Coagulation modifier drugs Flashcards
What is the meaning of hemostasis and coagulation?
This is the general term that describes stopping bleeding. Coagulation is hemostasis that happens as a physiological clotting of blood
What are the two clotting pathways and what is the result of the coagulation system?
The two pathways are the extrinsic and intrinsic pathway and they result in the production of fibrin
What is the fibrinolytic system and what is fibrinolysis?
This is a system that starts the breakdown of clots and balances the clotting process. Fibronolysis is when a thrombi is broken down to prevent excess clot formation
What is hemophilia?
This is a rare genetic disorder where natural coagulation is limited or absent. These patients can bleed to death
What are the 5 groups of coagulation-modifying drugs?
Anticoagulants, antiplatelet drugs, hemorheogiacal drugs, thrombolytic drugs, antifibrinolytic
What are anticoagulant drugs, and what is an example?
They do not affect formed blood clots, but they prevent intravascular thrombosis by decreasing blood coagulability. An example is unfractionated heparin and low molecular weight heparins and enoxaparin
What is the difference between unfractionated heparin and low molecular weight heparins?
The unfractionated is a larger molecule while low weight is a synthetic smaller molecule.
When would we be using heparins?
They are used to prevent clot formation that can cause stoke, heart attack, pulmonary embolism or DVT. it is also used as a bridge therapy when a patient stops taking warfarin for surgery or invasive procedures
What is warfarin?
Is is an anticoagulant that appears naturally and inhibits vitamin k synthesis so it prevents clot formation
WHat do antithrombin drugs do and what is the main example?
They inhibit thrombin and the main example is dabigatran
What is rivaroxaban?
This is a direct acting Xa inhibtiors
Overall what do anticoagulants do?
They work on different parts of the clotting cascade to prevent intravascular thrombosis. THEY DO NOT LYSE EXISTING CLOTS
Indications for anticoagulants?
Myocardial infarction, unstable angina, atrial fibrillation, indwelling devices.
Adverse effects of anticoagulants?
BLEEDING, thrombocytopenia, warfarin shouldnt be given to pregnant women
What is thrombocytopenia?
There are two types one is a drop in platelet count that is sudden and the other is a gradual fall in the count of platelets. Discontinue heparin for sudden and you can continue for the gradual reduction.
What is used to treat thrombocytopenia
Argatroban
How does protamine sulphate relate to heparin?
IV protamine sulphate can reverse the effects of 100 units of heparin
How does vitamin k relate to coagulation
Vitamin K can hasten the return to normal coagulation so should be watched out for when giving warfarin
What is heparin sodium?
It is a natural anticoagulant that comes from the lungs or intestinal mucosa of pigs.
WHat are heparin flushes (heparin leo)
This is when a small vial of aqueous heparin IV flush solution is used
What is warfarin sodium?
This is the most commonly prescribed anticoagulant and has a therapeutic INR of 2 to 3.5
What is an example of a direct thrombin inhibitor, and what does it do?
This is a prodrug that is used for stroke and thrombosis prevention
WHat are three examples of antiplatelet drugs?
Aspirin, clopidogrel bisulfate, eptifibatide
What is the MOA of aspirin?
It prevents platelet aggregation and causes vasodilation
WHat is the MOA of clopidogrel?
Affects platelet membranes, so they cant aggregate with each other
What is the MOA of eptifibatide
It prevents platelet aggregation by blocking receptor protein on platelet membrane
WHat are examples of thrombolytic drugs and what do they do?
They break down preformed clots in the coronary arteries. Examples are alteplase and tenecteplase
What is the MOA of thrombolytic drugs?
They breakdown clots in blood vessels by mimicking the body process of clot destruction
How do antifibrinolytic drugs work, and what is an example?
They prevent the lysis of fibrin which promotes clot formation. AN example is desmopressin acetate
What is the main drug example of antifibrinolytic drugs, and what can it be used for?
Desmopressin acetate (DDAVP). It can be used in severe cases of surgical and postoperative hemostasis
What should be done when administering intravenous heparin?
It should be double checked by another registered nurse
What is a serious case protamine sulphate can be used for?
It can be used for severe cases of anticoagulation
Can warfarin be administered with heparin? What would be an antidote for possible toxicity?
A patient can be given heparin if they are already taking warfarin until they have adequate levels of anticoagulation
What are possible interactions for warfarin?
Capsicum pepper, garlic, ginger, ginkgo, st johns wort, feverfew
What are some education points for patients on anticoagulant medication
They should have a medical alert bracelet, avoid foods high in vitamin k and consult their health provider before taking other drugs
