Hemostasis Medications, Antiplatelet/Thrombolysis Agents (Not on midterm 2) Flashcards by Eva Johnston

When do we use antifibrinolytic agents?

-Prevention and treatment of excessive bleeding

-Excessive oozing from surgical sites such as
chest tubes

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What things should clients watch out for while on anticoagulants?

Signs of abnormal bleeding
bleeding of gums while brushing teeth
unexplained nosebleeds
bruising
heavier menstrual bleeding
bloody or tarry stools, vomiting blood
bloody urine or sputum
abdominal pain

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What kind of drug is Dabigatran? How does it work on? What kind of response does it have?

it is a Direct-Acting Oral Anticoagulants (DOACs)

-Administered PO

Work on plasma proteins and have a direct rapid responses

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How is Warfarin administered? What must happen monthly while taking this drug? What is the normal INR range?

Only given orally
Must take monthly blood clotting lab test that tests prothrombin time (PT) (INR (international normalization reference ratio)

Normal target INR range 2 to 3 x control values
Some need to be 2.5 to 3.5 (normal is 0.8 to 1.2)

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What is the antidote to warfarin? When is it strongly contradicted in use?

Vitamin K (IV or PO)

warfarin is strongly contraindicated in pregnancy

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What do antifibrinolytic agents do?

Promote clot formation and / or clot maintenance

Some prevent the lysis of fibrin in an existing clots

prevents the breakdown of a protein called fibrin,

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How long does it take to reach the max effects of Warfarin? What must happen during the first few days of treatment with warfarin?

Effects depends on clotting factors turnover (protein degradation)

Max effect may take 3-5 days

Patients may be started on LMWH + warfarin

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What do antipltelet agents produce?

produces additive antiplatelet activity

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Ex of an antiplatelt that prevents platlet activation? How long do the effects last?

clopidogrel: Irreversible ADP receptor blocker

effect lasts life-time of platelet

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What does heparin suppress?

The formation of fibrin

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Ex of an antiplatelt that prevents plateleet activation? How long do the effects last?

clopidogrel: Irreversible ADP receptor blocker

effect lasts life-time of platelet

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what do thrombolytic agents convert? What do they re-establish?

Activate plasminogen and convert it to plasmin, which can digest fibrin

Re-establishes blood flow to:
*heart muscle via coronary arteries (MI)
*brain (stroke)

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What is hemostasis?

Process that halts bleeding after injury to a blood vessel

effects:
1Formation of a platelet plug
2. Production of fibrin
*end result of the clotting cascade involving a large number of plasma proteins (clotting factors)

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What is desmopressin? What it is used for the treatment of?

It is a antifibrinolytic agent (synthetic pituitary hormone)

used in the treatment of diabetes insipidus

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What do thromolytic drugs break down? What kind of drug/activator are they?

Drugs that break down preformed clots

Recombinant tissue plasminogen activator (tPA)

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Example of an antiplatelet that has irreversible inhibition of COX in platelets?

Acetylsalicylic acid (Aspirin)- 81 mg EC

-This should only be taken on recommendation and requirement!!

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What do antiplatelet agents reduce the risk of?

Used for the prevention of….. Reduce MI risk
Reduce stroke risk

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What do Anticoagulant drugs do?

-They inhibit the action or formation of clotting factors
-They prevent clot formation

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Vitiman K antagonist?

Warfarin

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Contradictions of use from thrombolytic agents?

Allergy
concurrent use of other anticoagulation

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What are thrombolytic agents used for? main adverse effects/contradictions of use?

Used for: Acute MI
Arterial thrombolysis
DVT
Occlusion of shunts or catheters
Pulmonary embolus

CONTRAINDICATIONS:
Allergy
concurrent use of other anticoagulation

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What two pathways is the coagulation cascade divided into? What does the clotting cascade result in?

1.) Intrinsic pathway
2.) Extrinsic pathway

Result is fibrin, a clot-forming substance

Contradictions of use for anticoagulants?

Known drug allergy
Acute bleeding process
Thrombocytopenia

Indications of use for thrombolytic agents?

Acute MI
Arterial thrombolysis
 DVT
Occlusion of shunts or catheters Pulmonary embolus

Anticoagulants: Adverse Effects

Bleeding risk

What is the main adverse effects of anticoagulants?

Risk of Increased bleeding - from mild to life-threatening

Ex of a Low-molecular-weight heparin (LMWHs)? What don't they require?

Enoxaparin, More predictable anticoagulant response Do not require frequent laboratory monitoring -Given SC

Ex of a direct thrombin inhibitor?

Dabigatran rapid onset  fixed doses  no blood test  few drug-drug interactions  no dietary concerns  lower risk of bleeds

Antidote for overdose (OD) for Heparin?

Protamine sulfate

Client Education/ what must we teach out clients when taking Warfarin?

Keep intake of vitamin K constant (tomatoes, dark leafy green vegetables) (if you have to much in your diet the drug won't be as effective and the risk of having a stroke increases) Wearing a medical alert bracelet Consult a physician before taking other drugs or OTC products, including natural health/herbal products MANY drug-drug interactions

What anticoagulant has a direct factor on Xa inhibitors? what kind of advantages does it have?

rivaroxaban Similar advantages as dabigatran

Anticoagulants: Mechanism of Action/ how do they work?

-Do NOT lyse existing clots -All prevent clot formation (heparin) Low-molecular-weight heparins (LMWH) Warfarin – oral

Antifibrinolytic Agents: Adverse Effects?

Uncommon and mild Rare reports of thrombotic events

What is Rivaroxaban?

It is a direct factor Xa anticoagulant inhibitor

What is Heparin monitored by? what does it measure? What does it need to be greater then?

dosage unpredictable -Monitored by activated partial thromboplastin times (aPTT) aPTT measure of the intrinsic pathway aPTTs need to be 1.5 – 2.5 x greater than control

Therapeutic effects of heparin/when is it used?

Massive deep vein thrombosis (DVT) Pulmonary embolism (PE) Preferred anticoagulant during pregnancy and when rapid anticoagulation is required

Example of hemostasis modifier agent? what do they do?

Thrombolytic drugs Lyse (break down) existing clots They are given during emergency situations where a clot is forming and blocking off vesicles

Antifibrinolytic Agents: Contraindications/When do we never use them?

Never used in DIC (disseminated intravascular coagulation)

What is Warfarin? What does it prevent? What does it inhibit?

It is an anticoagulant that reduces clotting factors in plasma -It stops the readiness of clot formation and Vitamin K essential for production of several clotting factors Works to extend the time of clothing so that that it prevents the formation of clots

Ex of an anti platelet that irreversible inhibits COX in platelets?

Acetylsalicylic acid (Aspirin)- 81 mg EC

What do Antiplatelet Drugs do?

They inhibit platelet aggregation -They prevent platelet plugs

What does Heparin indirectly inhibit?

Heparin indirectly inhibits activity of multiple proteins on cascade -Thrombin (II) (intrinsic pathway)

Three major groups of thrombotic drugs? What do they do?

Anticoagulants: Disrupt the coagulation cascade, thereby suppressing the production of fibrin Antiplatelets: Inhibit platlet aggregation Thrombolytics: Promote lysis of fibrin, causing dissolution of thromb

What is thrombosis?

a blood clot formed within a blood vessel or within the heart

What kind of agents are Thrombolytic Agents (fibrinolytic agents)? WHat is an example of one?

*Drugs that break down preformed clots (speed up the process) *Recombinant tissue plasminogen activator (tPA) Alteplase (slow infusion, short T1/2)

Ex of a antifibrinolytic agent that blocks plasminogen activation?

aminocaproic acid blocks plasminogen activation

Thrombolytic Agents: Adverse Effects?

Bleeding Dysrhthmias

Advantages of Direct-Acting Oral Anticoagulants (DOACs)?

rapid onset (no lag time) fixed doses (more standardized for person to person with less blood tests) no blood test few drug-drug interactions no dietary concerns lower risk of bleeds

What anticoagulant has a direct factor on Xa inhibitors? what kind of advantages does it have?

rivaroxaban Similar advantages as dabigatran

Ex of Recombinant tissue plasminogen activator (tPA) drug that breaks down performed clots?

Alteplase (slow infusion, short T1/2)

How is herparin administered? half life? When is it effective?

-Parenteral – IV or SC -Effective within minutes -Short half-life (1 to 2 hours)

Thrombolytic Agents: Mechanism of Action?

-Activate fibrinolytic system to break down clot in blood vessel -Re-establishes blood flow to heart muscle via coronary arteries (MI)  brain (stroke)

Ex of a LWMH? Affects? Antidote?

Enoxaparin Affects Factor Xa (10a) antidote: protamine sulfate