Drugs affecting blood coagulation chapter 48 Flashcards by Shaniya Capre

What are drugs that are affecting blood coagulation?

Antiplatelet Drugs
Anticoagulation Drugs
Thrombolytic Drugs
Hemostatic Drugs
Drugs to Control Bleeding

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Describe anti platelet drug?

Antiplatelet drugs inhibit platelet aggregation and adhesion
Decrease responsiveness of stimuli that cause plt to aggregate on vessel wall

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What are indications of anti platelet drugs?

CAD – prone to occluded vessels
Maintenance of arterial/venous grafts
Prevent cerebrovascular occlusion
During/post MI for thrombolytic effect

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whats aspirin?

Antiplatelet drug

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What are therapeutic actions of asprin?

Antiplatelet drug
Inhibits synthesis of thromboxane A2
* Decreases plt aggregation

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What are adverse affects of aspirin

Anti platelet drug

Bleeding
CNS –> HA dizziness, weakness
Monitor for salicylate poisoning

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What are contras of aspirin?

Anti platelet drug

Bleeding disorder
Uncontrolled HTN
Recent/impending surgery

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What are drug to drug interaction with aspirin?

Increase risk of bleeding when
combined with other
anticoag/antiplatelet drugs

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Describe anticoagulation?

All anticoagulants work in clotting cascade
but do so at different points
Prevent formation of new clots and
extension of clots already present
Do not dissolve clots
Heparin and warfarin are commonly used
Used to prevent or manage
thrombophlebitis, deep vein thrombosis
(DVT), and pulmonary emboli (PE)
Main adverse effect is bleeding

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What is heparin?

Anticoagulants

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What is the therapeutic action of heparin?

Anticoagulants
* Interfere with normal coagulation by disrupting normal clotting cascade
* Blocks formation of thrombin from prothrombin

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What are indications of heparin ?

Anticoagulants

Acute clinical situations
DVT prevention
Prevention of clotting in blood samples/dialysis tubing
NOT used in routine IV locks
Drug of choice in pregnancy – if necessary

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What are pharmacokinetics of heparin ?

Anticoagulants
SC
* Onset within 20-60 minutes
IV Administration
* IVP rapid action
IV continuous
* Weight based ordering
* Monitor PTT every 6 hours until stabilized and on
maintenance dose

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What are contras for heparin?

Anticoagulants

Active bleeding – hemorrhagic disorders, trauma, spinal taps, GI ulcers

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What are cautions of heparin?

Anticoagulants
* Thrombocytopenia
* HIT – drop in platelets approx. 30-50% from baseline
(Heparin induced thrombocypenia)
could cause platelets to clot in presence in heparin

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What to monitor for the therapeutic response heparin?

-PTT (60-80 most common range)
Partial thromboplastin; How long it takes your blood to clot
* aPTT (1.5 – 2.5 x control value)

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What is heparin antidote?

protamine sulfate

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How is warafin given?

Most commonly used oral anticoagulant

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what are therapeutic actions of warfarin (Coumadin)?

Anticoagulant
Prevents synthesis of vitamin K by bacteria in the GI tract
* This inhibits production of clotting factors II, VII, IX and X– known as the Vit K dependent factors

INR (nl < 1.1) determined by dx (2-3 most common range. Person on warfarin should be at 2-3

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What are indications with warfarin?

Anticoagulant
** Prevention or management of DVT, PE and embolization associated with atrial fibrillation and
prosthetic heart valves

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What are pharmacokinetics of Warfarin?

Anticoagulant
Anticoagulant effects occur 2-5 days after oral use

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What are contras/cautions with warafin?

Anticogulant
* Pregnancy, renal/hepatic dz, all others as per heparin

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What are drug to drug interactions with warafin?

Anticoagulant
MANY!! (ex: increased coag effect with PCN; decreased coag effect with digoxin)

Food high in Vit K

What is antidote for warfarin?

Anticoagulant
Antidote – phytonadione (vitamin K)
* PO, SQ, IVPB (beware)

What is dabigatran etexilate mesylate (Pradaxa)?

Anticoagulant

What is therapeutic action of dabigatran etexilate mesylate (Pradaxa)?

Anticoagulant Acts by inhibiting thrombin

What are indications of dabigatran etexilate mesylate (Pradaxa)?

Anticoagulant Indicated for atrial fibrillation (not caused by valve problems) to prevent stroke

What are contras/ cautions of dabigatran etexilate mesylate (Pradaxa)?

same as warfarin and heparin Contras: * Active bleeding – hemorrhagic disorders, trauma, spinal taps, GI ulcers * Cautions: * Thrombocytopenia * HIT – drop in platelets approx. 30-50% from baseline

difference between dabigatran etexilate mesylate (Pradaxa) and older drugs?

Antocoag Benefits over older coags: * Does not require frequent lab follow-up * Low potential for drug-drug interactions * No drug-food interactions

What are concerns with dabigatran etexilate mesylate (Pradaxa)

Anticoag * Bleeding episodes more serious Antidote – idarucizumab (Praxbind) ANTICOAGULANTS: DABIGATRAN

What is enoxaparin (Lovenox)?

ANTICOAGULANTS: LOW-MOLECULAR- WEIGHT HEPARINS (LMWH)

What a therapeutic actions of enoxaparin (Lovenox)?

Low molecular weight heparins Synthetic – inhibits thrombus/clots by binding to factors Xa and II

What are benefits of enoxaparin (Lovenox)?

Low molecular weight heparins More predictable response * No intense monitoring of blood required * Prevention or management of thromboembolic disorders * Less thrombocytopenia than heparin

What are indications enoxaparin (Lovenox)?

Low molecular weight heparins Often used for bridge therapy with warfarin

What are antidotes for enoxaparin (Lovenox)?

Low molecular weight heparins Antidote: protamine sulfate (?)

What is contra for enoxaparin (Lovenox)?

Low molecular weight heparins * Contra: epidural catheters

What is lepirudin (Refludan)?

Anticoag- Heparin/LMWH alternatives

What is therapeutic action of lepirudin (Refludan)?

Anticoag- Heparin/LMWH alternatives Inhibits thrombin – similar to heparin mechanism

What are indications for lepirudin (Refludan)??

Anticoag- Heparin/LMWH alternatives * Allergy to heparin * Pts at risk for HIT or with a documented history

What are pharmacokinetics of lepirudin (Refludan)?

Anticoag- Heparin/LMWH alternatives * PTT followed for therapeutic effect * IV route only (continuous infusion)

What are nursing considerations with lepirudin (Refludan)?

* Soft toothbrush * Electric razor * No IM shots * Hold veni puncture sites * Monitor for bleeding, bruising * When/what to report * Dietary restrictions (warfarin) * Let PCP know of other meds/ herb/ vitamins * No contact sports * Note allergy – consider for ALL heparin products * Medical alert bracelet * Avoid OTC drugs --addition of other drugs

Describe THROMBOLYTIC AGENTS

Dissolve thrombi * Stimulate conversion of plasminogen to plasmin – breaks fibrin clot * Goal is to reestablish blood flow and prevent or limit tissue damage

What are indications of thrombolytic agents?

* Indications: * Management of acute, severe thromboembolic disease such as MI, PE * Dissolve clots in arterial or venous catheters

What is alteplase (Activase)

thrombolytic agents tissue plasminogen activator (t-PA) -Fibrin specific – work specifically at the site of the clot * Lower risk of systemic thrombolysis than earlier drugs

What are contras of alteplase (Activase)

thrombolytic agents tissue plasminogen activator (t-PA) * Recent surgery * Active bleeding * CVA within last two months * Uncontrolled HTN * Pregnancy

What are cautions with alteplase (Activase)

thrombolytic agents tissue plasminogen activator (t-PA) * Monitor for bleeding * Cardiac reperfusion syndrome * Hypersensitivity – flushing, bronchospasm

What is **aminocaproic acid (Amicar)? And what is the therapeutic action

Hemostatic agent * Therapeutic actions: * Stop excessive bleeding -->prevents the lysis/breakdown of clots

What are indications aminocaproic acid (Amicar)?

Hemostatic angents/help control bleeding * Indications: * Used in surgery (IV), wound care (gel form/sponge), subarachnoid hemorrhage

What are contras aminocaproic acid (Amicar)?

Hemostatic agents/help control bleeding * Allergy, pregnancy * Cautions: * Renal/hepatic disease, monitor for excessive clotting

What are cautions aminocaproic acid (Amicar)?

Hemostatic agents/help control bleeding * Renal/hepatic disease, monitor for excessive clotting HEMOSTATIC AGENTS

What is therapeutic action and indications of Antihemophilic factor- (Factor VIII)

Help control bleeding: * Replacement factors for the specific clotting factors patient is missing/low * Factors VIII, VIIa, IX

What are Pharmacokinetics of Antihemophilic factor- (Factor VIII)

control bleeding * Given IV

What are adverse effects of Antihemophilic factor- (Factor VIII)

control bleeding * HA, flushing, fevers, chills

What are contras of Antihemophilic factor- (Factor VIII)

control bleeding * Allergy to mouse/bovine proteins * Pregnancy/ lactation