Mod 5- Coagulation Modifiers Flashcards by Ashley Yewell

Special considerations for children on blood coagulants

implement safety/ injury precautions

Know what to do if bleeding begins

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How are blood coagulants dosed for children?

Based on weight and age

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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

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What blood testing would you want to perform for an older adult on blood coagulants?

Kidney/ liver functions- start low & go slow

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What are 2 indications for blood coagulants?

Thromboembolic disorder- conditions that predispose a person to clots & emboli
Hemorrhagic disorder- excess bleeding occurs

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Action of Antiplatelets

alter the formation of the platelet plug

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Action of Anticoagulants

Interfere with the clotting cascade and thrombin formation

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Thrombolytic drugs are also called?

“Clot busters”

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Actions of Thrombolytic drugs

break down the thrombus that has been formed by stimulating the plasmin system

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Antiplatelet Medications

Aspirin 
clopidogrel 
Dipyridamole 
Eptifatide 
Tucagrelor

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Indications for Antiplatelet Agents

CV diseases that are prone to clogged vessels

- keep grafts open/ patent

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What are the effects of Aspirin?

anti-inflammatory
analgesic
antipyretic effects

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Contraindications for antiplatelet agents

allergy
pregnancy
lactation

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Cautions for antiplatelet agents

bleeding disorders
recent surgery
closed-head injury

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ADE of Antiplatelet Agents

BLEEDING
CNS: H/A, dizziness, weakness
GI distress

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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

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What notification should you make for a pt on Antiplatelet Agents?

Mark their chart

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Antiplatelet Prototype

Aspirin

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What are ADE of aspirin?

aspirin toxicity can lead to fever, coma, CV collapse

- dizziness, tinnitus, difficulty hearing & anaphylactoid reaction

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What are the suffixes for Anticoagulant Agents?

"-arin"
heparin 
warfarin 
"-xaban"
rivaroxaban 
apixaban 
Dabigatran

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You wouldn’t give Anticoagulant Agents to pt with these

allergy, pregnancy, renal or hepatic disorders

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Use caution when giving Anticoagulant Agents to these pts with these

CHF
thyrotoxicosis
senility
psychosis

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ADE of Anticoagulant Agents

Bleeding, GI Upset, Alopecia & dermatitis

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Drug/Drug interactions of Heparin

Oral anticoagulants, salicylates, penicillins, or cephalosporins (inc. bleeding time)

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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