Mod 5- Coagulation Modifiers Flashcards
Special considerations for children on blood coagulants
implement safety/ injury precautions
Know what to do if bleeding begins
How are blood coagulants dosed for children?
Based on weight and age
What type of blood coagulant drugs should NEVER be used in kids?
“-xaban” drugs, low-molecular weight heparins d/t unknown safety, no indications for antiplatelets or thrombolytics
What blood testing would you want to perform for an older adult on blood coagulants?
Kidney/ liver functions- start low & go slow
What are 2 indications for blood coagulants?
Thromboembolic disorder- conditions that predispose a person to clots & emboli
Hemorrhagic disorder- excess bleeding occurs
Action of Antiplatelets
alter the formation of the platelet plug
Action of Anticoagulants
Interfere with the clotting cascade and thrombin formation
Thrombolytic drugs are also called?
“Clot busters”
Actions of Thrombolytic drugs
break down the thrombus that has been formed by stimulating the plasmin system
Antiplatelet Medications
Aspirin clopidogrel Dipyridamole Eptifatide Tucagrelor
Indications for Antiplatelet Agents
- CV diseases that are prone to clogged vessels
- keep grafts open/ patent
What are the effects of Aspirin?
anti-inflammatory
analgesic
antipyretic effects
Contraindications for antiplatelet agents
allergy
pregnancy
lactation
Cautions for antiplatelet agents
bleeding disorders
recent surgery
closed-head injury
ADE of Antiplatelet Agents
BLEEDING
CNS: H/A, dizziness, weakness
GI distress
Drug/ Drug interactions of Antiplatelet Agents
another drug that affects blood clotting
CYP3A inhibitors- liver iso enzyme responsible for metabolism can affect levels of the drug
What notification should you make for a pt on Antiplatelet Agents?
Mark their chart
Antiplatelet Prototype
Aspirin
What are ADE of aspirin?
- aspirin toxicity can lead to fever, coma, CV collapse
- dizziness, tinnitus, difficulty hearing & anaphylactoid reaction
What are the suffixes for Anticoagulant Agents?
"-arin" heparin warfarin "-xaban" rivaroxaban apixaban Dabigatran
You wouldn’t give Anticoagulant Agents to pt with these
allergy, pregnancy, renal or hepatic disorders
Use caution when giving Anticoagulant Agents to these pts with these
CHF
thyrotoxicosis
senility
psychosis
ADE of Anticoagulant Agents
Bleeding, GI Upset, Alopecia & dermatitis
Drug/Drug interactions of Heparin
Oral anticoagulants, salicylates, penicillins, or cephalosporins (inc. bleeding time)
Drug/ Drug interactions of Heparin
nitroglycerin- decreases bleeding time
Drug/ Drug interactions of warfarin
Number of interactions- check drug guide
Why is a pt on Anticoagulant Agents dx with disturbed body image?
alopecia & skin rash as a side effect
What hx do you need to know about a pt on Anticoagulant Agents
recent surgery, bleeding, CVA in last 2 mo, obstetrical delivery, GI bleeding, uncontrolled hypertension, liver disease
What are the therapeutic blood levels of warfarin?
INR of 2-3
or
PT of 1.5-2.5x the control value
What are the therapeutic blood levels of heparin?
aPTT of 1.5-3x the control value
What is the warfarin antidote?
Vitamin K
What is the heparin antidote?
Protamine sulfate
Anticoagulant Agent Prototype
Heparin
What is the suffix of Thrombolytic Agents?
Think busting up clots- digesting is "-ase" altepase reteplase tenecteplase urokinase
Indications for Thrombolytic Agents
When does a clot need to be busted? Acute MI, pulmonary embolism, ischemic stroke
Contraindications for Thrombolytic Agents
allergy, pregnancy, (caution lactation), any condition that would be worsened by dissolution of clots (bleeding, recent surgery/ births)
ADE of Thrombolytic Agents
bleeding, cardiac arrhythmias, hypotension, hypersensitivity- rash, flushing, bronchospams, anyphylactic reactions
Drug/ Drug interactions of Thrombolytic Agents
anticoagulants
antiplatelet
What is an important thing to monitor for a pt taking Thrombolytic Agents
signs of bleeding, occult blood in stool
Thrombolytic Agent Prototype
Urokinase
What is the benefit of low-molecular-weight Heparins
Don’t affect thrombin or clotting times so less systemic effects
What do low-molecular weight heparins block?
Block factors Xa and Ila
block angiogenesis that allows cancer cells to develop new blood vessels
When are low-molecular weight heparins indicated?
prevention of clots/ emboli after surgery (joint replacement/ long bone fractures) or bed rest
What are the low-molecular weight heparin medications?
Dalteparin
Enoxaparin
What are 4 anticoagulant adjuncts? 🍀🥔🏈🥦
Lepirudin
protamine sulfate
prothrombin complex concentrate
Vitamin K
What medication is a hemorrheologic agent?
Pentoxifylline- helps trouble w/ blood flow when it is too thick and causes pain in the legs
What bleeding disorders are treated with clotting factors?
hemophilia
liver disease
bone marrow disorders
What is the action of antihemophilic drugs?
replaces clotting factors that are genetically missing or low
What are the indications for anyhemophilic drugs?
Prevents blood loss from injury or surgery & to treat bleeding disorders
How would you know a medication is an antihemophilic?
It will have the word “factor” in the name
What are contraindications of antihemophilics? 🐄🐁🐹🍼 + cautions
Allergy to bovine, mice, or hamster; lactation, caution in pregnancy
ADE of antihemophilics
HA, flushing, fever, chills lethargy
nausea/ vomiting
stinging, itching, burning at injections site
How are antihemophilic agents administered?
by IV ONLY
Antihemophilic Prototype
Antihemophilic factor
What is the action of a systemic hemostatic agent?
Prevents systemic clot breakdown to prevent blood loss
What is the indication of a topical hemostatic agent?
for surface injuries involving so much damage that clotting does not occur and blood is slowly and continually lost
What is a systemic hemostatic medication?
aminocaproic acid
What is a topical hemostatic medication?
absorbable gelatin, thrombin
Contraindications to systemic/ topical hemostatic agents
systemic: allergy, acute DIC, lactation
Topical: allergy to bovine
Caution in systemic/ topical hemostatic agents
systemic: cardiac disease, renal/hepatic dysfunction, pregnancy
Topical: no safety established in kids
ADE of systemic/ topical hemostatic agents
systemic: excess clotting, CNS, GI weakness, fatigue malaise, muscle pain
Topical: infections w/ sponges
Drug/Drug interactions of hemostatic agents
systemic: heparin, oral contraceptives or estrogen
