Module 5 - 1

Question 1

Antiplatelete

Answer 1

inhibit the initiation of a clot

Question 2

Anticoagulants

Answer 2

prevent formation of a mature clot (but they cannot dissolve a clot where one has already formed)

Question 3

thrombolytics

Answer 3

are used to dissolve clots that have already formed

Question 4

when bleeding occurs in the body, three mechanisms reduce blood loss

Answer 4

1. Vascular spasm
2. Formation of a platelet plug - platelet inhibitors
3. Blood clotting (coagulation) - anticoagulants

Question 5

Drugs that dissolve clots

Answer 5

“clot busters” are tissue plasminogen activators (tPA)

Question 6

Thrombus

Answer 6

clotting in an unbroken artery or vein is called a thrombus, and the abn disease process that accounts for it is called “thrombosis”

*** Thrombus is like skaters on a very rough surface. may become dislodged and be swept away in the blood.

Question 7

Abnormal thrombi

Answer 7

in “arteries” are usually initiated by a roughened, diseased surface of a blood vessel, such as occurs form atheroscherosis, trauma or infection

Question 8

DVT

Answer 8

Deep Venous Thrombosis
abn thrombotic clots that from the the “veins” usually happens when blood flows too slowly (stasis), allowing clotting factors to accumulate and initiate coagulation.

Question 9

embolus (pl. emboli)

Answer 9

when an atherosclerotic thrombus, blood clot, air bubble, or piece of fat or other debris is transported by the bloodstream.

Question 10

thromboembolic events

Answer 10

thrombosis and embolism can be understood as being part of the same disease. this lead to partial blockage, decreased blood flow, and chest pain

Question 11

The most serious types of thrombus

Answer 11

is when blood clots on top of an unstable atherosclerotic plaque

Question 12

The most serious type of embolus

Answer 12

is when the clot/plaque breaks free as an embolus

Question 13

what are the three different types of anti-clotting drugs?

Answer 13

1. Platelet Inhibitors
   hinder the ability of platelets to get sticky and form a platelet plug
2. Anticoagulants
   of the “deep clotting cascade” - hinder one or more steps in the cascade of soluble clotting factors that lead to the formation of thrombin
3. Thrombolytics - the “clot buster” drugs dissolve a clot after it has already formed

Question 14

Antiplatelet drugs are used to:

Answer 14

• Prevent or treat superficial venous thrombosis, and more mild cases of DVT
• Prevent the “mini-strokes” that are called TIAs that often presage an impending stroke
• Prevent and treat anginal chest pain that often presage an impending MI
• All platelet inhibitors work making platelets less sticky

Question 15

Aspirin - platelet inhibitor

Answer 15

NSAID is placed into the catergory of anti-clotting drugs

prophylaxis to relieve angina and prevent heat attacks and stroke.

Question 16

clopidogrel (Plavix)

Answer 16

Platelet Inhibitors prescription - currently the 2nd best selling drug worldwide

Question 17

Platelet inhibitors drugs side effect

Answer 17

Bruising. Any bleeding seen from platelet inhibitors is sometimes called “superficial bleeding” - bloody nose

Question 18

Anticoagulation drugs side effect

Answer 18

Deep Bleeding - bleeding into the joints, the abdomen, or brain (if pt on Coumadin)

Question 19

Coumadin adverse effect (anticoagulant)

Answer 19

bleeding into joints, the abdomen, or brain (brain hemorrhage)

Question 20

Bleeding Time (BT)

Answer 20

A test of superficial bleeding that can be used to demonstrate the effects of platelet inhibition.

Question 21

Anticoagulants are powerful drugs used to:

Answer 21

• provide anticoagulation during hemodialysis and cardiopulmonay bypass (CPB)
• prevent or treat DVT or pulmonary embolism (PE - which is related to DVT)
• Prevent or treat “Stroke” or the recurrence of stroke
• Prevent or treat MI or the recurrence of MI
• they all work by interrupting one or more of the clotting steps depicted in the following diagrams

Question 22

Coagulation cascade

Answer 22

anticoagulants impede the deep system of coagulation cascade through the:

• Extrinsic pathway
• Intrinsic pathway
• common pathway

Question 23

PTT test

Answer 23

to measure the heparins (anticoagulant) administered - inhibition of the “intrinsic pathway”

Question 24

INR (PT) test

Answer 24

to measure the “Coumadin” (anticoagulant) administered - inhibition of the “extrinsic pathway”

Question 25

Pradaxa (dabigatran)

Answer 25

direct thrombin inhibitors - common pathway, no test for this drug

Question 26

Heparins

Answer 26

stimulates our own natural anticoagulant called antithrombin III of the deep clotting cascade - best seen by checking the aPTT test. I.V

Question 27

Enoxaparin (Lovenox)

Answer 27

is low molecular weight heparins (LMWH) drug can be treat outpatients (NO HOSPITALIZATION) and don’t require blood tests (PTT) to monitor coagulation status

Question 28

Coumadin (warfarin) = RAT POISON

Answer 28

is an inhibitor of vitamin K dependent clotting factor made in the liver. measuring the “extrinix clotting pathway by INR (PT) test to confirm Coumadin’s effects in pt taking the drug - Oral only

Question 29

FFP

Answer 29

FRESH FROZEN PLASMA - since Coumadin inhibits vitamin K which is essential for some clotting to function, a vitamin -K injection or administration of FFP will counteract its effects and bring the coagulation state back to normal.

Question 30

The newest group of anticoagulants

Answer 30

Pradaxa (dabigatran)

1. Faxtor Xa inhibitors
2. Direct Thrombin Inhibitors (DTIs)

Question 31

Pradaxa (dabigatran)

Answer 31

Factor Xa inhibitor and Direct Thrombin Inhibitor

Question 32

plasminogen

Answer 32

when clots are formed, a lot of the natural protein plasminogen is incorporated into the clot in preparation for them time when the clot will need to be dissolved.

Question 33

t-PA - r-tPA

Answer 33

Tissue plasminogen activator - “Clot buster”

***t-PA convert plasminogen into an active enzyme (plasmin) which breaks apart the clot

Question 34

Thrombolytic drugs - when to use it

Answer 34

accelerate the normal “clot busting” process by augmenting the action of t-PA.

are used in situation where immedicate clot lyse is absolutely necessary to save a life

1. An acute heart attack
2. A thrombotic or embolic stroke
   * * they cannot be use in cases of a stroke caused by hemorrhage of blood (hemorrhagic stroke)

Question 35

Thrombolytic drugs

Answer 35

used through a catheter inserted into a coronary artery to bust a clot…maybe save a life

Question 36

alteplase (Activase)

Answer 36

this is a r-tPA drug (recombinant t-PA) the first t-PA approved by FDA 1996.