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Pharmacology Spring 2021: Set 2 > Hematologic: Heparin and Heparin Derivatives > Flashcards

Hematologic: Heparin and Heparin Derivatives Flashcards

1
Q

Types of anticoagulants

A
  1. heparin
  2. oral anticoagulants
  3. antiplatelet drugs
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2
Q

What are the brand and generic names of anticoagulants?

A
  1. Heparin
  2. Enoxaparin [Lovenox]
  3. Warfarin [Coumadin]
  4. Novel Anticoagulants (NOAC’s) (apixaban [Eliquis]
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3
Q

What type of drug is Enoxaparin [Lovenox]?

A

Heparin Derivative

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4
Q

How is Heparin prepared?

A

commercially from animal tissue

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5
Q

What is Heparins function?

A

prevent clot formation

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6
Q

What can Heparin NOT do?

A

can’t dissolve already formed clots

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7
Q

Why was Enoxaparin [Lovenox] created?

A
  1. prevent DVT (a blood clot in the deep veins-normally legs)
  2. in surgical patients
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8
Q

Why is Enoxaparin [Lovenox] preferred?

A
  1. SC

2. Less monitoring

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9
Q

How are Haparin and Heparin derivatives administered?

A
  1. Injection

2. IV

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10
Q

What type of injection is contraindicated for heparin and heparin derivatives? Why?

A
  1. IM

2. Risk of bleeding

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11
Q

Where are heparin and its derivatives metabolized?

A

Liver

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12
Q

How are heparin and its derivatives excreted?

A

Urine

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13
Q

Heparin and its derivatives: Steps- Actions

A
  1. Accelerates formation of an antithrombin III–thrombin complex
  2. Which inactivates thrombin
  3. And prevents the conversion of fibrinogen to fibrin
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14
Q

What is Heparin and its derivatives used to treat?

A
  1. DVT
  2. Pulmonary embolism
  3. Open-heart/ortho/intraabdominal surgeries
  4. Disseminated intravascular coagulation
  5. Unstable angina
  6. Post-MI
  7. Cerebral thrombosis in evolving stroke
  8. Left ventricular thrombi
  9. Heart failure
  10. History of embolism and atrial fibrillation
  11. Bypass/Hemodialysis/Blood transfusions
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15
Q

Adverse effects of Heparin and its derivatives?

A
  1. Hemorrhage
  2. Prolonged clotting time
  3. Thrombocytopenia
  4. Hypersensitivity reactions
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16
Q

What should you watch for in patients on Heparin and its derivatives?

A
  1. bleeding gums
  2. bruises
  3. petechiae
  4. epistaxis
  5. tarry stools
  6. hematuria, and hematemesis.
17
Q

What can cause Heparin and its derivatives to be inefefctive?

A

Neutralized by protamine sulfate.

18
Q

What labs to monitor for a patient on Heparin and its derivatives?

A
  1. HGB and HCT
  2. Platelet count
  3. PT
  4. INR
  5. PTT
19
Q

Pharmacodynamics Specifics

A

Heparin and heparin derivatives prevent the formation of new thrombi. Here’s how heparin works:

  1. Heparin inhibits the formation of thrombin and fibrin by activating antithrombin III.
  2. Antithrombin III then inactivates factors IXa, Xa, XIa, and XIIa in the intrinsic and common pathways. The end result is the prevention of a stable fibrin clot.
  3. In low doses, heparin increases the activity of antithrombin IIIagainst factor Xa and thrombin and inhibits clot formation.
  4. Much larger doses are necessary to inhibit fibrin formation after a clot has been formed. This relationship between dose and effect is the rationale for using low-dose heparin to prevent clotting.
  5. Whole blood clotting time, thrombin time, and PTT are prolonged during heparin therapy. However, these times may be only slightly prolonged with low or ultra-low preventive dosages.
20
Q

Why do we watch labs for platelets?

A

heparin-induced thrombocytopenia (HIT)

21
Q

What do we do if HIT occurs?

A

Use thrombin inhibitors instead of heparin:

  1. Lepirudin
  2. Argatroban
  3. Bivalirudin
22
Q

Drug-drug interactions with Heparin/heparin derivates

A
  1. Oral anticoagulants
  2. Nonsteroidal anti-inflammatory drugs (NSAIDs)
  3. Iron dextran
  4. Clopidogrel
  5. Cilostazol
  6. Antiplatelet drug (aspirin, ticlopidine, or dipyridamole)
  7. Antihistamines
  8. Digoxin
  9. Penicillins
  10. Cephalosporins
  11. Nitroglycerin
  12. Nicotine
  13. Phenothiazines
  14. Tetracycline hydrochloride
  15. Quinidine
  16. Neomycin sulfate
  17. IV penicillin
  18. Protamine sulfate and administration of fresh frozen plasma
23
Q

Heparin/heparin derivates AND oral anticoagulants REACTION RATIONALE

A

Because heparin and heparin derivatives act synergistically with all the oral anticoagulants, the risk of bleeding increases when the patient takes both drugs together. The prothrombin time (PT) and
international normalized ratio (INR), used to monitor the effects of oral anticoagulants, may also be prolonged.

24
Q

Heparin/heparin derivates AND nonsteroidal anti-inflammatory drugs (NSAIDs), iron dextran, clopidogrel, cilostazol, antiplatelet drugs (aspirin, ticlopidine, dipyridamole) REACTION RATIONALE

A

The risk of bleeding increases

25
Q

Heparin/heparin derivates AND antihistamines, digoxin, penicillins, cephalosporins, nitroglycerin, nicotine, phenothiazines, tetracycline hydrochloride,
quinidine, neomycin sulfate, and IV penicillin REACTION RATIONALE

A

antagonize or inactivates

26
Q

Nicotine

A

inactivates

27
Q

Nitroglycerin

A

inhibits

28
Q

Heparin/heparin derivates AND protamine sulfate and administration of fresh frozen plasma REACTION RATIONALE

A

counteract the effects

29
Q

Most adverse reactions can be avoided how?

A

prevented if the patient’s PTT is maintained

30
Q

Bleeding, the most common adverse effect of heparin and it derivatives, can be reversed easily by doing what?

A

protamine sulfate

31
Q

Why are you assessing vital signs and lab studies in patients receiving heparin and heparin derivatives?

A

maintain adequate fluid volume

32
Q

Why are you assessing PTT in patients receiving heparin and heparin derivatives?

A

Anticoagulation is present when PTT values are 1½ to 2 times the control values

33
Q

What should be avoided in patients receiving heparin and heparin derivatives?

A

IM injections

Pharmacology Spring 2021: Set 2 (14 decks)

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