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drug therapy for coagulation disorders Flashcards

1
Q

what does hemostasis mean

A

heme = blood
stasis = halt
halt of the blood

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2
Q

describe hemostasis

A

-natural process in body response to injury to tissue
-prevention or stoppage of blood loss from injured vessel (maintain vascular integrity)

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3
Q

what mechanisms are involved in hemostasis

A

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

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4
Q

describe the process of coagulation

A

plasminogin and fibrin form clot -> stop blood flow -> blood vessel is repaired -> plasmin (fibrinolysin) dissolves clot

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5
Q

whats the difference between intrinsic and extrinsic clotting pathways

A

-intrinsic is activated by trauma inside the vessel
-extrinsic is activated by trauma to the tissue around vessel

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6
Q

describe thrombogenesis

A

-formation and dissolving of thrombi
-normal body defense

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7
Q

describe arterial thrombosis

A

-obstruct arterial blood flow
-damaged arterial endothelium = platelet activation
-causes: atherosclerosis, HTN, turbulent arterial blood flow
-incomplete blockage = defificent blood flow = ischemia
-complete blockage = obstruction = necrosis

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8
Q

describe venous thrombosis

A

-reult of venous stasis
-slow venous blood flow = thrombin and procoagulant substances become concentrated
-“embolus”
-less cohesive than arterial embolus = easily detachable = travel
-classic = DVT
-dangerous r/t pulmonary embolism if detached
-1/2 patients are asymptomatic = double dangerous

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9
Q

what are the s/sx of DVT

A

-pain (particularly in lower extremity)
-errythema
-swollen
-hot

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10
Q

what is done to prevent DVT in bed bound hospital pts

A

-scds/TED
-anticoagulants may be given prophylactically

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11
Q

describe atherosclerosis

what is it and what can happen if untreated

A

-elevated lipid serum levels = lipid filled macrophages = fibrous plaques/lesions = sever ulceration and scar tissue build up in arteries
-consequences and clinical implications depend on location and size of thrombi/emobli
-progressive over time is left untreated
-heart = MI
-brain = TIA/CVA/stroke

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12
Q

what are anticoagulants used for

A

-used in thrombotic disorders (more effective in preventing venous thrombus)
-prevention of new formation or management of thromboembolic disorders
-thrombophlebitis, DVT, pulmonary embolism

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13
Q

whare are antiplatelets used for

A

-used to prevent arterial thrombus
-prevents one or more steps in prothromobtic activity of platelets

plt life = 7-10 days

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14
Q

what are thrombolytics used for

A

-dissolve thrombi and limit tissue damage in thromboembolic disorders
-stimulate conversion of plasminogen to plasmin (enzyme that breaks down fibrin)

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15
Q

do anticoagulants dissolve formed clots?

A

nope

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16
Q

describe dosing of anticoagulants

A

dosings to therapeutic levels is challenging

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17
Q

what is the main adverse effect of anticoagulants

A

bleeding

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18
Q

describe what heparin is used for

A

-does not dissolve existing clot
-anticoagulant
-given to prevent new clot formation and extension of clots present
-prevention and management of thromboembolic disorders (afib, DVT, PE)

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19
Q

describe giving heparin IV

what are you monitoring and how

A

-monitor aPTT/PTT per heparin nanogram protocol
-lab drawn approximately one hour before dosing until therapeutic
-bridge to oral anticoagulation (warfarin)

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20
Q

describe giving heparin SQ

A

-prophylaxis for DVT formation prevention in bed restricted hospital patients (dose: 5000units/ml)
-enoxaparin : low molecular weight heparin (prefilled syringe with airlock)

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21
Q

what is the antidote for heparin

A

protamine sulfate

heparin is an acid and protamine sulfate is a base (neutralizes)

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22
Q

describe warfarin

think about monitoring and dosing

A

-regulated by INR
-based on PT and INR
-lab drawn daily until therapeutic
-once therapeutic, drawn every 2-4 weeks for duration of anticoagulant therapy, unless dose adjusted

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23
Q

what is the antidote for warfarin

A

vitamin K

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24
Q

what is important to include in pt teaching for warfarin

A

-avoid foods high in vitamin K (green leafy vegetables and green tea)
-avoid grapefruit and cranberry juice, as well as alcohol (increases effects of warfarin)

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25
describe fondaparinux
-factor Xa inhibitor -SQ injection only (prefilled syringe) -prevention of DVT post hip/knee surgery -super expensive -can be IV in pts with heparin induced thrombcytopenia -does not require regular blod test monitoring
26
describe dabigatran
-direct thrombin inhibitor -tx of afib/stroke prevention -PO twice daily -does not require regular blood test monitoring
27
what is the reversal agent of dabigatran
idarucizumab
28
describe rivaroxaban
-factor Xa inhibitors -tx of afib/stroke prevention/ 2ndary DVT prevention -PO once a day -does not require regular blood test monitoring
29
describe apixaban
-facotr Xa inhibitor -tx of afib/stroke prevention -PO twice daily -does not require regular blood test monitoring
30
what is the black box warning for all factor Xa inhibitors
-do not stop abruptly -risk for rebound thrombotic event
31
what should you educate pts on when they are taking anticoagulants
-ecchymosis (increased bruising) -prolongation of bleeding episodes -dizziness, lightheadedness -hypotension -low Hgb/Hct -bloody/dark urine -CP/SOB -hemoptysis (bloody sputum)
32
what are some side effects of all anticoagulants
-risk for bleeding -may experience GI issies (dyspepsia (indigestion), nausea, upper abdominal pain, GI hemmorhage, diarrhea) -NSAID use discouraged (increased risk for GI ulcers/bleeding) -many meds/dietary interactions with anticoagulation
33
antiplatelets act by a variety of different mechanisms, what are they?
-inhibit platelet activation -inhibit platelet adhesion -inhibit platelet aggregation -inhibit procagulant activity
34
adverse effects of antiplatelets are dependent on...
the medication used
35
what are some important things to include with pt teaching on antiplatelets
-call platelets can increase risk of bleeding -following administration instructions is extremely important -too little = clot -too much = bleed tf out -report any signs of bleeding
36
what is clopidogrel and what does it do
-ADP receptor antagonist -antiplatelet -irreversibly inhibits ADP receptor on the surface of platelets (no antidote) -taken once daily, without regard for food
37
what is the antidote for clopidogrel
there is no antidote silly goose
38
describe the onset of action of clopidogrel
-extensive first pass effect -onset of action is slow so loading dose is required
39
can clopidogrel be use in conjuntion with ASA?
yep
40
does everyone respond to clopidogrel the same?
nope, there is significant variability in response
41
what are the most common side effects of clopidogrel
-pruritus (itching) -rash -purpura -diarrhea
42
who shouldnt take clopidogrel
pts with bleeding or peptic ulcer disease
43
name a thromboxane A2 inhibitor
aspirin
44
what does aspirin do
inhibits synthesis of prostaglandins = prevents formation of thomboxane A2 = **prevents platelet aggregation and thrombus formation**
45
what dose is used for aspirin when being used for antiplatelt effects and what conditions is it used for
-81-325mg -long term prevention of MI, CVA, and for pts with prosthetic heart valves -hx of stents that require antiplatelet need -also given for suspicion of active MI or TIA
46
what is the antidote for aspirin
no antidote silly goose -irreversible platelet effect -may need platelet transfusion
47
what are some side effects of aspirin
-minimal at low dose -can have risk for bleeding -stomach ulcers (take with food)
48
when shoulf caution be taken with aspirin
caution with NSAID use and other antiplatelet medications
49
give an example of a glycoprotein IIb/IIIa receptor antagonist
abciximab
50
describe what abciximab is and what it does
-antiplatelet -monoclonal antibdies that prevent the binding of fibrinogen -**this action will inhibit platelet aggregation**
51
what is abciximab used for
used for interventional procedures with ASA and heparin
52
what is a side effect of abciximab
insertional site bleeding apply pressure
53
name a phosphodiesterase -3 enzyme inhibitor
cilostazol
54
what does cilostazol do
inhibits platelet aggregation and produces vasodilation
55
what is cilostazol used for and when should symptoms improve
-used for management of **intermittent claudication** -sx should improve with tx in 2-4 weeks (can be up to 12)
56
what is intermittent claudication
-pain with activity caused by reduced blood flow to a limb, generally in the legs, relieved with rest -claudication is a sx of PAD or PVD
57
what does anagrelide do
inhibit platelet aggregation induced by cAMP, phosphodiesterase, ADP, and collagen
58
what is anagrelide used for
reduce platelet counts r/t essential thrombocythemia (excessive numbers of platelets)
59
what conditions are thrombolytics used to manage
-management of acute, severe thromboembolic disease -MI, PE, thromboembolic stroke (not hemorrhagic), iliofemoral thrombosis
60
what is the goal of using thrombolytics?
reestablish blood flow as quickly as possible, prevent/limit tissue damage
61
what is the main adverse effect of thrombolytics
bleeding
62
who administers thrombolytics
-only experienced personnel in ED/ICU or diagnostic/interventional setting with cardiac monitoring in place -close monitoring is required
63
what is needed preadministration of thrombolytics
baseline laboratories INR, aPTT, platelet count, fibrinogen
64
describe the decision to ass thrombolytics to medication regime
-weigh risk/benefit factors -avoiding invasive procedures -omitting anticoagulants or antiplatelets during use
65
what is altepase
-thrombolytic -high risk medication -recombinant plasminogen activator (rtpa or tpa) : protein that will destroy clots
66
what is altepase used to treat
-thrombus dissolution post CVA -massive PE to resotre pulmonary perfusion
67
describe the pharmacokinetics of altepase
-IV administration -metabolized in liver -excreted by kidneys -50%+ of the med is cleared from the body in 10 minutes
68
what are some side effects of altepase
-systemic bleeding -HA -epitaxis -hemoptysis -GI bleed
69
what are some nursing implications r/t altepase
-monitor for hypotension r/t increased risk for bleeding -monitor INR, platelet count, fibrinogen
70
what are some contraindications of altepase
-allergy -intracranial surgery/spinal surgery -severe hypotension -active bleeding/coagulation issues/anticoagulation medication -recent surgery -stroke aneurysm in last 2 months

Pharm 1 (29 decks)

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