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NURS 251 (Pharmacology 1) > Coagulation Modifier drugs > Flashcards

Coagulation Modifier drugs Flashcards

1
Q

What is hemostasis

A

General term for any process that stops bleeding

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2
Q

What does coagulation mean

A

The process of blood clot formation

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3
Q

What is the difference between a thrombus and an embolus

A

Thrombus is a blood clot
Embolus is a blood clot that moves through blood vessels

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4
Q

What is the cascading effect of coagulation

A

Each activated factor serves as a catalyst that amplifies the next reaction

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5
Q

What is the result of the coagulation system

A

Fibrin, a clot forming substance

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6
Q

What is the purpose of the fibrinolytic system

A

Initiates the breakdown of clots and balances the clotting process to prevent blood vessel blockage

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7
Q

How does fibrinolysis occur

A

Fibrin in the clots bind to plasminogen
Binding converts plasminogen to plasmin
Plasmin is an enzyme that eventually breaks down thrombus into fibrin degradation products
This keeps the thrombus localized and prevents it from becoming an embolus

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8
Q

What is hemophilia and what are the 2 types

A

A genetic disorder in which natural coagulation and hemostasis factors are limited or absent
Factor VII deficient
Factor VIII and/or IX deficiency

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9
Q

What are the 5 categories of coagulation modifiers ?

A

Anticoagulants
Antiplatelets
Hemorheological drugs
Thrombolytic drugs
Antifibrinolytic/hemostatic

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10
Q

How do anticoagulants prevent clot formation

A

They don’t affect clots that have already been formed
Prevents thrombosis by decreasing blood coagulability
Used prophylactically to prevent embolus and thrombus

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11
Q

What are the different types of thromboembolic events

A

Embolus in coronary artery: MI
Embolus in brain: Stroke
Embolus in lungs: Pulmonary embolus
Embolus in leg veins: DVT

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12
Q

What is the MOA of heparin anticoagulants

A

Inhibit clotting factors IIa(thrombin), Xa and IX
XI and XII also inactivated but not as important

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13
Q

Name an example of an unfractionated heparin and low-molecular weight heparin (LMWH)

A

Heparin and Enoxaparin

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14
Q

What requires more frequent lab monitoring of bleeding times? LMWH or Unfractionated Heparin

A

Unfractionated Heparin. It is not needed for LMWHs

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15
Q

When are the indications for heparin

A

Prevention of clot formations
Used as bridge therapy for patients to stop warfarin after surgery

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16
Q

What does warfarin do?

A

Inhibits vitamin K synthesis in the GI
This impairs the synthesis II, VII, IX and X
Prevents clot formation

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17
Q

How do antithrombin medications work and name one

A

Directly inhibit thrombin (factor IIa)
Dabigatran (synthetic)

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18
Q

T/F: Dabigatran has no antidote even though it has the most severe adverse effects

A

True

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19
Q

Name a direct acting Xa inhibitor

A

Rivaroxaban

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20
Q

What are the indications for anticoagulants

A

MI
Unstable angina
Atrial fibrillation
Conditions in which blood flow may be slowed and blood may pool

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21
Q

What are the contraindications of anticoagulants

A

Acute bleeding or high risk of bleeding
Pregnancy
Epidural catheters with LMWHs for risk of epidural hematoma

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22
Q

What are the adverse effects of anticoagulants

A

Increased bleeding time
Abdominal cramps
Lethargy
Muscle pain
Skin necrosis
Purple toes
Thrombocytopenia

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23
Q

What is heparin-induced thrombocytopenia (HIT) and what are the two types

A

Deficiency of platelets in blood
Type 1: Gradual reduction in platelets
Type 2: Acute reduction in platelets( >50% of baseline)

24
Q

T/F: Discontinue heparin therapy for Type 1HIT and continue heparin therapy for type 2 HIT

A

False: Discontinue for Type 2 and Continue for Type 1

25
Q

How can HIT be treated

A

Using thrombin inhibitor argatroban

26
Q

What are the symptoms of heparin toxicity

A

Hematuria
Melena (blood in stool)
Petechiae (red spots)
Ecchymoses (bruising)

27
Q

What is the purpose of IV protamine sulphate

A

Treat heparin toxicity
1 mg of protamine can reverse the effects of 100 units of heparin (1mg of protamine for each mg of LMWHs)

28
Q

What is used to reverse warfarin toxicity

A

Vitamin K1(phytonadione)

29
Q

How long does it normally take for the liver to resynthesize enough clotting factors to reverse the effects of warfarin? And how does Vitamin K1 affect this ?

A

36 - 42 hours
Vitamin K1 can return normal coagulation within 6 hours if given a high dose through IV (10 mg)

30
Q

What are some risks associated with giving Vitamin K IV

A

Warfarin resistance will occur for up to 7 days
Risk for anaphylaxis (decreased by diluting and giving every 30 mins)

31
Q

What is heparin sodium used for and what is the route, dosage and frequency?

A

DVT prophylaxis
5000 units SQ BID or TID
Does not need to be monitored when used for it.

32
Q

What are heparin flushes used for and what is a risk?

A

Used to flush IVs and central catheters
Risk of development of HIT so most places use saline as a flush for IVs instead.

33
Q

What is the most commonly used oral anticoagulant

A

Warfarin sodium

34
Q

Name 3 antiplatelet drugs and what do they do

A

Aspirin
Clopidogrel bisulfate
Eptifibatide
Prevent platelet adhesion at the site of injury, which occurs before the clotting cascade

35
Q

How does aspirin prevent platelet adhesion and what is it used for

A

Inhibits cyclooxygenase in platelet which prevents TXA2 (causes platelet aggregation and vasoconstriction)
May affect vitamin K dependent clotting factors
Used for stroke prevention and MI

36
Q

How does clopidogrel prevent platelet adhesion and what is it commonly used as

A

Alters platelet membrane so that it can no longer receive signal to aggregate and form platelet plug
Most commonly used as an ADP inhibitor

37
Q

T/F: Aspirin is better than clopidogrel at reducing number of MI’s, strokes and vascular deaths for at risk patients

A

False: Clopidogrel is better

38
Q

How does Eptifibatide prevent platelet adhesion and where is it usually used

A

Inhibits GP II/IIa
Usually used in critical care or cardiac catheterization settings where continuous cardiac monitoring is available

39
Q

Eptifibatide is only available for __________

A

IV infusion

40
Q

What are the adverse effects of antiplatelets

A

All pose a risk for serious bleeding episodes

41
Q

What are the contraindications of antiplatelets

A

Vitamin K deficiency, leukemia, thrombocytopenia

42
Q

Name 2 thrombolytic drugs and what they do

A

Alteplase
Tenecteplase
Breakdown already formed clots

43
Q

What is the MOA of thrombolytic drugs

A

Activates fibrinolysis to break down the clot quickly
Activates plasminogen and converts it to plasmin which lyses thrombus
Mimics body’s process of clot destruction

44
Q

What are the indications for thrombolytic drugs

A

Acute MI
Arterial thrombolysis
DVT
Occlusion of shunt/catheter
Pulmonary embolism
Acute ischemic stroke

45
Q

What are the adverse effects of thrombolytic drugs

A

Increased bleeding
Hypotension
Anaphylactoid reactions (mimic allergic reaction but not caused by immune response)
Cardiac dysrhythmias

46
Q

What is the purpose of antifibrinolytic drugs

A

Prevents the lysis of fibrin so it promotes clot formation

47
Q

What are the indications of antifibrinolytic drugs

A

Used to prevent and treat excessive bleeding
Treats hemophilia A
Treats type 1 Willebrand’s disease with desmopressin

48
Q

Name an antifibrinolytic drug

A

Desmopressin (DDAVP)

49
Q

What are the adverse effects of antifibrinolytic drugs

A

Dysrhythmia
Orthostatic hypotension
Bradycardia
Headache
Dizziness
Hallucinations
Fatigue
Abdominal cramps
Diarrhea

50
Q

T/F: Do not give SQ doses of heparin within 5 cm of umbilicus, abdominal incisions, open wounds, scars, drainage tubes, stomas, or areas of bruising or oozing

A

True

51
Q

Why shouldn’t you massage the injection site or aspirate SQ injections of heparin

A

May cause hematoma to form

52
Q

T/F: Anticoagulant effects from heparin are seen immediately whereas warfarin effects take several days

A

True

53
Q

What is the antidote for excessive coagulation from heparin

A

Protamine sulphate

54
Q

What herbal products interact with warfarin to cause increased bleeding

A

Capsicum pepper
Garlic
Ginger
Ginkgo
St. John’s wort
Feverfew

55
Q

What type of diet should patients have when taking anticoagulants

A

Low vitamin K (avoid tomatoes, dark leafy green veggies)

56
Q

What are the signs of internal bleeding

A

Decreased BP, restlessness, increased pulse

NURS 251 (Pharmacology 1) (20 decks)

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