Coagulation Modifiers Flashcards
Intrinsic Pathway has clotting factors convert _______ to ______
prothrombin, thrombin
Extrinsic Pathway releases ________ which activates factors _____ and ______
Thromboplastin, VII. X
The clotting factor produced by the liver is ______?
fibrin
Fibrin binds with _____ which converts to _____ which will then break down ______ into degradation products.
plasminogen, plasmin, fibrin
Antiplatelet drugs will..?
inhibit platelet aggregation and prevent platelet plugs.
Thrombolytic drugs will?
lyse existing clots.
Antifibrinolytic drugs are also called ______ and will..?
hemostatic, promote blood coagulation.
Anticoagulants will inhibit the action or formation of c_____ f____ and will ultimately prevent _____ formation.
clotting factors, clot
Anticoagulants have no effect on _____ ______
present clots
Anticoagulants used prophylactically to prevent ____ formation and an ______
thrombus, embolus
Anticoagulants Indicated for these three scenarios
- A fib
- Indwelling devices, like mechanical heart valves.
- Major orthopedic surgery
Heparin is an ______ drug class and works by blocking the conversion of ______ to ______
anticoagulants, fibrinogen, fibrin.
heparin SQ has an onset of ____, and a duration of _____
20-60 minutes, 8-12 hours
Heparin IV has an onset of _____ and a duration of ______
5 minutes, 2-6 hours.
Heparin has laboratory monitoring every ____ hours and is ______ _______. The _____ test is used and should have a normal range of 20-40 seconds.
Therapeutic ranges are ____ to ____ times pre-treatment level.
6 hours, dose dependent, aPTT, 1.5-2.5 times.
Low-molecular weight heparins target more ____ clotting factors therefore= _n_____ m_______ is _n_____
specific, no monitoring is needed.
Enoxaparin (Lovenox) is which class of drug?
Which route do we give it?
LMWH or anticoagulant, SQ
What is the antidote of heparin?
Protamine sulfate
IV doses of Heparin should be ______
Preferrable spots for injection_____
list the places you absolutely shouldn’t inject within 2 inches of:
aspirating or massaging the area causes:
double checked with another nurse, only in deep SQ spots.
stoma, abdominal incisions, scars, drainage tubes, umbilicus, open wounds.
hematoma
_______ laboratory values are done daily to monitor coagulation effects of heparin.
aPTT
Avoid these foods _____, _____, ______, and ______ when taking warfarin.
green leafy vegetables, pork, fish, milk products
Which class of drug is warfarin?
anticoagulant
onset of warfarin is ______?
24-72 hours
PT range for warfarin?
INR therapeutic range?
9.5-12 seconds
2.0-3.5
For severe bleeding while on warfarin give transfusions of _____ ______ or c_____ f_____ c____s
human plasma, clotting factor concentrates.
Since the full therapeutic effect of _____ takes several days, we wait until PT and INR levels are adequate to stop giving _____ which was giving anticoagulant effects in place of ______.
warfarin, heparin, warfarin.
High doses of vitamin K (___mg) IV will reverse the effects of ______ within _____ hours.
10, warfarin, 6.
When vitamin K is given while taking warfarin, there will be ______ resistance for up to ____ days.
warfarin, 7.
These herbal products (7 items) increase the risk of bleeding with this medication:
- capsicum pepper
- ginger
- garlic
- gingko
- St. John’s wort
- Feverfew
- dong quai
while taking with warfarin.
Dabigatran (Pradaxa) is this class of drug____, and this category: ________.
you must have good ____ function.
the antidote is _____
The route is ___
anticoagulant, direct thrombin inhibitor, renal, Praxbind.
PO
A direct thrombin inhibitor will inhibit _____ also called _____
IIa, fibrin.
Fondaparinux (Arixtra) is this class of drug _____ and this category________.
A major side effect is _______.
Monitoring or not?
route?
anticoagulants, selective factor inhibitor, thrombocytopenia, no monitoring, and SQ.
Selective factor inhibitors will inhibit ________
Xa
Direct oral anticoagulants have action against factor ___ and the drugs are ______ and ______.
Both of their routes are _____
_____ has a counterindication for ______ ________.
Xa, Rivaroxaban (Xarelto), Apixaban (Eliquis), grapefruit juice
Rivaroxaban has an antidote of _______ injection.
andexxa
LMWHs are contraindicated in patients with an..? Due to risk of ________ _________
indwelling epidural catheter, epidural hematoma.
Warfarin should never be taken in ______?
pregnancy
Bleeding risks should be avoided with _______ and can happen with both _____ and _____.
warfarin, warfarin and heparin.
Type 2 HIT is an acute fall in platelets of >___% and can lead to p_______ t__________
continued drug therapy can be _____.
50, paradoxical thrombosis, fatal.
Warfarin can cause what two skin problems?
skin necrosis and “purple toes” syndrome.
treatment of type 2 HIT?
thrombin inhibitors (lepirudin and argatroban)
If any of these five symptoms occur while taking heparin then stop drug immediately.
hematuria, melena, petechiae, ecchymosis, gum or mucous membrane bleeding.
___mg of protamine sulfate can reverse the effects of ____ units of heparin.
1, 100
Antiplatelets work to prevent platelet _____ at the site of blood vessel injury.
adhesion
High doses of aspirin can lead to…?
metabolic acidosis, respiratory alkalosis, tinnitus, and fluid and electrolyte imbalances.
aspirin is contraindicated for ____ symptoms in children and teens because of this syndrome..?
flu, Reye’s
Dipyridamole (Persantine) is an _________ drug and causes _____ changes. Often used with what drug?
antiplatelet, EKG, aspirin.
Clopidogrel (Plavix) is what class of drug and what category?
antiplatelet, Adenosine diphosphate antagonist
Eptifibatide (Integrilin) is what class of drug and what category?
antiplatelet, Glycoprotein IIb/IIIa receptor antagonist
Which route of Eptifibatide is used? Where is it usually used at? What is it used for?
IV, ICU, cardiac catheterization.
Thrombolytic drugs only work on ____-formed clots.
pre-formed
older thrombolytic drugs are strepto_____ and uro_____
streptokinase, urokinase
current thrombolytic drugs used?
t-plasminogen activators (tpa)
Alteplase (Activase) is which class and category of drug?
the route is a ____ followed by a 90 min ____ infusion.
thrombolytic, tpa, bolus, IV
Alteplase is indicated in _______ _____ _______.
Since this drug is weight based, give within ____ hours and for MI, only adults > ___ kg are qualified.
____ cost of drug.
acute ischemic stroke, 3, 67, high.
Tenecteplase (TNKase) is what class and category of drug?
route?
indication? must start this drug within ____ hours of symptom onset.
thrombolytic, tPa, single IV bolus, MI, 6.
thrombolytic drugs break down ____ into ____ which will dissolve the ____ network.
plasminogen, plasmin, fibrin.
Thrombolytic drugs are indicated for a_____ t______, _____, o_____ of ____ or ______, and p_______ e_______
arterial thrombolysis, DVT, occlusion of shunts or catheters, pulmonary embolus.
Three types of bleeding can happen with thrombolytic drugs. Name them.
- superficial
- intracranial
- internal
three adverse effects of thrombolytic drugs?
n/v, cardiac dysrhythmias, hypotension.
Name the two antifibrinolytic drugs?
tranexamic acid and desmopressin
Antifibrionlytic drugs will _____ clot formation.
promote
Antifibrinolytic drugs will prevent and treat excessive bleeding resulting from h________s or _______ complications.
hyperfibrinolysis, surgical.
antifibrinolytic drugs are indicated in ________ and ____ _____ disease.
hemophilia, von Willebrand’s
Desmopressin is a s______ p______e and indicated for which two conditions?
similar to which drug? which is an _____ hormone.
Nasal spray is used for n______ e_______s.
synthetic polypeptide, hemophilia, and diabetes insipidus, vasopressin, antidiuretic, nocturnal enuresis.
Tranexamin acid the _________ drug class will form a _______ complex that displaces _______ from ________ resulting in inhibition of f________s
antifibrionlytic, reversible, plasminogen, fibrin, fibrionlysis.
Tranexamic acid is indicated for what?
Can cause what with rapid IV injection.
used IV prior to surgery, hypotension.
