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coagulation modifiers Flashcards

1
Q

hemostasis

A

process that stops bleeding

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2
Q

coagulation

A

hemostasis that occurs because of clotting of blood

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3
Q

thrombus

A

blood clot

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4
Q

embolus

A

thrombus that moves through blood vessels. can cause DVT, heart attack, stroke

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5
Q

result of a coagulation system

A

fibrin (clot forming substance)

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6
Q

fibrinolysis

A

mechanism where thrombi are killed to prevent vessel blockage

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7
Q

fibrinolytic system steps

A

-fibrin binds to plasminogen
-plasminogen into plasmin
- plasmin breaks down fibrin

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8
Q

hemophilia

A

genetic disorder where coagulation and hemostasis factors are absent

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9
Q

anticoagulants MOA

A

-prevent the formation of clots
- no direct effect on a blood clot thats already formed
- prevent intravascular thrombosis by decreasing blood coagulability

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10
Q

thrombotic events

A
  • myocardial infarction (coronary artery)
  • brain vessel (stroke)
  • lungs (pulmonary embolism)
  • vein in leg (DVT)
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11
Q

what are two drug classes of anticoagulants

A

heparin and warfarin

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12
Q

unfractionated heparin

A

aka heparin sodium
- requires frequent lab monitoring for bleeding times (aPTT)
- big molecule
- no monitoring for catheter flush

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13
Q

LMWH

A
  • low molecular weight heparin
  • small molecule, more predictable
  • doesn’t need frequent monitoring
  • subcut. can cause bruising
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14
Q

heparin indications

A
  • prevent thrombotic events
  • used as bridge therapy for going off warfarin (ex- take heparin after surgery before warfarin kicks in bc it takes 5-7 days to work)
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15
Q

warfarin (Coumadin) MOA

A

inhibit vitamin K synthesis in GI tract
- inhibits vit K clotting factors synthesized in the liver
- prevention of clot formation

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16
Q

example of an antithrombin med and MOA

A

synthetic dabigatran (Pradaxa).
inhibits thrombin

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17
Q

ex of direct acting Xa inhibitors

A

rivaroxaban (Xarelto) PO

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18
Q

ex of direct thrombin inhibitor

A

dabigatran

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19
Q

is dabigatran a pro drug

A

yuh. must pass through liver in order to work

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20
Q

anticoagulant indications

A

used to prevent clot formation in certain settings in which clot formation is likely. ex-myocardial infarction, unstable angina, atrial fibrillation, indwelling devices, slowed blood flow

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21
Q

anticoagulant contraindications

A
  • allergy
  • acute bleeding
  • kidney disease
  • warfarin= contraindicated in pregnancy
  • LMWH= contraindicated in pt w/ indwelling epidural catheter. Risk of epidural hematoma
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22
Q

anticoagulant adverse effects

A
  • bleeding
  • heparin-induced thrombocytopenia
  • nausea, vomiting, cramps, thrombocytopenia
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23
Q

warfarin adverse effects

A

bleeding, lethargy, muscle pain, skin necrosis, purple toes syndrome

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24
Q

HIT type 1

A
  • gradual reduction in platelets
  • heparin therapy can be continued
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25
Q

HIT type 2

A
  • acute fall in # of platelets (platelets start to clot in response to heparin)
  • discontinue heparin therapy
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26
Q

HIT clinical manifestations and treatment

A
  • thrombosis that is fatal
  • treat with argatroban (thrombin inhibitor)
  • higher incidence with bovine than with porcine heparins
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27
Q

symptoms of toxic effects of warfarin

A

hematuria, melena (blood in stool), petechiae, ecchymoses, gum/ mucous membrane bleeding

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28
Q

IV treatment for toxic effects of heparin

A

not for HIT. protamine sulphate 1mg can reverse 100U of heparin. 1mg for 1mg of LMWH.

29
Q

how long after discontinuing warfarin does the liver resynthesize clotting factors

A

36-42 hrs

30
Q

what drug can hasten the return to normal coagulation

A

vitamin K (phytonadione)
- high doses can reverse anticoagulation in 6 hrs

31
Q

how long will warfarin resistance occur after vit K is given

A

up to 7 days

32
Q

IV vit K risk of anaphylaxis is diminished by

A

diluting it and giving it over 30 mins

33
Q

interactions that increase anticoagulant activity

A
  • enzyme inhibition of metabolism
  • displacement of drug from inactive protein binding sites
  • decrease in vit K absorption by large intestine
  • alteration in the platelet count
34
Q

heparin sodium

A

natural anticoagulant obtained from lungs or intestinal mucosa of pigs

35
Q

heparin sodium is also used for

A

DVT prophylaxis (prevention treatment for DVT)
- 5000U SUBCUT 2/3 times a day

36
Q

heparin sodium therapeutic route

A

IV
measurement of aPTT is necessary

37
Q

heparin flushes

A

heparin leo
- small vial of aq IV flush sol

38
Q

risk of HIT has caused most institutions to use

A

0.9% normal saline as a flush for heparin-lock IV ports

39
Q

what values do you need to monitor on warfarin

A

prothrombin time (PT) and the international normalized ratio (INR)

40
Q

normal INR without warfarin

A

0.8-1.2

41
Q

therapeutic INR with warfarin

A

2-3.5

42
Q

warfarin sodium dietary considerations

A

too much vitamin K can reduce warfarins ability to form clots

43
Q

ex of direct thrombin inhibitors

A

dabigitran etexilate mesylate (pradaxa)

44
Q

dabigitran etexilate mesylate is the first oral direct thrombin inhibitor used for….

A

stroke and thrombus prevention for pts with atrial fibrillation

45
Q

which direct thrombin inhibitor has no antidote

A

dabigitran etexilate mesylate

46
Q

what are 3 anti platelet drugs

A

aspirin, clopidogrel bisulfate (plavix), eptifibatide (Integrilin)

47
Q

aspirin effect

A

-vasodilation and prevention of platelet aggregation and clot formation
- used in stroke prevention

48
Q

when do you chew aspirin

A

myocardial infarction

49
Q

do not use aspirin for

A

pregnant ppl and kids

50
Q

clopidogrel (Plavix) MOA

A

alters platelet membrane so it can no longer receive signals to form a plug

51
Q

clopidogrel is used for

A

reducing number of MI, strokes, vascular death, preventing TIA and post MI thrombotic prevention

52
Q

eptifibatide is administered when

A

critical care or catheterization lab settings where continuous cardiac monitoring is available.
- used to treat acute unstable angina, MI, and during PCI

53
Q

eptifibatide route

A

IV only

54
Q

what do thrombolytic drugs do

A

break down or lyse preformed clots in the coronary arteries

55
Q

current thrombolytic drugs

A

alteplase (Activase) and tenecteplase (TNKase)

56
Q

thrombolytic drugs MOA

A

-activate fibrinolytic system to break down clot in blood vessels quickly
-activate plasminogen to plasmin which lyses the thrombus

57
Q

thrombolytic drugs indications

A
  • acute MI
    -arterial thrombolysis
  • DVT
  • occlusion of shunts
  • pulmonary embolism
  • acute ischemic stroke
58
Q

thrombolytic drugs adverse effects

A
  • bleeding: internal, intracranial, superficial
  • nausea, vomiting, hypotension, hypersensitivity, anaphylactoid reactions, cardiac dysrhythmias
59
Q

antifibrinolytic drugs

A
  • prevents lysis of fibrin
  • promotes clot formation
  • treatment for excessive bleeding from hyperfibrinolysis
  • treatment of hemophilia A or type 1 von Willebrand disease or desmopressin
60
Q

ex of antifibrinolytic drug

A

desmopressin acetate (DDAVP)

61
Q

desmopressin acetate used for

A

-surgical and post op hemostasis
- type 1 von willebrands disease and hemophilia A
- not as common

62
Q

antifibrinolytic adverse effects

A

uncommon
rare reports of thrombotic events
dysrhythmia, orthostatic hypotension, bradycardia, dizziness, fatigue, nausea vomiting

63
Q

what can be given as an antidote incase of excessive anticoagulation

A

protamine sulphate

64
Q

where is LMWH given

A

subcut in abdomen

65
Q

antidote for warfarin

A

vitamin k

66
Q

herbal products that can increase bleeding

A

capsicum pepper, garlic, ginger, ginkgo, st johns wort, feverfew, ginsing

67
Q

pt education with anticoagulants

A
  • wear a medical alert bracelet
  • avoid foods high in vit K
  • consult physician before taking OTC
68
Q

what to monitor for pts taking thrombolytic drugs

A

bleeding from gums, mucous membranes, nose and injection sites

69
Q

signs of internal bleeding

A

decreased BP, restlessness, increased pulse.

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