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Pharm Chapter Exam 2 materials > Coagulations > Flashcards

Coagulations Flashcards

1
Q

What are anticoagulants used for?

A

Used in thrombotic disorders to prevent New clot formation.

Think of DVT, PE, Thrombophlebitis or Post-op Surgery

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2
Q

What are antiplatelets used for?

A

To prevent arterial thrombosis by suppressing platelet aggregation

For patients with Hxn of bypass surgery, MI, and Stents

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3
Q

What are Thrombolytics used for?

A

Dissolve thrombi and limit tissue damage in thromboembolic disorders.

For strokes.

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4
Q

What is the adverse effect of anticoagulants?

A

Bleeding.

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5
Q

What are things Anticoagulants not used for?

A

It is not used for dissolving formed clots.

Does not improve blood flow in tissues around the clot.

Does not prevent ischemic damage beyond the clot.

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6
Q

What drug is classified as an anticoagulant?

A

Heparin.

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7
Q

What is the MOA of Heparin?

A

Depends on Dosage.

Low dosage = Inactivates factor Xa and inhibits conversion of prothrombin to thrombin.

High dosage = inactivates factors Ix, X, XI, XII and thrombin and inhibits conversion of fibrinogen to fibrin.

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8
Q

What is Heparin used for?

A

DVT and PE prophylaxis and treatment

Acute coronary syndromes: PCI, STEMI

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9
Q

What are ASE of Heparin?

A

HIT (Heparin induced thrombocytopenia), ecchymosis, bleeding risk, hypersensitivity, N/V

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10
Q

How is Heparin administered?

A

IV or SQ

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11
Q

What lab value should be monitored for Heparin?

A

PTT. Therapeutic range is 45-70

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12
Q

What is the contraindication for Heparin?

A

Severe thrombocytopenia.

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13
Q

What should be taught to patients with Heparin?

A

Rotate injection sites, teach bleeding risk precautions, hold pressure to wounds, report severe symptoms.

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14
Q

What drug is classified as Low Molecular Weight Heparins (LMWH)?

A

Enoxaparin.

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15
Q

What is the MOA of Enoxaparin?

A

Inactivates coagulation factor Xa and produces anticoagulation.

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16
Q

What is Enoxaparin used for?

A

DVT prophylaxis, ACS, unstable angina, acute DVT

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17
Q

What are the ASE of Enoxaparin?

A

Injection site hematoma, nausea, peripheral edema, bleeding

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18
Q

What is the antidote of Enoxaparin?

A

Protamine sulfate

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19
Q

What administration safety should the nurse know about Enoxaparin?

A

Air bubble is needed

DO NOT RUB SITE AFTER INJECTION

Peaks 3-5 hours and lasts 12 hours SQ

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20
Q

Do we need PTT monitoring for Enoxaparin?

A

No

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21
Q

What can be caused by Heparin Induced Thrombocytopenia?

A

Thrombocytopenia and Thrombosis due to peripheral platelet consumption and platelet activation.

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22
Q

What should the nurse do if the patient is suspected of HIT?

A

DISCONTINUE THE DRUG IMMEDIATELY.

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23
Q

What is a normal platelet count?

A

150000 to 3500000

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24
Q

What medication can be used for HIT instead of heparin?

A

Direct thrombin inhibitors

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25
Q

How would platelet count look like for patient with HIT?

A

Their platelet count would decrease by 30-50% of the their baseline (pre-heparin) platelet count.

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26
Q

Can HIT occur with LMWH?

A

Yes, but less common.

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27
Q

Is HIT life-threatening?

A

Yes

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28
Q

What drug is classified as an Anticoagulant?

A

Warfarin.

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29
Q

What is the MOA of Warfarin?

A

Interferes with hepatic synthesis of Vitamin K-dependent clotting factors.

Prevents formation of blood clots.

30
Q

What is Warfarin used for?

A

Prevention of venous thromboembolism, Atrial fibrillation embolization, coronary thrombosis, pulmonary embolism.

31
Q

What are the ASE of Warfarin?

A

Bleeding, anemia, hemorrhage, fever, dizziness, lethargy, fetal malformations, and abnormal bone development.

32
Q

How is Warfarin administered?

A

PO or IV

33
Q

What are the contraindications of Warfarin?

A

Pregnancy, bleeding, or hemorrhagic tendencies

34
Q

What is the antidote of Warfarin?

A

Vitamin K

35
Q

What should the nurse be aware of with Warfarin?

A

It is a highly protein bound medications so use precaution when giving with another highly protein bound medication due to increased risk of warfarin toxicity

36
Q

What should the nurse monitor for with a patient on Warfarin?

A

PT/INR.

Target is 2-3

37
Q

A patient on warfarin asked if he has to stop eating spinach when on warfarin. What should the nurse say?

A

Do not avoid foods with Vitamin K. Just have a consistent amount of Vitamin K food everyday.

38
Q

What class is Apixaban under as?

A

Anticoagulant.

39
Q

What is the MOA of Apixaban?

A

Factor Xa inhibitor

40
Q

What is Apixaban used for?

A

Nonvalvular A-Fib, DVT, PE, Venous Thromboembolism prophylaxis

41
Q

What are the ASE of Apixaban?

A

Hemorrhage, thrombosis with premature discontinuation.

42
Q

What are the contraindications for Apixaban?

A

Hypersensitivity and active bleeding.

43
Q

What is the antidote for Apixaban?

A

Andexanet alfa.

44
Q

What needs to be monitored for patients on Apixaban?

A

Nothing. No monitoring is needed.

45
Q

What drug is classified as Direct Thrombin Inhibitors (DTI)?

A

argatroban

46
Q

What is the MOA of argatroban?

A

Directly inhibits thrombin from converting fibrinogen to fibrin.

47
Q

What is argatroban used for?

A

HIT, DVT, PE, Percutaneous Coronary Intervention

48
Q

How is argatroban administered?

A

IV only

49
Q

What are the ASE of argatroban?

A

Bleeding, hypotension, chest pain, cardiac arrest, injection site reaction, N/V, GI upset, anemia, hematoma

50
Q

What is the antidote for argatroban ?

A

None

51
Q

What are antiplatelets mainly used for?

A

Prophylatic use. AKA prevent MI and strokes

52
Q

A patient that uses daily low dosage aspirin is scheduled for a surgery. What should the nurse do?

A

Tell the patient to stop taking their antiplatelet medication for 7 days before their surgery.

53
Q

What drug is classified as an Antiplatelet agent?

A

Clopidogrel

54
Q

What is the MOA of Clopidogrel?

A

Inhibits platelet aggregation and prevents ADP from binding to ADP platelet receptors

55
Q

What is Clopidogrel used for?

A

To prevent thrombosis associated with unstable angina, acute MI, stroke, TIA

56
Q

What ASE is associated with Clopidogrel?

A

Hypotension, hypertension, bronchospasm, elevated hepatic enzymes, peptic ulcer

57
Q

How is Clopidogrel administered?

A

PO

58
Q

What should be taught to a patient on Clopidogrel?

A

Increased bleeding risk when taken with certain herbal supplements like ginger, garlic, and green tea.

Do not take grapefruit juice

Higher risk for bleeding and bruising.

59
Q

When should labs be drawn for Heparin?

A

1 hour prior to dosing

60
Q

When should labs be drawn for Warfarin>

A

Daily until therapeutic.

Then drawn every 2 to 4 weeks for duration of anticoagulant therapy.

61
Q

What is the main goal of using thrombolytic agents?

A

To reestablish blood flow as quickly as possible.

Prevent/limit tissue damage.

62
Q

What drug is classified as Thrombolytic?

A

alteplase (Activase)

63
Q

What is the MOA of alteplase?

A

To convert plasminogen to plasmin, which digests fibrin and dissolves clot; also initiates fibrinolysis.

64
Q

What is alteplase used for?

A

To dissolve existing clots, treat acute MI, DVT, CVA, PE, arterial thrombosis, to clear IV catheters.

65
Q

What ASE are associated with alteplase?

A

Abnormal bleeding, Stroke, dysrhythmias, PE

66
Q

What is contraindicated with alteplase?

A

Patients with bleeding disorder or who have had recent trauma or surgery.

67
Q

How is alteplase administered?

A

Must be given within 12 hours of symptoms of MI and 3 hours of CVA.

68
Q

What is the antidote of alteplase?

A

Aminocaproic acid

69
Q

What are the contraindications for Thrombolytic Therapy?

A

Uncontrolled severe HTN

Aneurysm

AV malformation

Internal bleeding

Intracranial or intraspinal surgery.

70
Q

What labs are usually needed prior to Thrombolytic therapy?

A

INR, aPTT, platelet count

Pharm Chapter Exam 2 materials (6 decks)

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