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DPT 530 > CV: Anticoagulants > Flashcards

CV: Anticoagulants Flashcards

1
Q

what are the 3 categories of anticoagulation meds?

A

anticoagulant

antiplatelet

fibrinolytic

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2
Q

anticoagulants prevent what in what?

A

clot formation in venous system

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3
Q

do anticoagulants prevent clot formation in the venous or arterial system?

A

venous system

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4
Q

what meds prevent venous thrombosis?

A

anticoagulants

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5
Q

antiplatelet meds prevent what?

A

clot formation

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6
Q

do anti platelets prevent clot formation in the venous or arterial system?

A

arterial system

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7
Q

what do fibrinolytics do?

A

facilitate destruction of blood clots to re-establish blood flow

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8
Q

what are the 4 different anticoagulants?

A

1) heparin
2) Coumadin
3) direct thrombin inhibitors
4) factor Xa inhibitors

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9
Q

what is the primary indication for anticoagulants?

A

DVT

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10
Q

anticoagulants are administered for acute Rx of _____ ______ and ________

A

venous thrombosis and thromboembolism (VTE)

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11
Q

what are other indications for anticoagulants?

A

individuals at high risk for developing VTE following:
- surgical procedures (jt replacement, mech heart valve)
- CV events (MI, a fib, ischemic CVA)
- medical conditions causing dec activity/periods of immobility

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12
Q

can anticoagulants be given prophylactically?

A

yes

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13
Q

what is the primary drug fro initial Rx for clots in the venous system?

A

unfractionated heparin

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14
Q

what does unfractionated heparin do?

A

activates antithrombin protein to bind to clotting factors (thrombin, IXa, Xa) to render them inactive

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15
Q

t/f: unfractionated heparin are large sugar like molecules that are poorly absorbed by the GI tract, therefore administered IV as an infusion or SQ injection

A

true

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16
Q

is heparin taken orally or by injection?

A

injection

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17
Q

fractionated (LMWH) Heparein usually ends in what?

A

-parin

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18
Q

what kind of meds are Enoxaparin (Lovenox), Daltepin (Fragmin), and Tinzaparin (Innonep)?

A

fractionated (LMWH) Heparin

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19
Q

how is fractionated (LMWH) Heparin administered?

A

SQ injection

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20
Q

t/f: therapeutic effects of unfractionated heaprin are seen instantly

A

true

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21
Q

how many times a day is fractionated vs no fractionated heparin administered?

A

unfractionated=2x/day
fractionated=1x/day

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22
Q

are there less adverse effects with fractionated or unfractionated heparin?

A

fractionated

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23
Q

fractionated heparin is less likely to lead to _____ and _____

A

hemorrhage, HIT

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24
Q

t/f: fractionated heparin decreased the need for lab monitoring

A

true

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25
Q

what is the primary drug for long term Rx and/or prevention of DVT and PE and for maintanance of a mechanical heart valve?

A

Warfarin (Coumadin)

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26
Q

warfarin (coumadin) is a ______ antagonist

A

vit k

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27
Q

warfarin (coumadin) interferes with metabolism of what in the liver?

A

vit k

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28
Q

t/f: warfarin(Coumadin) impairs several clotting factors (II, VII, IX, X)

A

true

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29
Q

overtime, with the use of warfarin (Coumadin), levels of clotting factors in circulation____, decreasing blood coagulability

A

decreases

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30
Q

how is warfarin(Coumadin) administered?

A

orally

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31
Q

what is the lag time of warfarin(coumadin)?

A

several days until the therapeutic effects are achieved

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32
Q

t/f: the therapeutic effects of warfarin(Coumadin) are seen instantly

A

false, they take several days

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33
Q

what is given at the same time when warfarin(coumadin) is initiated?

A

heparin

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34
Q

t/f: you must monitor therapeutic levels of warfarin (Coumadin) using standardized lab tests

A

true

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35
Q

what are the standardized lab tests to measure levels of anticoagulants in the blood?

A

PT
aPTT
INR

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36
Q

when warfarin(coumadin) is utilized to maintain a mechanical heart valve, the pt must keep INR therapeutic levels in the acceptable range of ____ to ____

A

2.5-3.5

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37
Q

when warfarin (Coumadin) is utilized to Rx/prevent DVT/PE, the pt must keep INR therapeutic levels in the acceptable range of ____ to ____.

A

2.0-3.0

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38
Q

what do coagulation tests measure?

A

blood’s ability to clot as well as the length of time it takes

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39
Q

what do coagulation factor assays assess?

A

the fxn of coagulation factors

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40
Q

when are coagulation tests and assays used?

A

for pre-op testing, to assess unexplained bleeding, and to monitor anticoagulation therapies

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41
Q

what is PT time (prothrombin time)?

A

measurement used to determine the efficacy of the anticoagulant warfarin (Coumadin)

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42
Q

what is aPTT (activated partial thromboplastin time)?

A

used to monitor pt response to unfractionated heparin (no standardization)

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43
Q

there is no standardization for what coagulation test or assay?

A

aPTT

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44
Q

what is INR (international normalized ratio)?

A

calculates the pt prothrombin divided by the control prothrombin used to monitor pt therapeutic level of warfarin (Coumadin)

allows for comparable monitoring bw labs of warfarin and other vit k antagonists

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45
Q

what is the normal range for PT time?

A

11-12.5

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46
Q

what is the therapeutic range for PT time?

A

1/5-2x the control value

about 16-25

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47
Q

what is the normal range for aPTT?

A

30-40

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48
Q

what is the therapeutic range for aPTT?

A

1.5-2.5x the control value

about 45 to 100

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49
Q

what is the normal range for INR?

A

0.8-1.1

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50
Q

what is the therapeutic range for INR for DVT prophylaxis?

A

1.5-2.0x the control value

about 1 to 2

51
Q

what is the therapeutic range for INR for hx of TIA or CVA and aortic valve replacement?

A

2.5-3.5x the control value

about 2 to 4

52
Q

what is the therapeutic range for INR for PE?

A

2.5-3.5x the control value

about 2 to 4

53
Q

what is the therapeutic range for INR for DVT, a fib, mitral/aortic valve replacement, orthopedic surgery?

A

2-3x the control value

about 2 to 3

54
Q

when can someone on warfarin (Coumadin) be discharged home?

A

when the therapeutic range is met

55
Q

what is a possible critical value for warfarin(coumadin)?

A

5.5

56
Q

t/f: ranges for coagulation tests and assays are pt specific and dependent on pts acute condition, prescribed meds, and past medical hx

A

true

57
Q

range for coagulation tests are dependent on what 3 factors?

A

the pt’s acute condition

prescribed meds

past medical hx

58
Q

PTs should observe for what signs in a pt on anticoagulants?

A

increased bruising and bleeding

59
Q

what are the clinical implications of warfarin (coumadin)?

A

fall prevention screening and interventions as needed

prolonged pressure if site bleeds

examine skin for bruising, patechilae, or blood in urine

changes in Neuro condition due to increased risk of intracranial bleeding

60
Q

the anticoagulant effects of warfarin (Coumadin) can be reversed by what?

A

vit k

61
Q

if a pt’s INR reaches > ___ clotting time, there is an increased risk for bleeding (internal, intracranial)

A

4.5

62
Q

t/f: vit k may be given with warfarin (Coumadin) to lower an INR of greater than 5

A

true

63
Q

pts taking warfarin (Coumadin) are advised to monitor what?

A

their dietary intake and limit food high in vit k

64
Q

what foods are high in vit k?

A

leafy greens like spinach, broccoli, kale, brussel sprouts, cabbage, asparagus, and avocado

65
Q

what 3 drinks should be avoided with warfarin (Coumadin)?

A

green tea

cranberry juice

alcohol

66
Q

what do direct thrombin inhibitors do?

A

they bind directly to thrombin and inhibit its ability to convert fibrinogen to fibrin

67
Q

what kind of anticoagulant is Lepirudin (Refludan)?

A

direct thrombin inhibitors

68
Q

what kind of anticoagulant is Dabigatran (Pradaxa)?

A

direct thrombin inhibitors

69
Q

how is Dabigatran (Pradaxa) administered?

A

can be given orally for stroke and systemic embolism prevention in pts w/AFib or DVT

70
Q

how are direct thromin inhibitors administered?

A

IV or SQ

71
Q

t/f: direct thrombin inhibitors are more effective and have less side effects with less drug interactions

A

true

72
Q

what do factor Xa meds do?

A

directly inhibit factor Xa in clotting cascade

73
Q

what are the factor Xa inhibitors?

A

Fondaparinux (Arixtra)

Apixaban (Eliquis)

Rivaroxaban (Xarelto)

74
Q

how is Fondaparin (Arixtra) administered?

A

SQ following hip fx, Ortho surgery, and other surgery for DVT prevention

75
Q

what are two of the biggest factor Xa meds given?

A

Apixaban (Eliquis) and Rivaroxaban (Xarelto)

76
Q

what factor Xa meds are given orally for thromboembolic disease prevention, esp pts w/a fib?

A

Rivaroxaban (Xarelto)

77
Q

what is another name for Rivaroxaban (Xarelto)?

A

NOACs or DOACs (new or direct oral anticoagulants)

78
Q

how do antiplatelet meds work?

A

preventing excessive clotting caused by increased platelet activity to prevent arterial clots from forming

79
Q

when are antiplatelet meds given?

A

with coronary artery occlusions, cerebral/carotid artery disease, or after cerebral infarct

80
Q

what are the antiplatelet meds?

A

Aspirin

ADP receptor blockers

Glycoprotein 2b-3a receptor blockers

81
Q

how does Aspirin work?

A

decreased platelet aggregation by inhibiting synthesis of PGs and thromboxane

82
Q

what is an effective dose of Aspirin for antiplatelet effects?

A

75-325 mg taken orally

83
Q

t/f: the antithrombotic effects of Aspirin are achieved bc it inhibits platelet fxn irreversibly

A

true

84
Q

t/f: once the Aspirin reaches the platelet it inhibits it for its lifetime (7-8 days)

A

true

85
Q

what are the indications for Aspirin as an antiplatelet med?

A

Rx and prevention of acute MI (men>women)

prevention of ischemic CVA (women>men)

prevention of DVT in peripheral veins

following athrosclerotic plaque formation

86
Q

how do ADP receptor blockers work as antiplatelet meds?

A

it inhibits adenosine diphosphate receptors on the platelet membrane

87
Q

what does ADP normally do?

A

signals increased platelet activity

88
Q

what are the ADP receptor blockers?

A

Clopidogrel (Plavix)

Prasugrel (Effient)

Ticlopidine (Ticlad)

89
Q

t/f: Clopidogrel (Plavix) can be used with Aspirin for “dual anti-platelet” therapy after cardiac surgery or stenting when Aspirin alone isn’t enough

A

true

90
Q

which ADP receptor blockers is used a lot with unstable angina or when awaiting surgery?

A

Prasugrel (Effient)

91
Q

ADP receptor blockers are used to prevent thrombosis in what pts?

A

pts with unstable angin, acute coronary syndromes, a fib, and those at risk for MI, ischemic stroke

92
Q

ADP receptor blockers can be given to prevent what?

A

acute infarct following cardiac procedures/interventions (angioplasty and stenting)

93
Q

how do glycoprotein 2b-3a receptor blockers work?

A

by inhibiting the ability of fibrin to activate platelets

blocks glycoprotein receptors on the platelet membrane stimulated by fibrinogen

fibrinogen therefore can’t bind, decreasing platelet induced clotting

94
Q

what meds are the most powerful inhibitors of platelet activity?

A

glycoprotein 2b-3a receptor blockers

95
Q

what are the primary indications for glycoprotein 2b-3a receptor blockers?

A

to prevent thrombosis following balloon angioplasty and other percutaneous coronary interventions

96
Q

how are glycoprotein 2b-3a receptor blockers administered?

A

IV b4, during, and after (short-term) to maintain coronary blood flow and decrease mortality following balloon angioplasty

97
Q

what are theglycoprotein 2b-3a receptor blocker meds?

A

Abaximab (Reopro)

Eptifibatide (Integrilin)

Tirofiban (Aggrastat)

98
Q

how do fibrinolytic meds work?

A

facilitating the breakdown and dissolution of clots that already formed by converting plasminogen to plasmin

99
Q

how are fibrinolytics administered?

A

IV

100
Q

t/f: fibrolytics affect ALL vasculature

A

true

101
Q

why is there an increased risk for intracranial hemorrhage with fibrinolytics?

A

bc they effect ALL vasculature

102
Q

when are fibrinolytics contraindicated?

A

when a pt has a hx of hemorrhagic stroke, intracranial neoplasms, and internal bleeding

103
Q

what are the 4 indications for fibrinolytics?

A

1) Rx of acute MI
2) Rx of acute ischemic CVA
3) dissolving clots in peripheral arteries and large veins
4) dissolving acute, massive PEs if life threatening and causing cardiac compromise

104
Q

how soon after onset of symptoms of MI should fibrinolytics be given to restore coronary bloodf low, prevent myocardial damage, and Dec morbidity and mortality associated with MI?

A

12 hours

105
Q

t/f: there is up to 50% decrease in negative effects of an MI if fibrinolytic are administered in less than an hour after onset of symptoms

A

true

106
Q

why are fibrinolytic given to treat acute ischemic CVA?

A

bc they restore blood flow and prevent further damage to the brain tissue

107
Q

how soon after onset of symptoms should fibrinolytics be given to treat acute ischemic CVA?

A

3 hours

108
Q

when fibrinolytics are given to dissolve clots in peripheral arteries, how are they administered?

A

via intravascular catheter directly to the site of the clot

109
Q

what 2 fibrinolytics are no longer used in the US?

A

Streptokinase and Urokinase

110
Q

what are the fibrinolytic drugs?

A

TPA

Alteplase (Activase)

Reteplase (Retavase)

Tenecteplase (TNKase)

111
Q

which fibrinolytic is used a lot w/ischemic stroke to break up a clot?

A

Alteplase (Activase)

112
Q

what is the primary fibrinolytic agents used more effectively for cerebral vessels than coronary?

A

Alteplase (Activase)

113
Q

what are Reteplase (Retavase) and Tenecteplase (TNKase) derived from?

A

human TPA

114
Q

how are Reteplase (Reavase) and Tenecteplase (TNKase) given?

A

via a more rapid infusion called a “bolus”

a single injection given 2x, 30 minutes apart

115
Q

what is the benefit of Tenecteplase (TNKase)?

A

it’s more specific for activating plasminogen and less risk of converting an ischemic stroke to a hemorrhagic stroke

116
Q

what is the primary, most serious problem with anticoagulants?

A

hemorrhage

117
Q

what type of hemorrhage is especially at risk with anticoagulants?

A

intracranial hemorrhage

118
Q

what are PT implications for anticoagulants?

A

bruising and bleeding

fall risk

caution with wound care, deep tissue massage, chest percussion, and manual techniques

119
Q

t/f: there is a lower risk of bleeding with new anticoagulant eds like Xa inhibitors and direct thrombin inhibitors leading to less risk for hemorrhagic conversion

A

true

120
Q

what are potential adverse effects of anticoagulants?

A

hemorrhage

HIT

GI bleeds

liver/kidney toxicity

hypotension

excessive bruising

itching, nausea, anaphylaxis (fibrinolytics)

blood dyscrasia (Ticlid)

121
Q

what are the blood dyscrasia with Ticlid?

A

neutropenia, thrombocytopenia, and agranulocytosis

122
Q

what is HIT?

A

heparin induced thrombocytopenia

50% drop in platelet count w/in 4-10 days post heparin

very serious if it occurs and should d/c heparin and use a different anticoagulant

123
Q

what things should pts watch for on anticoagulants?

A

blood in urine/stool

bleeding gums

unexplained, severe nosebleeds

increased menstrual flow

GI distress esp with Aspirin

124
Q

when pts are on fibrinolytics, what should PTs be aware of?

A

the time of administration b4 mobilizing

DPT 530 (14 decks)

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