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NURS 3550 > CVS Drugs > Flashcards

CVS Drugs Flashcards

1
Q

what is hemostasis?

A

The physiologic process by which bleeding is stopped.

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2
Q

What are the 2 stages of hemostasis?

A

a) Formation of a platelet plug

b) Reinforcement of the platelet plug with fibrin.

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3
Q

How is a platelet plug formed?

A

-Platelets come in contact with collagen then adhere to site of vessel injury.

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4
Q

What is platelet aggregation?

A

Complex process that ends with formation of fibrinogen bridges between glycoprotein receptors on adjacent platelets. Glycoprotein receptors must be activated for this to happen.

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5
Q

What is coagulation?

A

Production of fibrin.

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6
Q

How is fibrin formed and what are the 2 pathways can be produced by?

A

Produced by two pathways- contact activation and tissue factor pathway.

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7
Q

How is the tissue factor pathway triggered?

A

Trauma to the vascular wall, which triggers release of tissue factor (thromboplastin)

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8
Q

What are the three things thrombin does?

A

a) Catalyzes the conversion of fibrinogen to fibrin.
b) Catalyzes the conversion of factor V into its active form.
c) Catalyzes the conversion of factor VIII into its active form.

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9
Q

How is the contact activation pathway triggered?

A

Triggered when blood makes contact with collagen that has been exposed as a result of trauma to a blood vessel wall.

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10
Q

What 4 factors require vitamin K?

A

Factors 7, 9, 10 and 2.

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11
Q

What enzyme removes blood clots in the body?

A

Plasmin.

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12
Q

What is arterial thrombosis?

A

the formation of an arterial thrombus in the arterial wall.

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13
Q

What is venous thrombosis?

A

Thrombosis in the venous walls. May result in embolus.

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14
Q

What are the 3 categories of drugs used to treat thromboembolic disorders?

A

a) anticoagulants
b) Antiplatelet drugs
c) Thrombolytic drugs

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15
Q

What do anticoagulants do?

A

Reduce formation of fibrin.

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16
Q

What are the 2 classes for anticoagulants?

A

a) Direct factor Xa inhibitors

b) direct thrombin inhibitors

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17
Q

What is the mechanism of action for heparin?

A

Enhance the activity of antithrombin.

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18
Q

How does antithrombin work?

A

It inactivates thrombin and factor Xa.

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19
Q

What are the 2 types of heparin?

A
  • Unfractionated heparin

- Low-molecular-weight heparins

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20
Q

What is unfractionated heparin?

A

Rapid acting anticoagulant administered only by injection.

21
Q

What is the mechanism of action for heparin?

A

Supresses coagulation by helping antithrombin inactivate clotting factors (thrombin and factor Xa). Heparin binds with thrombin and antithrombin to inactivate thrombin.

22
Q

What is it about heparin that makes it hard to cross membranes?

A
  • Fat
  • Juicy
  • Highly Polar
23
Q

What are the therapeutic uses of heparin?

A

-used for pregnant women.
-pulmonary embolism
- massive deep vein thrombosis
- open heart surgery
- renal dialysis
-PE
-stroke evolving
-low dose therapy postoperatively
Also used for thrombolytic therapy for MI.

24
Q

What are the adverse effects of heparin?

A

Hemorrhage, spinal hematoma, heparin induced thrombocytopenia, hypersensitivity reactions.

25
Q

What are the signs of blood loss?

A
  • BP drop
    • HR
  • bruises
  • petechiae
  • hematomas
  • cloudy urine
  • pelvic pain
26
Q

What is heparin-induced thrombocytopenia?

A

Reduced platelet counts and increase in thrombotic events.

27
Q

What are the contraindications of heparin?

A

Pts with thrombocytopenia, uncontrollable bleeding.

28
Q

What is the antidote for heparin overdose?

A

Protamine sulfate.

29
Q

How is heparin administered?

A

IV or subcut ONLY.

30
Q

What is low-molecular weight heparins?

A

Heparins that are composed of shorter molecules. Equally as effective as unfractionated heparin. Easier to give and dont need aPTT monitoring.

31
Q

What is the mechanism of action for LMW heparins?

A

Same as heparin, except it inactivates factor Xa more than thrombin because of its size.

32
Q

What are the therapeutic uses of LMW heparins?

A

a) Prevention of DVT
b) Treatment of DVT
c) Prevention of ischemic complications in pts with unstable angina.

33
Q

What is the MA of warfarin?

A

Suppresses coagulation by decreasing the production of factors 7,9,10 and prothrombin. Warfarin inhibits the enzyme needed to convert vit K into its active form, which inhibits the creation of the clotting factors.

34
Q

What are the therapeutic indications for Warfarin?

A

a) Prevention of venous thrombosis and PE.
2) Prevention of thromboembolism in pts with prosthetic heart valves
3) prevention of thrombosis in pts with afib.

35
Q

How is warfarin monitored?

A

Prothrombin time (PT) test. Average is 12 seconds. Warfarin treatment prolongs PT International normalized ratio used to interpret results. INR can be monitored at home.

36
Q

What are the adverse effects of warfarin?

A

Hemorrhage. not recommended for pregnant and lactating women.

37
Q

What are the 3 categories of drugs that interact with warfarin?

A

a) Drugs that increase anticoagulant effects
b) Drugs that promote bleeding
c) Drugs that decrease anticoagulant effects

38
Q

What are the mechanisms that increase the effects of warfarin?

A

a) Displace warfarin from plasma albumin
b) inhibit hepatic enzymes that degrade warfarin
c) decrease synthesis of clotting factors.

39
Q

What are the mechanisms that decrease the effects of warfarin?

A

a) Accelerate warfarin degeneration
b) increase clotting factors
c) inhibit warfarin abosprtion.

40
Q

What drugs produce interactions with warfarin?

A

a) Heparin
b) Aspirin
c) Nonaspirin Antiplatelet drugs
d) Acetaminophen

41
Q

What is warfarin contraindicated for?

A
  • Pts with severe thrombocytopenia
  • Uncontrollable bleeding
  • Pts undergoing lumbar puncture, surgery of eye, brain, spinal cord.
42
Q

What is the antidote for warfarin overdose?

A

Vit K b/c it antagonizes warfarin’s actions.

43
Q

What are the major differences between warfarin and heparin?

A
  • use different mechanisms to decrease fibrin formation
  • given different routes.
  • different tests used to monitor effects.
  • management of overdose is different,
44
Q

What is the MA for aspirin?

A

Causes platelet aggregation by causing irreversible inhibition of cyclooxygenase (enzyme used for platelet activation). Suppresses TXA2 vasoconstriction and platelet aggregation, reducing the risk of arterial thrombosis.

45
Q

How long can a single dose of aspirin last?

A

7-10 days (b/c the effects are irreversible)

46
Q

What are the therapeutic indications of aspirin?

A
  • Ischemic stroke
  • TIAs
  • Chronic Stable Angina
  • Unstable Angina
  • Coronary Stenting
  • Acute MI
  • Previous MI
  • Primary prevention of MI
47
Q

What are the adverse effects of aspirin?

A
  • GI bleeds

- Hemorrhagic stroke

48
Q

What test is heparin monitored with?

A

aPTT (activated partial thromboplastin time)

49
Q

What is INR?

A

international standard clotting time for blood. Measured for warfarin

NURS 3550 (11 decks)

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