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NUR 311 Pharmacology > Exam 3 Study Qs Anticoagulants Antiplatelets and Fibrinolytics > Flashcards

Exam 3 Study Qs Anticoagulants Antiplatelets and Fibrinolytics Flashcards

1
Q

What are the two stages of hemostasis?

A

Formation of platelet plug, reinforcement of platelet plug with fibrin (coagulation)

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2
Q

How does heparin work as an anticoagulant?

A

Assists antithrombin in inactivating thrombin and factor Xa

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3
Q

How does warfarin work as an anticoagulant?

A

Decreases synthesis of clotting factors dependent on vitamin K

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4
Q

How do thrombolytic drugs work?

A

Promote conversion of plasminogen to plasmin

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5
Q

Arterial thrombi cause what kind of injury?

A

Local injury

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6
Q

Venous thrombi cause what type of injury?

A

Distal injury

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7
Q

Name the three categories of drugs for thromboembolic disorders? Where in the vascular system do they work?

A

Anticoagulants - veins
Antiplatelet agents - arteries
Thrombolytics - veins or arteries

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8
Q

What factors does heparin deactivate? What does this prevent?

A

Assists antithrombin in deactivating thrombin and factor Xa to prevent more venous thrombi.

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9
Q

What factor do low molecular weight anticoagulants deactivate?

A

Factor Xa

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10
Q

Which anticoagulant can be given during pregnancy?

A

Heparin

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11
Q

What is the antidote for heparin?

A

Protamine sulfate

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12
Q

Which lab is used to monitor heparin? What is the recommended range?

A

aPTT. 1.5-2 times the control.

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13
Q

What potentially-fatal disorder occurs with heparin?

A

Heparin induced thrombocytopenia (HIT)

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14
Q

List contraindications to heparin

A

Thrombocytopenia; uncontrollable bleeding; surgery of eye, brain, or spinal cord; lumbar puncture or regional anesthesia.

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15
Q

List signs and symptoms indicative of bleeding?

A

Decreased BP, increased HR, gum bleeding, bruises, petechiae, hematomas, red or black/tarry stools, discolored/cloudy urine, pelvic pain from ovaries, headache or faintness, lumbar pain from adrenal gland

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16
Q

Discuss the proper administration of heparin Sub-Q

A

Lower abdomen, rotate sites; no rubbing; no aspiration; 2” from umbilicus; 25-26 gauges; 1/2 to 5/8 needle; gentle, firm pressure for 1-2 minutes after.

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17
Q

List drugs which may increase bleeding with heparin

A

ASA, antiplatelet drugs, NSAIDS, glucocorticoids

18
Q

What is the antidote for low molecular weight anticoagulants?

A

Protamine sulfate

19
Q

How does warfarin work?

A

Interferes with synthesis of Vitamin K-dependent clotting factors

20
Q

Where in the vascular system does warfarin work?

A

Veins

21
Q

How is warfarin distributed? Can it enter the placenta or breast milk?

A

Highly-protein bound, crosses placenta and enters breast milk

22
Q

What lab is used to monitor warfarin therapy? What is the suggested range?

A

PT & INR; INR 2-3 (3-4.5 if mechanical heart valve.

23
Q

Which anticoagulant is Pregnancy Category X?

A

Warfarin (Coumadin)

24
Q

What is the antidote for warfarin?

A

Vitamin K (phytonadione), fresh frozen plasma (FFP)

25
Q

List contraindications to warfarin

A

Active bleeding; severe thrombocytopenia; decreased synthesis of vitamin K (alcoholism, Vitamin K deficiency, liver disease); surgery of eye, brain, & spinal cord; lumbar puncture or regional anesthesia; pregnancy & lactation

26
Q

What would you tell a patient on warfarin who wants to take Tylenol?

A

Need to monitor INR - 4 325 mg tablets a day for one week can increase risk of elevated INR by 10X (May need to lower warfarin dose)

27
Q

What two drugs increase the synthesis of Vitamin K-dependent clotting factors?

A

Vitamin K, oral contraceptives

28
Q

What foods are high in vitamin K?

A

Spinach, kale, lettuce, turnips, greens cabbage, watercress, peas, asparagus, broccoli, oats, whole wheat, green tea, mayonnaise, canola oil, soybean oil.

29
Q

How does dabigatran (Pradaxa) work?

A

Directly binds thrombin, which prevents fibrin formation and activation of factor VIII.

30
Q

What are the advantages of dabigatran (Pradaxa) over warfarin? Disadvantages?

A

Less bleeding, faster onset, no blood work, fewer food interactions, fixed dosing, reversal agent Praxibind, GI distress, less experience BID dosing, must give on time.

31
Q

How does rivaroxaban (Xarelto) work?

A

Directly inhibits factor Xa in clots and serum and inhibits prothrombinase, which prevents fibrin formation. Prevention of stroke and systemic embolization in nonvalvular atrial fibrillation.

32
Q

How does apixaban (Eliquis) work? What is the approved use?

A

Directly inhibits Factor Xa in clots and serum and inhibits prothrombinase, which prevents fibrin formation. Prevention of stroke and systemic embolization in nonvalvular atrial fibrillation.

33
Q

In what part of the vascular system do antiplatelet agents work?

A

Arteries

34
Q

List three classes of antiplatelet agents

A

ASA, P2Y12 ADP receptor antagonists, glycoprotein IIb/IIIa receptor antagonists

35
Q

How does aspirin work? How long are platelets affected? How many days before surgery should aspirin be stopped?

A

Inhibits COX-1, decreasing platelet aggregation, and inhibits COX-2, decreasing vasoconstriction, 7-10 days.

36
Q

How do ADP receptor antagonists work? How long are platelets affected?

A

Blocks ADP receptors and prevents platelet aggregation (clopidogrel-Plavix). 7-10 days, take off 5 days prior to surgery.

37
Q

What is a significant adverse blood dyscrasia that may be caused by the ADP receptor antagonist, clopidogrel (Plavix)? What drugs may prevent its action?

A

Thrombotic thrombocytopenia purpura (TTP). Proton inhibitors may inhibit CYP2C19, which activates clopidogrel (Plavix).

38
Q

How do GP IIb/IIIa receptor antagonists work? Size of effect?

A

Blocks GP IIb/IIIa receptors & prevents fibrinogen bridges. Large effect, because final step in platelet aggregation.

39
Q

What is the major adverse effect of thrombolytic therapy?

A

Serious bleeding

40
Q

Which thrombolytic drug is administered as a single IV bolus?

A

Temectaplase (TKNase)

NUR 311 Pharmacology (4 decks)

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