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Pharm unit 3 > Coagulation Modifiers > Flashcards

Coagulation Modifiers Flashcards

1
Q

Coagulation system

A

cascade process resulting in fibrin which forms clots

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2
Q

Fibrinolytic system

A
  • breakdown of clots
  • plasmin breaks down fibrin
  • keep thrombus in place to prevent embolus
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3
Q

Hemostasis

A
  • a general process that stops bleeding
  • coagulation
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4
Q

Hemophilia

A
  • coagulation/hemostasis factors limited or absent
  • pt needs to be given a coagulation factor or they could bleed to death
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5
Q

Classes of coagulation modifiers

A
  • Anticoagulants
  • Antiplatelet
  • Hemorheologic
  • Thrombolytics
  • Antifibrinolytic/hemostatic
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6
Q

Anticoagulants (antithrombotic)

A
  • don’t work on already-formed clots
  • decrease blood coagulability
  • prevent clot formation emboli
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7
Q

MI

A

when embolus lodges in a coronary artery

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8
Q

stroke

A

embolus obstructs brain vessel

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9
Q

pulmonary emboli

A

in pulmonary circulation

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10
Q

Heparins MOA

A

inhibit clotting factor (thrombin)

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11
Q

Types of heparin

A

Unfractionated heparin (just heparin)
Low molecule weight heparin (LMWH)

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12
Q

Enoxaparin (Lovenox) and Dalteparin (Fragmin) drug class

A

LMWH

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13
Q

Unfractionated heparin precaution

A

aPTT/bleeding times

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14
Q

Heparin flush precaution

A

no monitoring needed

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15
Q

What is a heparin flush?

A
  • Dosage (10-100units/mL) is very different from heparin doses used to treat clots
  • Used to keep the central line clear
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16
Q

LMWH precaution

A

more predictable, so bleeding time monitoring is not needed

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17
Q

Warfarin MOA

A
  • inhibit vitamin K synthesis in the GI tract
  • inhibit vitamin K-dependent clotting factors in the liver
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18
Q

Lepirudin, Argatroban, Bivalirudin, Dabigatran drug class

A

Direct thrombin inhibitors

19
Q

Fondaparinux, Ivaroxaban, Apixaban drug class

A

Selective factor Xa inhibitors

20
Q

Type I Heparin-Induced Thrombocytopenia (HIT)

A
  • Gradual reduction in platelets
  • Heparin therapy can usually be continued
21
Q

Type II Heparin-Induced Thrombocytopenia (HIT)

A
  • More than 50% reduction of platelets from baseline
  • Discontinue heparin
22
Q

Type III Heparin-Induced Thrombocytopenia (HIT)

A
  • A thrombosis can be fatal
  • treated with thrombin inhibitors
23
Q

Purple toes syndrome

A

Caused by the use of warfarin. Also skin necrosis

24
Q

S/S of HIT

A
  • hematuria
  • melena
  • petechiae
  • ecchymoses
  • bleeding gums
25
Q

Antidote for HIT

A
  • Protamine sulfate 1mg IV reverses 100 units of heparin
  • high doses of K will reverse anticoagulation but cause warfarin resistance (~7 days)
26
Q

treatment of severe bleeding from HIT

A
  • transfusions of plasma or clotting factor
  • Kcentra or Profiline
27
Q

IV vitamin K precaution

A
  • high doses (>10mg) risk for anaphylaxis
  • diluting and giving over 30min reduces risk
  • warfarin resistence
28
Q

Warfarin precaution

A

monitor INR

29
Q

INR Levels

A

Normal = 1.0
Therapeutic = 2 - 3.5

30
Q

Aspirin used for

A
  • Ischemic stroke/attack
  • Chronic stable angina
  • Unstable angina
  • Coronary stenting
  • MI (acute or previous)
  • MI prevention
    (Antiplatelet)
31
Q

Aspirin AE

A
  • N/V
  • bruising
  • risk of bleeding
32
Q

Clopidogrel MOA

A
  • ADP receptor antagonist
  • alters the platelet membrane
33
Q

Clopidogrel AE

A
  • chest px
  • abdominal px
  • N/V/D
34
Q

Clopidogrel black box warning

A

genetic abnormalities

35
Q

Clopidogrel indications

A
  • prevent blockage of coronary artery stents
  • reduces thrombotic events in acute coronary syndromes
  • MI
  • Ischemic stroke
  • Vascular death
36
Q

Alteplase, Reteplase, and Tenecteplase

A

Thrombolytic drugs

37
Q

Thrombolytics MOA

A
  • Activate fibrinolytic system
  • Break down clots quickly
  • Activate plasminogen to convert into plasmin to digest fibrin
  • This reestablishes blood flow to the heart
38
Q

Thrombolytics indications

A
  • Acute MI
  • Ischemic stroke
  • DVT
  • Arterial thrombolysis
  • Occlusion of shunts/catheters
  • Pulmonary embolus
39
Q

Thrombolytics AE

A
  • bleeding
  • N/V
  • hypotn
  • anaphylactoid reactions
  • dangerous dysrhythmias
40
Q

Antifibrinolytic Drugs

A
  • Prevent lysis of fibrin
  • Promotes clot formation
41
Q

Antifibrinolytics indications

A
  • Prevention/tx of excessive bleeding d/t hyperfibrinolysis or surg complications
  • Von Willebrand’s dz
42
Q

Aminocaproic acid, Tranexamic acid, desmopressin classification

A

Antifibrinolytic drugs

43
Q

Antifibrinolytic AE

A
  • usually mild and uncommon
  • rare thrombotic events
  • dysrhythmia, ortho hypotn, brady, HA, dizzy, fatigue, N/V/D, abdominal cramping
44
Q

Aspirin interactions

A

Ginko, decreases the action of aspirin and may cause increased bleeding times

Pharm unit 3 (13 decks)

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