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pharm exam 2 > drug therapy coagulation disorders > Flashcards

drug therapy coagulation disorders Flashcards

1
Q

heme means

A

blood

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2
Q

stasis means

A

halt

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3
Q

hemostasis means

A

halt of the blood

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4
Q

inferior vena cava brings blood from

A

the lower body extremities

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5
Q

prevention in hemostasis is what

A

stoppage of blood loss from injured vessel (maintains vascular compartment integrity)

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6
Q

mechanisms involved in hemostasis

A

vasoconstriction

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7
Q

what will you see with hemostasis

A

formation of platelet plug, sequential activation of clotting factors, reparation of the opening in damaged vessel

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8
Q

plasminogen & fibrin form color = what

A

stops blood flow = blood vessel repaired = plasmin(fibrinolysis) dissolves clot

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9
Q

what is the primary organ responsible for clotting factors

A

liver

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10
Q

intrinsic pathway is activated where

A

by trauma inside the blood vessels, starts when blood is exposed to collagen factor 12

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11
Q

extrinsic pathway occurs when

A

there is external trauma that occurs (vascular tissue trauma or trauma around the tissue)

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12
Q

thrombogenesis

A

formation and dissolving of thrombi; normal body defense

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13
Q

atrial thrombosis

A

obstruct arterial blood flow

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14
Q

what causes arterial thrombosis

A

atherosclerosis, HTN, turbulent arterial blood flow

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15
Q

incomplete blockage of arterial thrombosis

A

deficient blood flow= ischemia

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16
Q

complete blockage of arterial thrombosis

A

obstruction = necrosis (tissue death)

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17
Q

when there is damaged arterial endothelium what happens

A

platelet activation

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18
Q

venous thrombosis

A

result of venous stasis

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19
Q

slow venous blood flow =

A

thrombin and procoagulant substances become concentrated and form embolus

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20
Q

venous thrombosis is what compared to arterial thrombus

A

it is less cohesive making easily detachable and travel

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21
Q

pulmonary embolism are

A

life threatening

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22
Q

classic deep vein thrombosis s/sx

A

pain in lower extremities, erythema, swollen, hot (heat),

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23
Q

with atherosclerosis, you will see

A

elevated lipid serum levels, lipid filled macrohphages = fibrous plaques/ lesions = severe ulceration and scar tissue

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24
Q

if the blood clot in in the heart what could happed

A

myocardial infarction

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25
Q

if blood clot is in the brain, what could happen

A

TIA(warning sign to a stroke)/ CVA/ stroke

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26
Q

anticoagulants are used for

A

thrombotic disorders (more effective in preventing venous thrombus)

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27
Q

antiplatelets are used to

A

prevent arterial thrombosis

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28
Q

thrombolytics do what

A

dissolve thrombi and limit tissue damage in thromboembolic disorders

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29
Q

(venous) anticoagulants do not

A

dissolve clots

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30
Q

anticoagulants prevent

A

newer formation or management of thromboembolic disorders, thrombophlebitis, DVT, pulmonary embolism

31
Q

adverse effects of anticoagulants

A

bleeding

32
Q

anticoagulant medications

A

heparin(does not dissolve existing clot), warfarin, fondaparinux, dabigatran, rivaroxaban, apizaban

33
Q

heparin is given to

A

prevent new clot formation and extension of clots present; prevention and management of thromboembolic disorders (Afib, DVT, PE)

34
Q

if giving heparin IV what do you monitor

A

aPTT/PTT per heparin nanogram protocol: lab drawn ~equal to 1 hour before dosing until therapeutic/ bridge to oral anticoagulation

35
Q

if giving heparin SQ it is for

A

DVT formation prevention in bed restricted hospital patients

36
Q

SQ of heparin medication

A

enoxaparin: low molecular weight heparin (prefilled syringe with air lock)

37
Q

antidote for heparin

A

protamine sulfate (base)

38
Q

antidote for warfarin

A

vitamin K

39
Q

when teaching patients about warfarin what do you want to teach

A

avoid foods high in vitamin K: green leafy veggies, green tea; avoid grapefruit juice, cranberry juice and alcohol

40
Q

what to monitor with warfarin

A

PT/IRN (should be between 2-3)

41
Q

standard dose of heparin

A

25,000 units in 500 mL D5W IV start at 1000 units/hr

42
Q

fondaparinux (arixtra) is

A

factor Xa inhibitor, SQ injection only (prevention of DVT post hip/knee surgery), can be IV in pt’s with heparin induced thrombocytopenia

43
Q

dabigatran (Pradaxa) is

A

direct thrombin inhibitor, Tx of Afib/ stroke prevention/ PO twice a day; idarucizumab = antidote

44
Q

dabigatran (Pradaxa) is

A

direct thrombin inhibitor, Tx of Afib/ stroke prevention/ PO twice a day; idarucizumab = antidote

45
Q

rivaroaxaban (Xarelto) is

A

factor Xa inhibitor; Tx of Afib/ stroke prevention/ secondary DVT prevention/ PO once a day

46
Q

apixaban (eliquis) is

A

factor Xa inhibitor’ Tx of Afib/ stroke prevention/ PO twice daily

47
Q

s/sx of using anticoagulants

A

ecchymosis(increase bruising), prolongation of bleeding episodes, dizziness, lightheaded, hypotension, low hbg/hct, bloody/dark urine, CP/SOB/ hemoptysis(cough up blood)

48
Q

what issues may patients experience with anticoagulants

A

gastrointestinal issues (dyspepsia, nausea, upper abdominal pain, GI hemorrhage and diarrhea)

49
Q

the use of what is discouraged when taking anticoagulants

A

NSAID (increased rheumatoid factor GI ulcers/ bleeding)(ibuprofen, alive, aspirin)

50
Q

antiplatelets act by a variety of mechanisms such as

A

inhibit platelet activation, inhibit platelet adhesion, inhibit platelet aggregation, inhibit procoagulant activity

51
Q

adverse effects of antiplatelets

A

depend on medication; increase risk fro bleeding

52
Q

anti platelet medications

A

clopidogrel, aspirin, abciximab, cilostazol, anagrelide

53
Q

clopidogrel (plavix) is what

A

ADP receptor antagonist; irreversibly inhibit ADP receptor on surface of platelets (no antidote); extensive first pass= slow loading dose required; can be used in conjunction with ASA

54
Q

common side effects of clopidogrel

A

pruritus, rash, purpura, and diarrhea

55
Q

a patient on clopidogrel, do not use in patient with

A

bleeding or peptic ulcer disease

56
Q

aspirin is what

A

thromboxane A2 inhibitors; inhibits synthesis of prostaglandins = prevents formation of thromboxane A2 = prevents PLT aggregation and thrombus formation

57
Q

when to give aspirin

A

for long term prevention of MI, CVA and for patients with prosthetic heart valves/ hx of stents that require antiplatelet need/ also give or suspicion of active MI or TIA

58
Q

side effects of aspirin

A

minimal at low dose/ can have rheumatoid factor bleeding/ stomach ulcers

59
Q

abciximab is what

A

glycoprotein IIb/IIIa receptor antagonists; monoclonal antibodies that prevent the binding of fibrinogen, this action will inhibit platelet aggregation

60
Q

abciximab is used for interventional procedures with

A

ASA and heparin (side effects: insertional site bleeding = pressure)

61
Q

cilostazol is what

A

phosphodiesterase- 3 enzyme inhibitors: inhibits platelet aggregation and produces vasodilation

62
Q

cilostazol is used for

A

management of intermittent claudication

63
Q

claudication is a symptom of

A

the peripheral artery or peripheral vascular disease

64
Q

anagrelide does what

A

inhibit platelet aggregation induced by cAMP phosphodiesterase, ADP, and collagen

65
Q

anagrelide is used for

A

to reduce platelet counts r/t essential thrombocythemia (excessive numbers of platelet)

66
Q

thrombolytic agents do what

A

given to dissolve thrombi; stimulate conversion of plasminogen to plasmin (enzyme that breaks down fibrin); management of acute, severe thromboembolic disease (MI, PE, thrombi-emolic stroke)

67
Q

goal of thrombolytic agents

A

reestablish blood flow as quickly as possible, prevent/ limit tissue damage

68
Q

adverse effect of thrombolytic agents

A

bleeding

69
Q

thrombolytic therapy high risk medication

A

altepase; recombinant plasminogen activator: protein that will lysis or destroy clots

70
Q

altepase tx

A

thrombus dissolution post CVA/ massive PE to restore pulmonary perfusion

71
Q

altepase is administered by

A

IV, metabolized in live, excreted by the kidneys; 50% of medication is cleared from body in 10 minutes

72
Q

side effects of altepase

A

systemic bleeding, HA, epistaxis(bleeding from nose), hemoptysis, GI bleed

73
Q

contraindications of altepase

A

allergy, intracranial surgery/ spinal surgery, severe hypotension, active bleeding/ coagulation issues/ anticoagulation med, recent surgery, stroke aneurysm in last 2 months

pharm exam 2 (8 decks)

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