Coagulation Modifying Agents Part 1: Antiplatelets and Anticoagulants Flashcards
1
Q
PARENTERAL • Heparin Type Products a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
a. Heparin, Enoxaparin
2
Q
PARENTERAL • Non-Heparin Products a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
b. Argatroban, Fondaparinux
3
Q
ORAL • Vitamin K Antagonists a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
c. Warfarin
4
Q
ORAL • NOAC/DOACs a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
d. Apixaban, Rivaroxaban, Dabigatran
5
Q
◦ Can be used in Pregnant Patients
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
A
Heparin
6
Q
USED TO DVT prophylaxis ◦ DVT/PE treatment (therapeutic) a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
Heparin
7
Q
The Steps for Heparin SQ
•For subcutaneous injections, use a 20- to 22-gauge needle to withdraw medication from the vial.
Then, change the needle to a smaller needle (25- or 26-gauge, ½ to ⅝ inches long).
•Administer deep subcutaneous injections in the abdomen, ensuring a distance of at least 2
inches from the umbilicus
•Do not aspirate
•Apply gentle pressure for 1 to 2 min after the injection.
•Rotate and record injection sites
A
dddd
8
Q
◦ Body- ◦ Petechiae, bruising, hematoma a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
a. Heparin, Enoxaparin
9
Q
OTHER ADVERSE EFFECTS ◦ Osteoporosis – LONG TERM a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
a. Heparin, Enoxaparin
10
Q
OTHER ADVERSE EFFECTS ◦ Osteoporosis – LONG TERM a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
11
Q
•REVERSAL AGENT/ANTIDOTE • Protamine Sulfate a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
a. Heparin, Enoxaparin
12
Q
•CONTRA-INDICATIONS ◦ AVOID in epidurals + neurosurgery ◦ Hematoma in the spine can cause swelling which can lead to paralysis a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
13
Q
• Pork allergy- from intestinal mucosa from pigs, Pork- religious • Recommend consulting professional a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
14
Q
Check aPTT for appropriate range, review CBC (H/H,Plts)
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
A
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
15
Q
S/s of bleeding, Monitor Hgb/hct/plts
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
A
a. Heparin, Enoxaparin
16
Q
S/s of bleeding, Monitor Hgb/hct/plts
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
A
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
17
Q
Weight based dosing, 80 kg patient
◦ 80 mg SC every 12 hours
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
A
Enoxaparin
18
Q
◦ General adult dose is 5,000 units SC every 8 or 12 hours
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
A
Heparin
19
Q
◦ General adult dose is 5,000 units SC every 8 or 12 hours
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
A
Heparin
20
Q
•USED TO TREAT (Continuous IV drip) • patients who have developed HIT • Hx of HIT with active PE/DVT a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
Argatroban
21
Q
USED TO TREAT • Continuous IV drip- patients who have developed HIT a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
Argatroban
22
Q
USED TO TREAT (Subcutaneous injection) • patients who have developed HIT • Hx of HIT with active PE/DVT • DVT/PE prophylaxis or treatment a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
Fondaparinux
23
Q
Wich cause HIT- Heparin induced thrombocytopenia causes
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
A
a. Heparin, Enoxaparin
24
Q
USED TO TREAT ◦ Mechanical Heart valves (prevent stroke/clot formation) a. Heparin, Enoxaparin b. Argatroban, Fondaparinux c. Warfarin d. Apixaban, Rivaroxaban, Dabigatran
A
c. Warfarin
25
```
PT
INR
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
c. Warfarin
26
```
ADVERSE EFFECTS
◦ Bleeding (review H/H/Plts)- BOXED WARNING FROM THE FDA
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
c. Warfarin
27
```
ADVERSE EFFECTS
◦ Skin Necrosis (<1%)
◦ Protein C
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
c. Warfarin
28
◦ Protein C
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
c. Warfarin
29
```
ADVERSE EFFECTS
◦ Purple Toe Syndrome
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
c. Warfarin
30
```
•CONTRA-INDICATIONS
◦ AVOID in epidurals + neurosurgery
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
31
```
• PREGNANCY CATEGORY X
• Heparin is safe to use as an alternative
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
c. Warfarin
32
```
•REVERSAL AGENTS
• Vitamin K/ Phytonadione (Aquamephyton®)
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
c. Warfarin
33
```
•REVERSAL AGENTS
• KCentra®- Human Clotting Factors II,VII, IX
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
c. Warfarin
34
```
•DRUG INTERACTIONS
• SSRI’s- Bleed risk
• NSAIDS- Bleed risk
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
c. Warfarin
35
• NSAIDS- Bleed risk (recommend acetaminophen instead!)
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
c. Warfarin
36
St. Johns Wort (decreases ? levels)
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
c. Warfarin
37
Limit Vitamin K in Diet
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
c. Warfarin
38
Start on heparin IV drip and warfarin while in the hospital. Wait until INR is therapeutic
◦ (5 days of overlap warfarin/heparin) before discharge
T or F
T
39
```
PATIENT EDUCATION CONTINUED:
▪Instruct patients to do things like use electric shaver, soft bristle toothbrush to
reduce risk for a bleed
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
c. Warfarin
40
Factor Xa Inhibitors
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
Apixaban, Rivaroxaban
41
•2)Direct Thrombin Inhibitor –
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
Dabigatran
42
```
• REVERSAL AGENT
• Andexanet Alfa (Andexxa®)
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
Apixaban, Rivaroxaban,
43
? must be given with food
| d. Apixaban, Rivaroxaban, Dabigatran
Rivaroxaban
44
```
USED TO TREAT:
• Atrial fibrillation (non-valvular)
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
Dabigatran
45
```
REVERSAL AGENT
Praxbind® (Idarucizumab)
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
Dabigatran
46
```
CONTRA-INDICATIONS
– Same as other anticoagulants
– Active Bleeding
– Peptic Ulcer Disease
– Neurosurgery/epidural
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
```
All
47
Must be given with full glass of water. If GI upset occurs even with full glass of water, can give with meals
a. Heparin, Enoxaparin
b. Argatroban, Fondaparinux
c. Warfarin
d. Apixaban, Rivaroxaban, Dabigatran
Dabigatran
48
P2Y12 ADP Receptor
Antagonists
a. Aspirin
b. Clopidogrel, Ticagrelor
b. Clopidogrel, Ticagrelor
49
```
Primary: (Heart + Brain)
• Coronary Stenting
• Acute MI/ Angina
• Stroke (Atrial fibrillation)
• TIA’s
a. Aspirin
b. Clopidogrel, Ticagrelor
```
a. Aspirin
50
• Pediatrics- Kawasaki (NEVER GIVE TO CHILDREN- outside of this disease)
a. Aspirin
b. Clopidogrel, Ticagrelor
a. Aspirin
51
-A sthma
-S alicylism (N/V/D, rapid breathing- hyperventilation)
-P remature closing of PDA/Platelet disaggregation/ Peptic Ulcer
Disease
-I ntestinal bleeding
-R eye’s Syndrome/Ringing in the ears/Renal Impairment/Rapid
Breathing/RESPIRATORY ALKALOSIS
-I diosyncratic Reaction
-N oise (Tinnitus)/Nephropathy
a. Aspirin
b. Clopidogrel, Ticagrelor
a. Aspirin
52
Avoid with Reye Syndrome
a. Aspirin
b. Clopidogrel, Ticagrelor
a. Aspirin
53
```
CONTRA-INDICATIONS
– Active Bleeding
– Peptic Ulcer Disease
– Children (especially if infected with a virus)
a. Aspirin
b. Clopidogrel, Ticagrelor
```
a. Aspirin
54
– Peptic Ulcer Disease
a. Aspirin
b. Clopidogrel, Ticagrelor
a. Aspirin
55
• Percutaneous Coronary Intervention (STENT placement)
a. Aspirin
b. Clopidogrel, Ticagrelor
b. Clopidogrel, Ticagrelor
56
•Thrombotic Thrombocytic Purpura (TTP)
a. Aspirin
b. Clopidogrel, Ticagrelor
b. Clopidogrel, Ticagrelor
57
```
CONTRA-INDICATIONS
– Active Bleeding
– Peptic Ulcer Disease
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”
```
b. Clopidogrel, Ticagrelor
58
```
USED TO TREAT
–Ischemic Stroke
–Massive Pulmonary Embolism
–Massive Myocardial Infarction
–Central venous catheter clearance (tiny dose
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”
```
c. alteplase “plase”
59
Tissue Plasminogen Activator (TPA) Clot bluster
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”
c. alteplase “plase”
60
```
Most STROKE guidelines allow within 3 to 4.5 hours of symptom
ONSET
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”
```
c. alteplase “plase”
61
c. alteplase “plase” Most STROKE guidelines allow within ? to ? hours of symptom
ONSET
3 to 4.5 hours
62
```
CONTRA-INDICATIONS
◦ Active Bleeding
◦ GI Bleed/ Peptic Ulcer Disease
◦ On active anticoagulants
◦ Hemorrhagic Stroke
◦ Clotting Disorders, etc.
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”
```
c. alteplase “plase”
63
POST ADMINISTRATION:
Minimize bruising or bleeding by limiting venipunctures and
subcutaneous/IM injections. Hold direct pressure to injection
site or ABG site for up to 30 min until oozing stops
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”
c. alteplase “plase”
64
Bracelet: Some facilities give patients bracelet to wear that
says “No Anticoagulants, No Antiplatelets 24 hours after
Alteplase Administration” because bleed risk is so high
a. Aspirin
b. Clopidogrel, Ticagrelor
c. alteplase “plase”
c. alteplase “plase”
