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Pharm II > Drugs Affecting Blood Coagulation > Flashcards

Drugs Affecting Blood Coagulation Flashcards

1
Q

blood vessel injury

A

local vasoconstriction seals off small injury; platelets form a plug; thrombin seals system; extrinsic pathway clots the blood that has leaked out

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2
Q

types of blood disorders

A

thromboembolic disorder; hemorrhagic disorder

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3
Q

thromboembolic disorder

A

conditions that predispose a person to the formation of clots and emboli

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4
Q

hemorrhagic disorder

A

disorder in which excess bleeding occurs

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5
Q

action of anticoagulants

A

warfarin, heparin; interfere with the clotting cascade and thrombin formation

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6
Q

action of antiplatelet

A

acetylsalicylic acid (ASA); alter the formation of the platelet plug

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7
Q

action of thrombolytic drugs

A

break down the thrombus that has been formed by stimulating the plasmin system (clotbusters)

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8
Q

action of ASA

A

inhibit platelet adhesion and aggregation by blocking receptor sites on the platelet membrane

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9
Q

anagrelide

A

blocks the production of platelets in bone marrow

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10
Q

indications of ASA

A

prevent cost formation; reduce risk of recurrent TIAs or strokes; reduce death or nonfatal MI; MI prophylaxis; anti-inflammatory, analgesic, and antipyretic effects

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11
Q

pharmacokinetics of ASA

A

well absorbed and bound to plasma proteins; metabolized in the liver and excreted in the urine

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12
Q

contraindications of ASA

A

allergy, pregnancy, and lactation

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13
Q

cautions of ASA

A

bleeding disorder, recent surgery, close-headed injury

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14
Q

adverse effects of ASA

A

bleeding; headache, dizziness, weakness; GI distress

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15
Q

drug-drug interactions of ASA

A

another drug that affects blood clotting; ASA, herbals

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16
Q

anticoagulants

A

heparin (IV); warfarin (PO)

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17
Q

actions of anticoagulants

A

interfere with the normal cascade of events involved in the clotting process

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18
Q

contraindications of anticoagulants

A

allergy and condition that could be compromised by bleeding tendencies; pregnancy, renal, or hepatic disorders

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19
Q

cautions of anicoagulants

A

CHF, senility, or psychosis

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20
Q

adverse effects of anticoagulants

A

bleeding, GI upset, hepatic dysfunction, alopecia, dermatitis, bone marrow suppression, prolonged, and painful erection

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21
Q

toxic effects of anticoagulants

A

hematuria, melena (blood in stool), petechiae, ecchymoses, and gum or mucous membrane bleeding

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22
Q

what do you do if a patient is experiencing a toxic effect

A

stop drug immediately

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23
Q

precautions of anticoagulants

A

contraindicated in patients with thrombocytopenia; should not be used during eye, spinal cord, or brain surgery, lumbar function or regional anesthesia; cautiously in clients who have hemophilia, PUD, severe HTN, or kidney disease or threatened abortion

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24
Q

interactions between heparin

A

oral anticoagulants, salicylates, penicillin’s, or cephalosporins

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25
Q

what specific drugs should you use caution with due to an increased risk of bleeding

A

NSAIDs, ASA, and other anticoagulants; avoid concurrent use, injury; limit venipuncture and injections

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26
Q

where is heparin obtained from

A

lungs or intestinal mucosa of pigs; natural anticoagulant

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27
Q

what is the normal range of units given of heparin IV

A

10-40K units/mL

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28
Q

what measurement is needed every 6 hours while taking IV heparin

A

PTT

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29
Q

nursing implications of IV heparin

A

double checked with another nurse; may be given as bolus or infusion; effects are seen immediately; lab values needed to monitor coagulation effects

30
Q

protamine sulfate

A

antidote for excessive anticoagulation

31
Q

what is the measurement needed to reverse heparin

A

1mg protamine sulfate=100 units of heparin

32
Q

type I of heparin-induced thrombocytopenia

A

gradual reduction in platelets; heparin therapy can generally be continued

33
Q

type II of heparin-induced thrombocytopenia

A

acute fall in the number of platelets (more than 50% reduction from baseline)

34
Q

type II of heparin-induced thrombocytopenia

A

acute fall in the number of platelets (more than 50% reduction from baseline); discontinue heparin

35
Q

clinical manifestations of heparin-induced thrombocytopenia

A

thrombosis that can be fatal

36
Q

clinical manifestations of warfarin use

A

skin necrosis and “purple toes” syndrome

37
Q

how much heparin subq do you give for DVT prophylaxis

A

5000 unites two-three times a day

38
Q

where can’t you give heparin subq? (within 2 inches of…)

A

umbilicus, abdominal incisions, open wounds, scars, drainage tubes, or stomas

39
Q

where should a heparin subq shot be given?

A

areas of deep subcutaneous fat and sites

40
Q

enoxaparin

A

inhibit thrombus and clot formation; do not greatly affect thrombin, clotting, or prothrombin times; fewer systemic adverse effects

41
Q

when is enoxaparin used

A

prophylaxis and treatment: DVT, bedrest, postop

42
Q

what should you not do with enoxaparin

A

aspirate subq injections or massage the injection site

43
Q

what should be monitored when a patient is on warfarin

A

(oral anticoagulant) PT and INR

44
Q

INR values

A

1.0- normal
2-3.5 with warfarin

45
Q

intended responses of warfarin

A

increased clotting time, decreased clot formation (existing clots don’t grow), maintain blood flow

46
Q

can warfarin and heparin mix

A

yes until PT/INR levels indicate adequate anticoagulation

47
Q

what is the antidote for warfarin

A

VITAMIN K

48
Q

patient education for anticoagulants

A

lab testing; signs of abnormal bleeding; injury prevention; wear medical ID bracelet; avoid foods high in vitamin K

49
Q

food high in vitamin K

A

tomatoes, dark leafy green veggies

50
Q

herbal reactions with anticoagualnts

A

increased bleeding
capsicum pepper, garlic, ginger, ginkgo, st john’s wort, feverfew

51
Q

nursing considerations for anticoagulants

A

recent surgery; active internal bleeding; anything affecting bloof

52
Q

thrombolytic agents

A

alteplase; break down the thrombus that has been formed stimulating the plasmin system (clotbuster)

53
Q

actions of alteplase

A

activating plasminogen to plasmin, which in turn breaks down fibrin threads in a clot to dissolve a formed clot

54
Q

indications of alteplase

A

acute MI, pulmonary emboli, ischemic stroke

55
Q

pharmacokinetics of alteplase

A

drugs must be injected and are cleared from the body after liver metabolism; pregnancy and lactation

56
Q

contraindications of alteplase

A

allergy; any condition that would be worsened by dissolution of clots

57
Q

adverse effects of alteplase

A

bleeding; cardiac arrhythmias; hypotension; hypersensitivity- rash, flushing, bronchospasm, and anaphylactic reaction

58
Q

drug-drug interactions of alteplase

A

anticoagulants and antiplatelet

59
Q

hemophilia

A

genetic lack of clotting factors that leaves the patient vulnerable to excessive bleeding with any injury

60
Q

liver disease

A

clotting factors and proteins needed for clotting are not produced

61
Q

bone marrow disorders

A

platelets are not formed in sufficient quantity to be effective

62
Q

hemostatic agents

A

aminocaproic acid; prevent wide or systemic clot breakdown, thus preventing blood loss in situations in which serious systemic bleeding could occur, or hyperfibrinolysis

63
Q

actions and indications of aminocaproic acid

A

prevent systemic clot breakdown to prevent blood loss

64
Q

actions and indications of topical hemostatic agents

A

for surface injuries involve so much damage to the small vessels in the area that clotting does not occur and blood is slowly and continually lost

65
Q

pharmacokinetics of aminocaproic acid

A

oral and IV, rapidly absorbed, widely distributed throughout body, excreted largely unchanged in urine

66
Q

pharmacokinetics of topical hemostatic agents

A

sponges, sprays, topical solution

67
Q

contraindications of aminocaproic acid

A

allergy, acute DIC

68
Q

contraindications of topical hemostatic agents

A

allergy to bovine products

69
Q

cautions of aminocaproic acid

A

cardiac disease, renal/hepatic dysfunction, pregnancy and lactation

70
Q

cautions of topical hemostatic agents

A

safety in children not established

71
Q

adverse effects of aminocaproic acid

A

excessive clotting CNS, GI, weakness, fatigue, malaise, and muscle pain

72
Q

adverse reactions of topical hemostatic agents

A

none reported

Pharm II (4 decks)

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