Drugs for coagulation disorders

Question 1

What is the order of the coagulation cascade?

Answer 1

1. Injured cells release prothrombin activator.
2. Prothrombin activator changes prothrombin to thrombin.
   3.Thrombin changes fibrinogen to fibrin.
   4.Fibrin forms insoluble web over injured area to stop blood flow.

Question 2

Prothrombin time (PT)

Answer 2

10-13 seconds

Question 3

International normalized ratio (INR)

Answer 3

1

Question 4

Partial thromboplastin time (aPTT)

Answer 4

25-35 seconds

Question 5

Platelet count

Answer 5

150,000-400,000

Question 6

What do anticoagulants do?

Answer 6

blood thinner- inhibit clotting factors.
prevent thrombus formation and growth.

Question 7

What are antiplatelets?

Answer 7

They make things slippery- inhibit platelet action.
prevent thrombi growth.

Question 8

What are thrombolytics?

Answer 8

Dissolve existing thrombi.

Question 9

What is an anticoagulation drug?

Answer 9

heparin

Question 10

What is the MOA of heparin?

Answer 10

Suppress coagulation.
Helps anti-thrombin inactivate clotting factors.
Prevents enlargement or formation of new clots.

Question 11

What are other considerations for heparin?

Answer 11

AE: abnormal bleeding, heparin-induced thrombocytopenia.

Parenteral ( SQ/IV only); monitor aPTT.
Monitor intake of food with vit. K and alcohol.

Question 12

What is an anticoagulant drug?

Answer 12

low molecular weight heparin (LMWH)
enoxaparin (Lovenox)

Question 12

What is the antagonist of heparin?

Answer 12

protamine sulfate IV
(1 mg for every 100 units of heparin)

Question 12

What is the MOA of enoxaparin?

Answer 12

Composed of molecules that are shorter than those in unfractionated heparin.
Unable to activate thrombin.

Question 13

What is the prime use for enoxaparin?

Answer 13

DVT prevention and treatment

Question 13

Nursing considerations for enoxaparin.

Answer 13

SQ only, based on body weight (1mg/kg) or for DVT
DVT prophylaxis- 30mg BID

No need to monitor aPTT.

Question 14

What is the antagonist for enoxaparin?

Answer 14

protamine sulfate IV (1mg for every 100 units of heparin)

Question 15

What is another anticoagulant?

Answer 15

warfarin (Coumadin)

Question 16

What is the MOA of warfarin?

Answer 16

Vit. K antagonist(inhibits action)
Suppresses synthesis of coagulation.

Question 17

What are the prime uses of warfarin?

Answer 17

DVT, MI, PE
Prosthetic heart valves, A-fib

Question 18

Nursing considerations for warfarin:

Answer 18

AE: abnormal bleeding, effects can last 10 days after d/c

Administration: oral only; dosed based on INR results; therapeutic INR 2-3

Question 19

What is the antagonist for warfarin?

Answer 19

Phytonadione (vitamin K) SQ/IV
fresh frozen plasma

Question 20

What is a direct factor X inhibitor/anticoagulant?

Answer 20

rivaroxaban (Xarelto) and Apixaban (Eliquis)

Question 21

What is the MOA for rivaroxaban and apixaban?

Answer 21

Selective inhibition of factor Xa.
Binds directly with active center of factor inhibiting production of thrombin.

Question 22

Nursing considerations for rivaroxaban and apixaban:

Answer 22

Reduce risk of stroke and PE in patients with A-fib.
Bleeding precautions, easy to bruise.
PO usually QD or BID.
Does not require lab monitoring.

Question 23

What drug is an antiplatelet?

Answer 23

aspirin (ASA)

Question 24

What is the MOA of aspirin?

Answer 24

Non-selective and irreversible inhibitor of COX. TXA2 is a factor that promotes the platelet activation.

Question 25

What are the prime uses of aspirin?

Answer 25

Ischemic stroke, TIAs, chronic stable angina, acute MI, coronary stenting, dysrhythmias.

Question 26

AE of aspirin and administration considerations for aspirin:

Answer 26

GI upset, bleeding, renal impairment, Reye’s syndrome (kids).

81-325mg

Lifespan of platelets is 7-10 days. Since irreversible, action lasts 7-10days.

Question 27

What is an antiplatelet?

Answer 27

clopidogrel (Plavix)

Question 28

What is the MOA of clopidogrel(Plavix)?

Answer 28

Irreversibly inhibits ADP receptors on platelets preventing ADP stimulated platelet aggregation.

At recommended dose, 40-60% of platelet aggregation is inhibited.

Question 29

What are the prim uses of clopidogrel?

Answer 29

Prevent blockage of coronary artery stents.

Reduces thrombotic events in patients with acute coronary syndromes. (MI, ischemic stroke, and vascular death)

Question 30

Nursing considerations for colpidogrel?

Answer 30

AE: flulike symptoms, HA, dizzy, bruising, rash, pruitis.

75mg daily, can have a loading dose of 300mg one time prior to starting therapy.

Question 31

What is fibrinolysis?

Answer 31

Clot removal- starts 24-48hours of clot formation.

Initiated by release of tissue plasminogen activator.

Question 32

What drug is a thrombolytic?

Answer 32

alteplase (Activase or TPA)

Question 33

What is the MOA of alteplase?

Answer 33

Promotes conversion of plasminogen to plasmin.
Then digests fibrin and dissolves clots.

Question 34

What is the prime us of alteplase?

Answer 34

Dissolve life-threatening clots (MI, stroke)

Question 35

AE and nursing considerations for alteplase:

Answer 35

AE abnormal bleeding.

Administer <12 hours of onset of symptoms for MI or 3 hours for stroke, given IV.

Question 36

Iron supplement:

Answer 36

Ferrous sulfate

Question 37

What is ferrous sulfate used for?

Answer 37

Replenish iron stores, promote hemoglobin synthesis.

Used for anemia and low iron levels.

Question 38

Other nursing considerations for ferrious sulfate use:

Answer 38

AE: Dark/tarry/green/black stool, abdominal pain, metallic taste, N/V/D, constipation.

Take with food to avoid GI upset. Sit upright 30 min. to decrease risk of esophageal irritation.