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HLSC 220 > Hemostasis Medications, Antiplatelet/Thrombolysis Agents (Not on midterm 2) > Flashcards

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

1
Q

When do we use antifibrinolytic agents?

A

-Prevention and treatment of excessive bleeding

-Excessive oozing from surgical sites such as
chest tubes

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2
Q

What things should clients watch out for while on anticoagulants?

A

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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3
Q

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

A

it is a Direct-Acting Oral Anticoagulants (DOACs)

-Administered PO

Work on plasma proteins and have a direct rapid responses

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4
Q

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

A

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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5
Q

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

A

Vitamin K (IV or PO)

warfarin is strongly contraindicated in pregnancy

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6
Q

What do antifibrinolytic agents do?

A

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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7
Q

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

A

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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8
Q

What do antipltelet agents produce?

A

produces additive antiplatelet activity

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9
Q

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

A

clopidogrel: Irreversible ADP receptor blocker

effect lasts life-time of platelet

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10
Q

What does heparin suppress?

A

The formation of fibrin

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11
Q

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

A

clopidogrel: Irreversible ADP receptor blocker

effect lasts life-time of platelet

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12
Q

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

A

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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13
Q

What is hemostasis?

A

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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14
Q

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

A

It is a antifibrinolytic agent (synthetic pituitary hormone)

used in the treatment of diabetes insipidus

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15
Q

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

A

Drugs that break down preformed clots

Recombinant tissue plasminogen activator (tPA)

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16
Q

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

A

Acetylsalicylic acid (Aspirin)- 81 mg EC

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

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17
Q

What do antiplatelet agents reduce the risk of?

A

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

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18
Q

What do Anticoagulant drugs do?

A

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

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19
Q

Vitiman K antagonist?

A

Warfarin

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20
Q

Contradictions of use from thrombolytic agents?

A

Allergy
concurrent use of other anticoagulation

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21
Q

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

A

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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22
Q

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

A

1.) Intrinsic pathway
2.) Extrinsic pathway

Result is fibrin, a clot-forming substance

23
Q

Contradictions of use for anticoagulants?

A

Known drug allergy
Acute bleeding process
Thrombocytopenia

24
Q

Indications of use for thrombolytic agents?

A

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

25
Q

Anticoagulants: Adverse Effects

A

Bleeding risk

26
Q

What is the main adverse effects of anticoagulants?

A

Risk of Increased bleeding - from mild to life-threatening

27
Q

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

A

Enoxaparin,

More predictable anticoagulant response

Do not require frequent laboratory monitoring

-Given SC

28
Q

Ex of a direct thrombin inhibitor?

A

Dabigatran

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

29
Q

Antidote for overdose (OD) for Heparin?

A

Protamine sulfate

30
Q

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

A

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

31
Q

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

A

rivaroxaban

Similar advantages as dabigatran

32
Q

Anticoagulants: Mechanism of Action/ how do they work?

A

-Do NOT lyse existing clots
-All prevent clot formation (heparin)

Low-molecular-weight heparins (LMWH)

Warfarin – oral

33
Q

Antifibrinolytic Agents: Adverse Effects?

A

Uncommon and mild
Rare reports of thrombotic events

34
Q

What is Rivaroxaban?

A

It is a direct factor Xa anticoagulant inhibitor

35
Q

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

A

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

36
Q

Therapeutic effects of heparin/when is it used?

A

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

37
Q

Example of hemostasis modifier agent? what do they do?

A

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

38
Q

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

A

Never used in DIC (disseminated intravascular coagulation)

39
Q

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

A

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

40
Q

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

A

Acetylsalicylic acid (Aspirin)- 81 mg EC

41
Q

What do Antiplatelet Drugs do?

A

They inhibit platelet aggregation
-They prevent platelet plugs

42
Q

What does Heparin indirectly inhibit?

A

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

(intrinsic pathway)

43
Q

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

A

Anticoagulants: Disrupt the coagulation cascade, thereby suppressing the production of fibrin

Antiplatelets: Inhibit platlet aggregation

Thrombolytics: Promote lysis of fibrin, causing dissolution of thromb

44
Q

What is thrombosis?

A

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

45
Q

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

A

*Drugs that break down preformed clots (speed up the process)
*Recombinant tissue plasminogen activator (tPA)

Alteplase (slow infusion, short T1/2)

46
Q

Ex of a antifibrinolytic agent that blocks plasminogen activation?

A

aminocaproic acid

blocks plasminogen activation

47
Q

Thrombolytic Agents: Adverse Effects?

A

Bleeding

Dysrhthmias

48
Q

Advantages of Direct-Acting Oral Anticoagulants (DOACs)?

A

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

49
Q

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

A

rivaroxaban

Similar advantages as dabigatran

50
Q

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

A

Alteplase (slow infusion, short T1/2)

51
Q

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

A

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

52
Q

Thrombolytic Agents: Mechanism of Action?

A

-Activate fibrinolytic system to break down
clot in blood vessel

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

53
Q

Ex of a LWMH? Affects? Antidote?

A

Enoxaparin

Affects Factor Xa (10a)
antidote: protamine sulfate

HLSC 220 (18 decks)

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