of Apixaban (Eliquis) & Rivaroxaban (Xarelto

A

Direct inhibitor of factor Xa

57
Q

Indications of Apixaban (Eliquis) & Rivaroxaban (Xarelto

A

prevent strokes in patients with afib,
post-op thrombo-prophylaxis, treat DVT & PE

58
Q

Adverse effects of Apixaban (Eliquis) & Rivaroxaban (Xarelto

A

bleeding,
hematoma,
dizziness,
rash,
gastrointestinal distress, peripheral edema

59
Q

Black box warnings for Apixaban (Eliquis) & Rivaroxaban (Xarelto

A

Spinal hematomas if patient has epidural catheter

Risk of thrombosis if drugs ABRUPTLY stopped

60
Q

Drug interactions with Apixaban (Eliquis) & Rivaroxaban (Xarelto

A

Decreased effects: phenytoin, carbamazepine, rifampin, and st. johns wort

Increased effects: CYP3A4 inhibitors (amiodarone, erythromycin, ketonazole, HIV meds, diltiazem, verapamil, grapefruit juice)

61
Q

Do you have to routine monitor Apixaban (Eliquis) & Rivaroxaban (Xarelto

A

NO

62
Q

antidote for Apixaban (Eliquis) & Rivaroxaban (Xarelto

A

andexxa

(recombinant factor Xa, inactivated-zhzo)

63
Q

can you give Apixaban & rivaroxaban in conjunction with other anticoagulants

A

NO

64
Q

What organ function and levels do we need to monitor with Apixaban & rivaroxaban

A

Liver function

ALT
AST
GGT

65
Q

2 types of antiplatelet drugs

A 
Aspirin 
Clopidogrel (plavix)
66
Q

S/E of Aspirin

A

GI (n/v),
drowsiness/confusion,
bleeding

67
Q

nursing considerations for aspirin

A

Don’t crush enteric coated

OTC medication considerations

Reye’s syndrome: children with a virus NO ASPIRIN

68
Q

contraindications for aspirin

A

thrombocytopenia,
active bleeding,
blood cancers,
traumatic injuries,
GI ulcers,
vitamin K deficiency,
recent hemorrhagic stroke

69
Q

What is the antidote for Aspirin

A

DDAVP (Desmopressin)

70
Q

MOA of Clopidogrel (Plavix) & Ticagrelor (Brilinta)

A

Antiplatelet ADP inhibitor

Alters the platelet membrane so it doesn’t receive the signal to aggregate

71
Q

Indications of Clopidogrel (Plavix) & Ticagrelor (Brilinta)

A

reduce risk of stroke, prophylaxis of TIAs,
post-MI

72
Q

Contraindications of Clopidogrel (Plavix) & Ticagrelor (Brilinta)

A

thrombocytopenia,
active bleeding,
blood cancers,
traumatic injuries,
GI ulcers,
vitamin K deficiency,
recent hemorrhagic stroke

73
Q

Side effects of Clopidogrel & Ticagrelor

A

chest pain,
edema,
flu-like symptoms,
abdominal pain,
diarrhea,
nausea,
epistaxis,
rash,pruritus

74
Q

Route of Clopidogrel & Ticagrelor

A

PO

75
Q

Clopidogrel Black Box Warning

A

patients with certain genetic abnormalities, who may have higher rate of CV events due to reduced conversion to its active metabolite

76
Q

Ticagelor Black Box Warning

A

Increased bleeding risk risk with aspirin doses over 100mg

77
Q

Antidote for Clopidogrel & Ticagrelor

A

DDAVP or platelet transfusion

78
Q

What reduces the effectiveness of Clopidogrel

A

amiodarone,
calcium channel blockers, NSAIDS,
PPIs

79
Q

2 Thrombin Inhibitors

A

argatroban
bivalrudin

80
Q

class of argatroban and bivalrudin

A

Direct Thrombin Inhibitors

81
Q

MOA of Direct Thrombin Inhibitors

A

Inhibit thrombin (factor IIa)

82
Q

indications of argatroban and bivalrudin

A

treat HIT, and for patients undergoing procedures (PCI) who are at high risk for HIT

83
Q

route of argatroban and bivalrudin

A

IV only

84
Q

Adverse effects of argatroban and bivalrudin

A

bleeding

85
Q

Argatroban should be cautioned in patients with what

A

hepatic dysfunction

86
Q

What labs do we monitor with Direct thrombin inhibitors

A

Anti-Xa
H&H
platelets

87
Q

What is aspirin

A

NSAID -
Blocks prostaglandin synthesis through the COX enzyme pathways

88
Q

What does aspirin block

A

Platelet aggregation

89
Q

what does aspirin prevent

A

platelets from clumping together

90
Q

What are the indications of aspirin

A

prevent/treat MI,
prevent ischemic stroke

91
Q

Route of aspirin

A

PO

92
Q

What can you do in an acute event with aspirin

A

Chew a baby aspirin but cannot be enteric coated

NUR 325 Patho (18 decks)

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