Drugs for coagulation disorders Flashcards by Michaella Dobbert

What is the order of the coagulation cascade?

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

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Prothrombin time (PT)

10-13 seconds

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International normalized ratio (INR)

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Partial thromboplastin time (aPTT)

25-35 seconds

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Platelet count

150,000-400,000

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What do anticoagulants do?

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

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What are antiplatelets?

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

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What are thrombolytics?

Dissolve existing thrombi.

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What is an anticoagulation drug?

heparin

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What is the MOA of heparin?

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

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What are other considerations for heparin?

AE: abnormal bleeding, heparin-induced thrombocytopenia.

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

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What is an anticoagulant drug?

low molecular weight heparin (LMWH)
enoxaparin (Lovenox)

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What is the antagonist of heparin?

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

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What is the MOA of enoxaparin?

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

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What is the prime use for enoxaparin?

DVT prevention and treatment

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Nursing considerations for enoxaparin.

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

No need to monitor aPTT.

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What is the antagonist for enoxaparin?

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

What is another anticoagulant?

warfarin (Coumadin)

What is the MOA of warfarin?

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

What are the prime uses of warfarin?

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

Nursing considerations for warfarin:

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

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

What is the antagonist for warfarin?

Phytonadione (vitamin K) SQ/IV
fresh frozen plasma

What is a direct factor X inhibitor/anticoagulant?

rivaroxaban (Xarelto) and Apixaban (Eliquis)

What is the MOA for rivaroxaban and apixaban?

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

Nursing considerations for rivaroxaban and apixaban:

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.

What drug is an antiplatelet?

aspirin (ASA)

What is the MOA of aspirin?

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

What are the prime uses of aspirin?

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

AE of aspirin and administration considerations for aspirin:

GI upset, bleeding, renal impairment, Reye's syndrome (kids). 81-325mg Lifespan of platelets is 7-10 days. Since irreversible, action lasts 7-10days.

What is an antiplatelet?

clopidogrel (Plavix)

What is the MOA of clopidogrel(Plavix)?

Irreversibly inhibits ADP receptors on platelets preventing ADP stimulated platelet aggregation. At recommended dose, 40-60% of platelet aggregation is inhibited.

What are the prim uses of clopidogrel?

Prevent blockage of coronary artery stents. Reduces thrombotic events in patients with acute coronary syndromes. (MI, ischemic stroke, and vascular death)

Nursing considerations for colpidogrel?

AE: flulike symptoms, HA, dizzy, bruising, rash, pruitis. 75mg daily, can have a loading dose of 300mg one time prior to starting therapy.

What is fibrinolysis?

Clot removal- starts 24-48hours of clot formation. Initiated by release of tissue plasminogen activator.

What drug is a thrombolytic?

alteplase (Activase or TPA)

What is the MOA of alteplase?

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

What is the prime us of alteplase?

Dissolve life-threatening clots (MI, stroke)

AE and nursing considerations for alteplase:

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

Iron supplement:

Ferrous sulfate

What is ferrous sulfate used for?

Replenish iron stores, promote hemoglobin synthesis. Used for anemia and low iron levels.

Other nursing considerations for ferrious sulfate use:

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.