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Pharm 2 > Exam 2- hematologic > Flashcards

Exam 2- hematologic Flashcards

1
Q

Anticoagulants and Antiplatelets (MOA and type of modification)

A
  • prevention of clot formation
  • inhibition of specific clotting factors
  • inhibition of platelet actions
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2
Q

Heparin- type/class

A

anticoagulant/Indirect Thrombin Inhibitor

- Heparin is the traditional drug of choice for rapid anticoagulation.

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3
Q

Heparin MOA

A

Prevents clotting by activating antithrombin III, thus indirectly inactivating both thrombin and factor Xa. This inhibits fibrin formation

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4
Q

Heparin- Nursing implications (antidote, risks, labs)

A
  • Not absorbed by the intestinal tract and must be given by subcutaneous injection or IV infusion (Do not give IM)
  • Antidote: Protamine Sulfate
  • Risks: Bleeding, Heparin Induced Thrombocytopenia (HIT) (monitor platelets too)
  • Monitored through parital thromboplastin time (aPTT)
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5
Q

Heparin black box warning

A

Spinal/ epidural bleeding with epidural or Lumbar Puncture

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6
Q

Enoxaparin (Lovenox) class/type

A
  • Anticoagulants

- Low molecular weight heparin

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7
Q

Enoxaparin vs. Heparin (6)

A
  • More predictable anticoagulant response than heparin
  • Does not require laboratory monitoring
  • HIT less likely, but higher risk in someone who has had HIT from Heparin
  • Given subcutaneously
  • Can be administered at home
  • same antidote (protamine sulfate)
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8
Q

Warfarin (Coumadin) class/type

A
  • Vitamin K antagonist

- Anticoagulant

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9
Q

Warfarin (Coumadin) MOA

A

Inhibits Vitamin K, thereby preventing the synthesis of four coagulation factors (factor VII, IX, X, and prothrombin.)

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10
Q

Warfarin (Coumadin) Nursing implications/education

A
  • Given orally only
  • Monitored by prothrombin time (PT) and INR (PT-INR) (must be monitored closely)
  • Antidote: Vitamin K
  • Foods high in vitamin K may decrease anticoagulant effects
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11
Q

Warfarin (Coumadin) CI (1)

A
  • Do not use in pregnancy or lactation
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12
Q

Warfarin (Coumadin) Heparin bridge therapy

A
  • Warfarin effects may take 8 to 12 hr, and full therapeutic effect is not achieved for 3 to 5 days.
  • For clients in the hospital setting, explain the need for continued heparin infusion when starting oral warfarin
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13
Q

Dabigatran (Pradaxa) class/type

A

Direct Thrombin Inhibitor

Anticoagulant

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14
Q

Dabigatran (Pradaxa) MOA

A

Work by directly inhibiting thrombin, thus preventing a thrombus from developing.

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15
Q

Dabigatran (Pradaxa) Nursing Implications/Antidote

A
  • Stop 1-6 days prior to surgery
  • antidote- Praxibind
  • Take with food
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16
Q

Dabigatran (Pradaxa) Side effects (4)

A
  • GI discomfort
  • nausea, vomiting
  • esophageal reflux
  • ulcer formation
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17
Q

Dabigatran (Pradaxa) black box warning

A
  • Premature discontinuation INCREASES risk of thrombotic events
  • Epidural/spinal hematoma
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18
Q

Aspirin (ASA) goal/type

A
  • prevent initial clot formation

- antiplatelet

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19
Q

Aspirin (ASA) MOA

A
  • MOA: Blocks thromboxane
  • Result is a “slippery” platelet
  • Because platelets are slippery they do not clump together (aggregate)
  • If things aren’t sticking together, clotting is reduced
  • Irreversibly bound- once platelet bound to ASA it is done
20
Q

Aspirin (ASA) indications

A
  • 81mg “baby aspirin” used in prevention of MI and stroke
  • This low dose affects mostly platelets and will not have as much of an effect on COX-2 pain/fever
  • Lower dose thought to have lower side effects
  • In acute MI
  • chew Aspirin for faster absorption and take a higher dose (325mg)
21
Q

CLOPidogrel (Plavix) goal/class/type

A
  • ADP Receptor Blocker
  • prevent initial clot formation
  • antiplatelet
  • prevents CLots, an Oral Platelet Inhibitor (CLOPI).
22
Q

CLOPidogrel (Plavix) MOA

A
  • Blocks the adenosine diphosphate (ADP) receptor on the platelet membrane, preventing the platelet from “connecting” with other platelets.
  • slippery platelets
23
Q

Thrombolytics goals/indications/risks

A
  • Break down existing clots
  • Extreme risk of bleeding
  • Only used for life-threatening illnesses
  • Dissolve existing intravascular clots in MI and Stroke
  • Risk of bleeding with thrombolytics may outweigh benefits.
    (In patients greater than age 75- research shows do not decrease mortality)
24
Q

Alteplase (Activase) class

A

thrombolytic

25
Q

Alteplase (Activase) MOA

A
  • Activate plasminogen and convert it to plasmin, which can dissolves fibrin clots
  • Reestablish blood flow so that viable tissue may be reperfused and not be destroyed
26
Q

Alteplase (Activase) Key points

A
  • Should be given within 6 hours of MI symptom onset or 3 hours of thrombotic stroke (60 minute max preferred)
  • With stroke, must rule out intracranial hemorrhage
27
Q

Alteplase (Activase) Nursing implications (5)

A
  • Follow strict manufacturer’s guidelines for preparation and administration
  • Monitor IV sites for bleeding, redness, pain
  • Monitor for bleeding from gums, mucous membranes, nose, injection sites
  • Observe for signs of internal bleeding (decreased BP, restlessness, increased pulse)
  • Hold pressure to puncture sites for at least 30 minutes
28
Q

Aminocaproic acid (Amicar) class

A

hemostatics

29
Q

Aminocaproic acid (Amicar) Use/specific indications (3)

A
  • Hemostatics are used to promote the formation of clots.
  • Hemophilia
  • Post Op Cardiac Surgery
  • Aplastic anemia
30
Q

Aminocaproic acid (Amicar) MOA

A

Occupies binding sites on plasminogen and plasmin

Prevents breakdown of fibrin clots by plasmin

31
Q

Aminocaproic acid (Amicar) side effects (5)

A
  • Muscle wasting and weakness  rhabdomyolysis
  • Formation of abnormal clots
  • Pulmonary thrombus or embolus
  • Hypotension (with rapid IV administration)
  • Bradycardia (with rapid IV administration)
32
Q

Aminocaproic acid (Amicar) CI/cautions (4)

A
  • History of CVA in last 3 months
  • Other thrombotic events
  • Severe HTN
  • Bleeding in the Urinary Tract
33
Q

Aminocaproic acid (Amicar) Nursing implications (4)

A
  • Check IV site
  • Monitor labs
  • Observe for signs of thrombosis/embolism
  • Chest pain
  • Leg pain
  • Difficulty breathing
  • Monitor urine
  • Color
  • Difficulty urinating
34
Q

Epoetin alfa (Epogen) class

A

Erythropoietin/Hematopoietic growth factor

35
Q

Epoetin alfa (Epogen) MOA

A
  • Stimulates the division and differentiation of stem cells in the bone marrow
  • Promotes the synthesis of hemoglobin and causes a shift of marrow reticulocytes into the circulation
36
Q

Epoetin alfa (Epogen) indications

A
  • Treatment of anemia associated with renal failure

- Anemia associated with cancers

37
Q

Epoetin alfa (Epogen) CI/cautions

A
  • Hemoglobin above 12 g/dL

- Bone marrow malignancies

38
Q

Epoetin alfa (Epogen) Black box warning (4)

A
  • Thromboembolic events
  • Transient ischemic attack
  • Myocardial infarction
  • Hypertension
39
Q

Epoetin alfa (Epogen) Nursing implications

A
  • Assess labs closely
  • Watch vital signs
  • Monitor for thromboembolic events
40
Q

Epoetin alfa (Epogen) Blood doping

A
  • Elevating red blood cells in athletes bloodstream
  • Increasing the amount of red cells increase the amount of oxygen delivered to the muscles allowing them to work more efficiently
  • After 2-4 weeks of treatment effects can be seen
  • Athlete can then stop taking and benefit from effects during this window without continuing to take it
  • Epoetin can be metabolized within days making it difficult to detect, especially if it was stopped weeks prior
  • Difficult to detect Epoetin vs Naturally occurring erythropoietin
41
Q

Filgrastim (Neupogen) class

A

Colony-stimulating factor

42
Q

Filgrastim (Neupogen) MOA

A
  • Increase in neutrophil production in the bone marrow

- Enhance the phagocytic and cytotoxic functions of existing neutrophils

43
Q

Filgrastim (Neupogen) Side effects (8)

A
  • Nausea and Vomiting very common
  • Fever/chills
  • Bone pain
  • Spleen rupture
  • Leukocytosis (too many neutrophils)
  • Respiratory failure
  • Retinal hemorrhage
  • MI
44
Q

Filgrastim (Neupogen) indications

A
  • Receiving chemotherapy or radiation therapy
  • Receiving bone marrow transplants
  • Chronic neutropenia
  • Immunosuppressive AIDS
  • Severe infections
45
Q

Filgrastim (Neupogen) CI/cautions

A
  • Sickle-cell disease
  • Pre-existing cardiac disease
  • Sensitivity to e.coli (used to produce drug)
46
Q

Filgrastim (Neupogen) Drug interactions (2 and why)

A
  • Not administered until at least 24 hours after a chemotherapy session
  • Chemo and Neupogen have opposite actions
  • Lithium
  • Lithium promotes neutrophil release increasing risk for leukocytosis

Pharm 2 (5 decks)

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