Coagulation Modifier Drugs Flashcards
What are the Coagulation Modifying drug Classes?
Anticoagulants
Antiplatelet
Hemorheological
Thrombolytic
Antifibrinolytic
What are anticoagulant drugs?
Drugs that work to inhibit the formation of a clot. Have no direct effect on a formed clot.
What is the MoA of anticoagulant drugs?
will vary depending on what drug is being used. All anticoagulants will work at different points in the coagulation cascade.
What are the Indications of Anti Coagulants?
Prevent clot formation to avoid MI, CVA, PE, DVT
bridge therapy for patient
discontinuing warfarin
What are the contraindications of Anticoagulant drugs?
Drug allergy, acute bleeding, pregnancy in warfarin,
Adverse Effects of Anticoagulants
Bleeding, heparin induced thrombocytopenia, nausea vomiting, abdominal cramps
Adverse Effects of Warfarin
Bleeding
lethargy
muscle pain
skin necrosis
Purple toes syndrome
How do you manage a Heparin overdose (toxic effects)?
- Stop the drug immediately (this may be enough in the cases of small amount of heparin)
- Administer an antidote such as Protamine sulphate for heparin (1 mg /100 units of unfractionated & 1 mg/ 1mg of LMWH)
- Replace RBCs in large amount of blood is lost
How do you manage a Warfarin overdose (toxic effects)?
- Discontinue Warfarin
- Administer the lowest amount of Phytonadione (vitamin K1) possible to speed up a return to healthy coagulation
3.Use a heparin as an antithrombotic as Warfarin will not have a therapeutic effect for 7 days after being discontinued - In severe bleeding cases transfuse human plasma/ clotting factors
What is Heparin induced Thrombocytopenia? Explain the Types.
Low levels of platelets in the body, is treated with thrombin inhibitors (argatroban)
Type 1: A gradual reduction of Platelets in the body. Heparin can normally be continued
Type 2: An acute fall of the number of platelets in the body (50% or >). Heparin must be discontinued.
What do PT and INR values represent?
These numbers measure the degree to which a persons blood coagulability has been reduced by a anticoagulant. 0.8-1.2 without warfarin/ 2-3.5 on warfarin
List the Anticoagulant Drugs you need to know for the Exam
Heparin (unfractionated)
LMWH (enoxaparin)
Warfarin (coumadin)
Dabigatran (synthetic antithrombin)
Rivaroxaban (direct acting Xa inhibitor)
What is the difference between UFH and LMWH
LMWH is cleaved off of UFH and has a longer HL meaning it can be taken less often, better bioavailability, and greater affinity for factor Xa
Pharmacokinetics of Warfarin
Route: PO
Onset of Action: 24-72hrs
Peak: 4hrs
HL:0.5-3 days
Duration of Action:2-5 days
What are Antiplatelet drugs?
Drugs that act to prevent the binding of platelets to the site of blood vessel injury
What is the MoA of Antiplatelet drugs>
Antiplatelet drugs work by interfering with various stages of platelet activation and aggregation, ultimately preventing the formation of blood clots.
ASA: inhibits platelet aggregation and vasoconstriction
Clopidogrel: Alters platelet membrane so that it can no longer receive signal to aggregate and form plug
Eptifibatide: Block the receptor protein in the platelet membrane
what are the Indications of Antiplatelet drugs?
Antithrombotic effects
(reduces the formation of Blood clots)
What are the Contraindications of Antiplatelet drugs?
known drug allergy, active bleeding, traumatic injury, leukemia, GI ulcer, vitamin K deficiency, recent stroke. ASA in children with flu like symptoms
What are the adverse effects of Antiplatelet drugs?
Can induce bleeding
List the Antiplatelet Drugs you need to know for the Exam
ASA
Clopidogrel
Eptifibatide
What are Thrombolytic Drugs?
Drugs that cause the breakdown of clots in the coronary arteries
What is the MoA of Thrombolytic drugs?
Enhances the effect of the natural fibrinolytic system to break down clots, by activating plasminogen to plasmin which is proteolytic enzyme
What are the Indications of Thrombolytic drugs?
Acute MIs
Arterial thrombi
DWT Occlusion of shunts/ catheters
Ischemic stroke
What are the Contraindications of Thrombolytic Drugs?
allergy, major surgery, trauma, bleeding, drugs that alter clotting,
what are the Adverse effects of Thrombolytic drugs?
Bleeding, nausea, vomiting, hypotension, cardiac dysrhythmias
List the Thrombolytic drugs you need to know for the Exam
Alteplase, Tenecteplase
What are Antifibrinolytic drugs?
Drugs that prevent the lysis of fibrin which results in enhanced clot formation
What is the MoA of Antifibrinolytic drugs?
depends on the drug
desmopressin acetate: increases von Willebrand factor helping anchor the clot to vessel
What are the indications of Antifibrinolytic drugs?
Used in the prevention and treatment of severe bleeding
What are the Contraindications of Antifibrinolytic drugs?
allergy, impaired intravascular coagulation
What are the Adverse effects of Antifibrinolytic drugs?
dysthymias, orthostatic hypotension, bradycardia, convulsions, hallucinations
List the Antifibrinolytic drugs you need to know for the exam
desmopressin acetate
What are nursing implications for Coagulation Modifying drugs?
Assessing pt vitals, medical hx, bleeding hx, and potential contraindications, teach pt to follow strict guidelines, monitor for bleeding, pt should wear medical alert braclet, avoid foods high in vitamin K (tomatoes, leafy green veggies)
What are Nursing Implications of Heparin
Ensuring dose is double checked, ensure med is given IV, do not massage the injection site, give injection 5 cm away from umbilicus, stoma, scars…etc., do not aspirate med, effect will be immediate, protamine sulphate is the antidote
what are nursing implications for Warfarin ?
may be started while pt is still on heparin, full therapeutic effect will take several days, monitor PT/INR, antidote is vitamin K, G products may cause excessive bleeding
Name the G products + the two others that may cause bleeding
Capsicum pepper
Garlic
Ginger
Ginkgo
St. John’s wort
Feverfew
