Exam 4 - Coagulation Modifier Drugs

Question 1

anticoagulants

Answer 1

• inhibit the action or formation of the clotting factors
• PREVENTS clots

Question 2

antiplatelets

Answer 2

• prevent platelet plugs from forming by inhibiting platelet aggregation
• best for preventing heart attacks and stroke

Question 3

heparin

Answer 3

• prevents clotting factor by activating antithrombin
• indirectly inactivates thrombin and factor Xa
• route: IV or subq
• indications: conditions necessitating prompt anticoagulation activity
• nursing consideration: starts working quickly, high risk medication
• use cautiously in patients with spinal or epidural anesthesia
• SE: bleeding, hematoma, anemia, thrombocytopenia

Question 4

heparin anti-dote

Answer 4

protamine sulfate

Question 5

heparin induced thrombocytopenia (HIT)

Answer 5

• low platelet count and increased development of thrombi: caused by antibody development
• monitor platelet counts
• stop heparin immediately if platelet count is less than 100,000
• non-heparin anticoagulants can be used as substitute if anticoagulation still needed

Question 6

labs with heparin

Answer 6

• anti Xa
• aPTT

Question 7

enoxaparin

Answer 7

• low molecular weight heparin
• labs are not necessary
• route: subq
• indication: given prophylaxis and treatment
  SE: bleeding, thrombocytopenia
• black box warning: use cautiously in patients with spinal or epidural anesthesia
• nursing considerations: do not give with heparin, only give with warfarin when treating PE or DVT
• do not expel air bubble in pre-filled syringe
• rotate injection sites
• safe in pregnancy

Question 8

enoxaparin anti-dote

Answer 8

• protamine

Question 9

warfarin

Answer 9

• vitamin K inhibitor: prevents synthesis of four coagulation factors (VII, IX, X, prothrombin)
• indications: prevention DVT, reduce TIA or MI, thrombic events for pts with atrial fibrillation or heart valves
• route: only PO, once daily about 5pm
• SE: bleeding, lethargy, muscle pain, purple toes
• do not use while pregnant
• nursing considerations: hold before surgery, lab monitoring
• drug, food, alcohol interactions

Question 10

warfarin anti-dote

Answer 10

• vitamin K (IV)
• fresh frozen plasma (FFP)
• whole blood

Question 11

what should you do when using warfarin

Answer 11

• wear medical alert bracelet
• use soft bristle toothbrush
• use electric toothbrush and razor

Question 12

what food must be avoided when taking warfarin

Answer 12

• must avoid foods high in vitamin K because they will reduce warfarin’s ability to prevent clots

Question 13

foods highest in vitamin K

Answer 13

• kale
• broccoli
• brussel sprouts
• cabbage
• pickled cucumber
• asparagus
• kiwi
• okra
• green beans
• lettuce

Question 14

apixaban and rivaroxaban

Answer 14

• direct inhibitor of factor Xa
• indications: prevent stokes in pts with afib, post-op thrombo-prophylaxis, treat DVT and PE
• SE: bleeding, hematoma, GI distress, peripheral edema
• black box warning: spinal hematomas if pt has epidural catheter, risk of thrombosis is stopped abruptly
• nursing considerations: drug interactions (increased effect with grapefruit juice)
• no monitoring required
• do not give with other anticoagulants
• watch liver function

Question 15

apixaban and rivaroxaban antidote

Answer 15

• andexxa
• very expensive

Question 16

aspirin

Answer 16

• blocks prostaglandin synthesis through the COX enzyme pathways; blocks platelet aggregation
• prevents platelets from clumping together
• indications: prevent/treat MI, prevent ischemic stroke
• route: PO; acute event chew baby aspirin
• SE: GI, drowsiness/confusion, bleeding
• nursing considerations: don’t crush enteric coated, OTC considerations, Reyes syndrome

Question 17

aspirin, clopidogrel, ticagrelor contraindications

Answer 17

• thrombocytopenia
• active bleeding
• blood cancers
• traumatic injuries
• GI ulcers
• vitamin K deficiency
• recent hemorrhagic stroke

Question 18

aspirin antidote

Answer 18

• DDVAP
• desmopressin

Question 19

clopidogrel and ticagrelor

Answer 19

• anti platelet ADP inhibitor; alters the platelet membrane so it doesn’t receive the signal to aggregate
• indications: risk of stroke, prophylaxis of TIAs, post MI
• SE: chest pain, edema, flu symptoms, GI, epistaxis, rash, pruritus
• route: PO

Question 20

clopidogrel black box warning

Answer 20

• pts with certain genetic abnormalities who may have a higher rate of CV events due to reduced conversion to its active metabolite

Question 21

ticagelor black box warning

Answer 21

• increased bleeding risk with aspirin doses over 100mg

Question 22

clopidogrel and ticagrelor antidote

Answer 22

• DDAVP
• platelet transfusion

Question 23

agratroban and bivalrudin

Answer 23

• direct thrombin inhibitors
• inhibit thrombin (IIa)
• indications: treat HIT and for pts undergoing procedures who are at high risk for HIT
• route: IV only
• careful in pts with hepatic dysfunction
• SE: bleeding
• nursing consideration: labs ( anti-Xa, H&H, platelets)

Question 24

warfarin labs

Answer 24

• PT
• INR
• must monitor monthly after we get pts to therapeutic (2-3.5)