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PathoPharm > Coagulation Modifiers > Flashcards

Coagulation Modifiers Flashcards

1
Q

Herbal and Alternative Therapies that interfere with anticoagulants

A
  • Chamomile (Migraines, cramps, anxiety)
  • Chondroitin (osteoarthritis)
  • Fish oil (CAD) increases bleeding
  • Garlic (high cholesterol)
  • Ginger (N, V of pregnancy)
  • Vitamin E

4 G’s

  • Ginkgo (improve cognitive function, intermittent claudication)
  • Ginseng (mood elevation) decreases anticoagulant activity
  • Glucosamine (osteoarthritis) increases risk of bleeding
  • Green leaf tea (cancer, CV disease, improvement of cognitive function)
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2
Q

Anticoagulants: Heparin characteristics and antidote

A
  • Inhibits clotting factors
  • IV or subcutaneous, immediate onset of action
  • Acute treatment of thromboembolic disorders
  • ***Antidote is protamine sulfate (reversal agent)
  • Does not enter breast milk and can be used in lactation
  • Monitor aPTT (activated partial thromboplastin time)
  • Therapeutic level is 1.5 to 2.5 times the normal (30-40 seconds is the normal or control value) (Should be around 45-100 seconds)
  • Also monitor anti-Xa (therapeutic range 0.3 to 0.7 units)

Therapeutic uses

  • Prevention and treatment of venous thrombosis and pulmonary emboli
  • Treatment of embolization of atrial fibrillation
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3
Q

Anticoagulants: Heparin contraindications and adverse effects

A

Contraindications

  • Active internal bleeding
  • severe HPTN (^ risk of fistulas and vessel destruction, etc)
  • Serious bleeding pathologies
  • trauma
  • thrombocytopenia

Adverse effects
- Bruising, bleeding
- HIT = heparin induced thrombocytopenia
(alternative is to use lepirudin (Refludan)

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4
Q

Anticoagulants: Low-Molecular-Weight Heparins: examples and characteristics and differences between heparin

A
  • enoxaparin (Lovenox)
  • tinzaparin (Innohep)
  • dalteparin (Fragmin)

TED + -parin

  • Cause fewer systemic adverse effects
  • Indicated for the prevention of clots and emboli formation after certain surgeries or bed rest
  • Typically administered for 7-10 days after hip surgery

Differences with heparin:

  • Subcutaneous only
  • Weight-based dosing
  • BID dosing
  • More expensive
  • No aPTT monitoring
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5
Q

Anticoagulants: Warfarin (Coumadin): characteristics and antidote

A
  • Oral
  • Decreases the production of Vitamin K dependent clotting factors in the liver
  • Many drug interactions with warfarin
  • Maximum effect takes 36-72 hours (not used in acute situation)
  • Not immediate like heparin
  • Trouble with scheduled surgery (take them off this, wait 36-72hrs, and give LMWH, perform surgery when everything is fine
  • Vitamin K is the antidote
  • Therapeutic range is 1.5 to 2.5 times the normal level
  • Therapeutic INR is 2 to 3
  • Normal (or control value) PT is 11-12.5 seconds (when not on warfarin)
  • Vitamin C may decrease the effect
  • Vitamin E may increase the effect of warfarin
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6
Q

Anticoagulant: Fondaparinux (Arixtra) characteristics

A
  • ***Used with orthopedic surgery patients
  • Selectively inhibits factor Xa
  • Given subcutaneously based on patient’s weight
  • routine laboratory monitoring not required
  • No specific antidote for overdose
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7
Q

Anticoagulant: Factor Xa inhibitors: examples and characteristics

A
  • Apixaban (Eliquis)
  • Rivaroxaban (Xarelto)
  • Edoxaban (Savaysa)

ARE + -xaban

  • No PT/INR monitoring
  • Bleeding is most common adverse effect
  • Oral medications
  • No specific antidote
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8
Q

Anticoagulant: Direct Thrombin Inhibitor: Dabigatran (Pradaxa-U.S.) characteristics

A
  • Oral agent
  • Prevents development of thrombi.
  • Rapidly absorbed
  • Indicated for
    reducing the risk of stoke and systemic embolism in patients with non-valvular atrial fibrillation
  • Adverse reactions- bleeding, dyspepsia
    No INR monitoring
  • Reversal agent Idarucizumab (praxbind)
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9
Q

Anticoagulant: Direct Thrombin Inhibitor: Desirudin (Iprivask)

A
  • Used to prevent clots in patients with orthopedic surgery (intra and postop)
  • Parenteral
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10
Q

Anticoagulant: Direct Thrombin Inhibitor: Argatroban (Argatroban)

A
  • Same trade and generic name
  • Can be used for percutaneous coronary procedures (intra and postop to prevent clots over stent)
  • Can be used for HIT
  • Given IV, lower dose for those with hepatic dysfunction
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11
Q

Anticoagulant: Direct Thrombin Inhibitor: Bivalirudin (Angiomax)

A
  • Parenteral, used in percutaneous coronary procedures

- Duration of action 2 hours

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12
Q

Anticoagulant: Direct Thrombin Inhibitor: Lepirudin (Refludan)

A
  • Administer IV
  • Used as an anticoagulant when heparin is contraindicated related to heparin induced thrombocytopenia (HIT) (stop heparin and start this)
  • Pregnancy category B
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13
Q

Anticoagulant: Direct Thrombin Inhibitor: example list

A
  • Dabigatran (Pradaxa-U.S.)
  • Desirudin (Iprivask)
  • Argatroban (Argatroban)
  • Bivalirudin (Angiomax)
  • Lepirudin (Refludan)

DL DAB + -tran/-ban + -rudin*

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14
Q

Antiplatelet Drugs: example list

A
  • Aspirin
  • Dipyridamole (Persantine)

ADP receptor blockers:

  • Ticlopidine (Ticlid)
  • Clopidogrel (Plavix)
  • Prasugrel (Effient)
  • Ticagrelor (Brilinta) (used for ACS)
  • —PTCT + -clop- + -grel-

Glycoprotein IIb/IIIa receptor blockers (parenteral):

  • Abciximab (ReoPro)
  • Eptifibatide (Integrilin)
  • Tirofiban (Aggrastat)
  • — TEA + -fiba-
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15
Q

Antiplatelet: characteristics

A

Actions
- Inhibit platelet adhesion and aggregation by blocking receptors sites on the platelet membrane

Indications
- Reduce risk of recurrent TIAs or strokes; reduce death or nonfatal MI; MI prophylaxis; anti-inflammatory, analgesic, and antipyretic effects

Pharmacokinetics

  • Well absorbed and bound to plasma proteins
  • Metabolized in the liver and excreted in the urine
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16
Q

Antiplatelet: contraindications and adverse effects

A

Contraindications

  • Allergy, pregnancy, and lactation
  • Active Bleeding

Caution

  • Bleeding disorder, recent surgery, closed-head injury
  • Severe hepatic disease

Adverse Effects

  • Bleeding
  • Headache, dizziness, and weakness
  • GI distress

Drug-to-Drug Interactions
- Another drug that affects blood clotting

17
Q

Antiplatelet: GP IIB/IIIA Inhibitors

A
  • All given IV
  • Usually in combination with ASA and heparin
  • Indicated for Acute coronary syndrome
  • Unstable angina and non-Q wave MI
  • Percutaneous coronary interventions

Adverse events

  • Bleeding
  • Especially from PCI or IV site
18
Q

Antiplatelet: nuring implications

A

Assessment

  • Level of consciousness
  • Pulse, BP
  • Peripheral vascular checks
  • CBC, PT, INR, PTT, fibrinogen (clotting studies)
  • Assess for bruising, tarry stools, dark urine

Implementation

  • Give with food to decrease GI upset
  • Use electric razor, soft bristled tooth brush
  • No contact sports
  • Additional pressure after needle sticks
  • Patient should inform health care workers of anticoagulant use; increased risk of bleeding with procedures
  • Evaluate for blood loss: Petechiae, bleeding gums, bruises, dark stool/urine
19
Q

Drugs for Intermittent Claudication: examples and characteristics

A
  • Pentoxifylline (Trental)
  • cilostazol (Pletal); antiplatelet; vasodilator
  • Aspirin and clopidogrel are also used to manage IC

PACC *

  • Intermittent Claudication is pain or cramping in the lower legs that worsens with walking or exercise
  • Primary symptoms of Peripheral Vascular Disease (PVD)
20
Q

Claudication drugs: pentoxifylline (Trental) characteristics

A
  • Xanthine (like caffeine and theophylline)
  • Decreases platelet aggregation and decreases viscosity (increases flexibility of RBCs)
  • Decreased clot formation and improve blood flow through blood vessels
  • Used to treat intermittent claudication
  • Stimulates the heart, causes headache, nausea, dizziness, and GI upset
21
Q

Thrombolytic Agents: examples list

A
  • ***Tissue plasminogen activator (t-PA)
  • streptokinase (Streptase)
  • urokinase (Abbokinase)
  • alteplase (Activase)-currently available
  • reteplase (Retavase)-currently available
  • Anistreplase (Eminase)-currently available
  • Tenecteplase (TNKase)-currently available

**STUAART + -plase/-ase

22
Q

Thrombolytic Agents: characteristics and indications

A

Actions

  • Break down existing clots
  • Activating plasminogen to plasmin, which in turn breaks down fibrin threads in a clot to dissolve a formed clot
  • Breaks down a pre-formed clot (clot resolution)

Indications

  • Acute MI, pulmonary emboli, ischemic stroke
  • Also called fibrinolytics or “clot busters”
  • Extreme risk of bleeding
  • Only used for life-threatening illnesses

Pharmacokinetics

  • Drugs must be injected and are cleared from the body after liver metabolism
  • Cross the placenta but unknown if drugs enter breast milk
23
Q

Thrombolytic Agents: contraindications and adverse effects and drug interactions

A

Contraindications

  • Allergy
  • Active internal bleeding
  • History of hemorrhagic stroke
  • History of intracranial or intra-spinal surgery in the last 2 months
  • History of thoracic, pelvic or abdominal surgery in the last 10 days
  • Any condition that would be worsened by dissolution of clots (recent surgery, active bleeding…)

Adverse Effects

  • Bleeding
  • Cardiac arrhythmias
  • Hypotension

Drug-to-Drug Interactions:

  • Anticoagulants
  • Antiplatelet
24
Q

Thrombolytics: Nursing Implications

A
  • Apply pressure 20-30 minutes for puncture
  • Monitor neurological changes (slurred speech, lethargy, confusion, hemiparesis)
  • Monitor for hypotension and tachycardia; monitor VS
  • Assess pulses, monitor for bleeding
  • Monitor excretions for occult blood
  • Avoid injections if possible
25
Q

Systemic Hemostatic Agents: examples

A
  • Aminocaproic acid (Amicar) Inhibits plasmin; Classified as a systemic hemostatic agent; Used to treat excessive bleeding

drugs similar to Aminocaproic acid:

  • Desmopressin (DDAVP, Stimate)
  • Thrombin, topical (Evithrom, Recothrom, Thrombinar)
  • Tranexamic acid (Cyklokapron, Lysteda)

ADTT

26
Q

Systemic Hemostatic Agents: characteristics and adverse effects

A
  • Also called antifibrinolytic agents

Actions
- Stop the natural plasminogen clot-dissolving mechanism by blocking its activation or by directly inhibiting plasmin.

Indications
- Prevent or treat excess bleeding

Adverse effects
- Excessive clotting

27
Q

Antihemophilic therapy: characteristics

A

Actions
- Replace clotting factors that are either genetically missing or low in a particular type of hemophilia

Indications
- Prevent blood loss from injury or surgery and to treat bleeding disorders

Pharmacokinetics
- Replace normal clotting factors and are processed as such by the body

PathoPharm (7 decks)

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