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Pharmacology > Hemostasis Modifier Drugs (52) > Flashcards

Hemostasis Modifier Drugs (52) Flashcards

1
Q

What is the process of hemostasis

A

Stopping bleeding after an injury to a blood vessel
-platelet plugs
-fibrin production

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2
Q

Anticoagulants

A

Inhibit the action or formation of clotting factors
-prevent clot formation

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3
Q

Antiplatelet drugs

A

Inhibit platelet aggregation
-prevent platelet plugs

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4
Q

Thrombocytes drugs

A

Lyse/break down existing clots

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5
Q

Hemostatic agents

A

Promote blood coagulation

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6
Q

What is the final clotting product

A

Fibrin

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7
Q

Anticoagulants or blood thinners are used prophylacticlly to prevent

A

-clot formation
-emboli (dislodged clot)

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8
Q

anticoagulants or blood thinners DO NOT

A

Lyse existing clots

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9
Q

Anticoagulants are used to prevent clots in certain settings such as (6)

A

-MI
-unstable angina
-A FIB
-DVT
-indwelling devices
-PE

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10
Q

Anticoagulants ALL prevent

A

Clot formation

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11
Q

Anticoagulants examples (4)

A

-heparin
-low molecular weight heparins
-warfarin
-direct acting oral anticoagulants

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12
Q

Contraindications of anticoagulants

A

-allergies
-acute bleeding process
-thrombocytopenia

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13
Q

AE of anticoagulants: bleeding risk

A

Gums bleed, nosebleeds, unusual brushing, anemia, tarry stools

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14
Q

Heparin action

A

Indirectly inhibits activity of multiple proteins on cascade

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15
Q

What proteins is heparin inhibiting (3)

A

-thrombin (II)
-factor Xa
-other factors a part of intrinsic pathway

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16
Q

Natural heparin comes from

A

Animal sources

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17
Q

Predicting the dosage of heparin

A

Dosage is unpredictable

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18
Q

What is heparin monitored by

A

Activated partial thromboplastin times or aPTT

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19
Q

APTT is a measure of

A

The intrinsic pathway

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20
Q

How much greater do aPTTs need to be than control

A

1.5 - 2.5x

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21
Q

Heparin (3)

A

-parenteral IV or SC
-effective within minutes
-short half life (1 to 2 hours)

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22
Q

What is Heparin Induced Thrombocytopenia or HIT

A
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23
Q

What percentage of the population experiences HIT

A

1-5%, and usual within less than 4 days of administration

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24
Q

What to do when HIT

A

Stop heparin administration, and use alternative

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25
Q

Heparin has a risk of _____ reactions

A

Hypersensitivity reactions
-urticaria, fever, chills

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26
Q

Anticoagulant effects of heparin are reversed by

A

Protamine sulfate
-antidote

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27
Q

Example of low molecular weight heparins

A

Enoxaparin

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28
Q

Low molecular weight heparins have a more

A

Predictable anticoagulant response

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29
Q

Low molecular weight heparins do not require

A

More frequent laboratory monitoring
-can be given at home
-SC every two hours

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30
Q

Low molecular weight heparins indirectly inhibit

A

Factor X ONLY

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31
Q

Low molecular weight heparins cause ____ but less than heparin

A

Thrombocytopenia

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32
Q

Low molecular weight heparins promote

A

Sulphate antidote

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33
Q

Other anticoagulant drugs

A

-danaparoid
-fondaparinux

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34
Q

Danaparoid

A

Structurally distinct from heparin
-alternative to heparin
-SC or IV

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35
Q

Fondaparinux

A

Synthetic
-SC or IV

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36
Q

Heparin doses usually are

A

Double checked with another nurse

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37
Q

SC doses of heparin

A

Should be given in areas of deep subcutaneous fat -abdomin + rotate site

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38
Q

Antidote for heparin

A

Protamine sulphate

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39
Q

Low molecular weight heparins are given

A

SC in abdomen ONLY, rotate sites

40
Q

Antidote for Low molecular weight heparins

A

Protamine sulphate

41
Q

What is the vitamin K agonist?

A

Warfarin

42
Q

What is vitamin K essential for

A

Production of several clotting factors in liver cells
-such as VII, IX, X, pro-thrombin

43
Q

Warfarin reduces the ___ for ___ clotting factors in plasma

A

Ready for action
-extending clotting time

44
Q

Warfarin: effects

A

Depend on clotting factors turnover (protein degradation)

45
Q

Max effect of warfarin

A

May take 3 to 5 days
-start within 24 hours

46
Q

What is a common combination started within 5 days

A

Large molecular weight heparin and warfarin

47
Q

Warfarin is administered

A

PO
-dosage is variable

48
Q

How is warfarin monitored

A

By clotting lab test
-prothrombin time
-INR

49
Q

PT/INR

A

Measures activity of extrinsic pathway

50
Q

PT to be therapeutic is ____ to _____ times the normal level

A

1.3 to 1.5 times

51
Q

Normal target INR range

A

2 to 3 x control
-some cases 2.5 to 3.5

52
Q

INR =

A

(PT observed/ PT control) ISI

53
Q

ISI =

A

International sensitivity index

54
Q

What happens to warfarin effectiveness when too much vitamin K is in diet?

A
55
Q

What happens to warfarin effectiveness when too little vitamin K is in diet?

A
56
Q

Vitamin K can be given if exessive PT/INR

A

-IV (slow infusion) 4-8h effect
-PO effect within 24 h

57
Q

Warfarin x pregnancy

A

Risks of fetal bleeding, teratogenicity and spontaneous abortion
-LMWH

58
Q

With anticoagulants you need to maintain intake of

A

Vitamin K to be consistent
-tomatoes, dark leafy green vegetables

59
Q

Warfarin may be started while

A

The client is still on heparins

60
Q

DOACs advantages over warfarin

A

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

61
Q

What is a direct thrombin inhibitor

A

Dabigatran

62
Q

Dabigatran

A

PO administration

63
Q

Direct factor Xa inhibitors

A

Rivaroxaban

64
Q

Rivaroxaban

A

PO administration

65
Q

Adverse effects of anticoagulants

A

Increased bleeding
-can be mild to life threatening

66
Q

All DOACs need

A

Annual renal function test
-if below min function, changed to vitamin K antagonist

67
Q

What is important for anticoagulants

A

Regular lab testing with signs of abnormal bleeding

68
Q

Antiplatlet agents prevent

A

Paltelet activation

69
Q

Example of anti platelet agent

A

Acetylsalicylic acid or aspirin

70
Q

How does ASA work

A

Irreversible inhibition of COX in platelets

71
Q

What antiplatlet drugs prevent platelet activation

A

Clopidogrel

72
Q

Clopidogrel

A

Irreversible ADP receptor blocker
-effects last life time of platelet

73
Q

Indications of anti platelet drugs

A

Antithrombotic effects
-reduce MI risk
-reduce stroke risk

74
Q

Aspirin + Clopidogrel combination

A

Produces additive anti platelet activity

75
Q

GPIIb/IIIa antagonists MOA

A

Antagonizes receptor on platelets that are required for fibrinogen cross linking

76
Q

Thrombolytic drugs

A

Break down preformed clots

77
Q

Thrombolytic drug: tPA

A

Recombinant tissue plasminogen activator

78
Q

Recombinant tissue plasminogen activator example

A

Alteplase

79
Q

TPA acts on

A

Plasminogen- inactive plasma protein, making it from becoming plasmin- the active protein, to digest fibrin

80
Q

Thrombolytic agents MOA

A

Activate fibrinolytic system to break down clot in blood vessel
-convert plasmin

81
Q

Thrombolytic agents re-establishes

A

Blood flow to heart muscle via coronary arteries and the brain

82
Q

Indications for Thrombolytic agents

A

-acute MI
-arterial Thrombolytic
-DVT
-occlusion of shunts or catheters
-pulmonary embolus

83
Q

Contraindications of Thrombolytic agents

A

-allergies
-concurrent use of other anticoagulation

84
Q

Adverse effects: Thrombolytic agents

A

-bleeding
-GI
-hypotension
-anaphylactic reactions
-dysrhythmias

85
Q

Antifibrinolytic agents

A

Prevent the lysis of fibrin in an existing clot
-improve clotting factor survival

86
Q

Antifibrinolytic promote

A

Clot formation and/or clot maintenance

87
Q

Antifibrinolytic agent examples

A

Aminocaproic acid

88
Q

Aminocaproic acid

A

Inhibits fibrinolysis by blocking plasminogen activation

89
Q

Aminocaproic acid indications

A

Trauma, antidote to Thrombolytic agents

90
Q

Desmopressin

A

Antifibrinolytic agent, similar to vasopressin (ADH)

91
Q

Desmopressin indication

A

Mild hemophilia A
-increases plasma concentration of factor VIII

92
Q

Indications of Antifibrinolytic agents

A

Prevention and treatment of excessive bleeding

93
Q

Excessive bleeding examples

A

-hyperfibrinolysis
-surgical complications
-oozing form surgical sites (chest tubes)
-reducing total blood loss and duration of bleeding

94
Q

Contraindications of Antifibrinolytic agents

A

-allergies
-never used in DIC (disseminated intramuscular coagulation)

95
Q

Adverse effects of Antifibrinolytic are

A

Uncommon and mild
-rare reports of thrombotic event

Pharmacology (23 decks)

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