CV - antiplatelets

Question 1

thrombolytic medication [fibrinolytics]

drug names

Answer 1

alteplase [tPA-tissue plasminogen activator]

streptokinase

Question 2

streptokinase + tPA [fibrinolytics]

MOA

Answer 2

dissolves clots that have already formed

-also prevents new clots

Question 3

streptokinase + tPA [fibrinolytics]

Tx

Answer 3

AMI
massive PE [tPA only]
stroke [tPA only]
restore patency to cental IV catheter [tPA only]

Question 4

streptokinase + tPA [fibrinolytics]

AE

Answer 4

• bleeding
• death
• bleeding possibly reversed by amino caproid acid IV
• anaphylacis

Question 5

streptokinase + tPA [fibrinolytics]

CI

Answer 5

• stroke w/in 3 mo

- SBP> 185

Question 6

streptokinase + atelplase + tenecteplase [fibrinolytics]

RN teaching

Answer 6

ideally give w/in 3 hr of onset of stroke symptoms
LKWT
client w acute crushing chest pain = ECG w/in 10 min
STEMI= door to needle [tPA] w/in 30 min or door to baloon (cath lab) w/in 90 min

Question 7

following thrombolytic therapy, _____ often given to prevent ______

Answer 7

heparin or ASA

rethrombosis

Question 8

antiplatelet drugs

Answer 8

ASA + clopidogrel [Plavix]

Question 9

ASA + clopidogrel [antiplatelet]

MOA

Answer 9

prevents platelets fr clumping together in arterial clotting

Question 10

ASA + clopidogrel [antiplatelet]

Tx

Answer 10

prevents reinfarction in clients following AMI

Question 11

ASA + clopidogrel [antiplatelet]

AE

Answer 11

• N/V
• dyspsea
• hemorrhagic stroke
• gastric bleeds
• tinnitus

Question 12

ASA + clopidogrel [antiplatelet]

RN teaching

Answer 12

MONA: ASA during acute MI

–discontinue ASA 5 days before surgery

Question 13

factor Xa Inhibitor

drug

Answer 13

heparin, LMWH Enoxaparin

Question 14

heparin, LMWH Enoxaparin [Xa inhibitor]

MOA

Answer 14

inhibits both thrombin + Xa factor which then inhibits fibrin formation

*enoxaparin prevents DVT

Question 15

heparin, LMWH Enoxaparin [Xa inhibitor]

AE

Answer 15

• heparin toxicity: admin protamine sulfate

- hemorrhage - check platelets [hold if <100K or aPTT>140sec]

Question 16

heparin, LMWH Enoxaparin [Xa inhibitor]

RN teaching

Answer 16

monitor for aPTT a.5-2x the baseline

Question 17

vitamin K inhibitor

drug

Answer 17

warfarin

Question 18

warfarin [vit K inhibitor]

MOA

Answer 18

antagonizes vit K to prevent synth of coag factors

Question 19

warfarin [vit K inhibitor]

therapeutic range

Answer 19

MI, Afib, Venous thrombosis: PT/INR 2-3

Mech valve or recurrent systemic embolism: PT/INR 3-4.5

Question 20

reversal agent of vit K IV

Answer 20

phytonadione

Question 21

warfarin [vit K inhibitor]

RN teaching

Answer 21

• maintain a consistent intake of vitamin K
• full therapeutic effect takes 3-5 days
• tell dentist ur taking warfarin
• avoid ETOH
• continue heparin while we start the PO warfarin

Question 22

direct thrombin inhibitors

drugs

Answer 22

bivalirudin, dabigatran, argatroban, apixaban

Question 23

direct thrombin inhibitors

MOA

Answer 23

binds w + inhibits thrombin to prevent

Question 24

direct thrombin inhibitors

Tx

Answer 24

• bivalrudin can be given along w ASA to clients who undergo PCI
• hip replacement

Question 25

direct thrombin inhibitors

interactions

Answer 25

• feverfew
• resveratrol
• saw palmetto incr risk for bleeding

Question 26

direct thrombin inhibitors

RN teaching

Answer 26

stop taking this med before surgery

Question 27

direct inhibitor of factor Xa

drug

Answer 27

rivaroxaban

Question 28

rivaroxaban (direct inhibitor of Xa)

interactions

Answer 28

feverfew
garlic
ginger
gingko biloba
resveratrol
saw palmetto

Question 29

rivaroxaban (direct Xa inhibitor)

RN teaching

Answer 29

• wait atleast 18 hr following last dose before removal of epidural catheter
• wait another 6 hr after removal of catheter before restarting rivatoxaban