objective 2.2 (pt.3) (2) Flashcards
a general term for any process that stoep bleeding
hemostasis
hemostasis that occurs bcuz of the physiological clotting of blood
coagulation
a technical term for blood clot
thrombus
thrombus that moves through blood vessels and becomes lodged somewhere else in the body
embolus
Initiates the breakdown of clots and serves to balance the clotting process
Fibrin in the clot binds to a circulating protein known as plasminogen. This binding converts plaminogen to plasmin
fibrinolytic system
the mechanism by which formed thrombi are lysed to prevent excessive clot formation and BV blockage
fibrinolysis
the clot binds to a circulating protein known as plasminogen. This binding converts plaminogen to plasmin
fibrin
the enzymatic protein that eventually breaks down the fibrin thrombus. This keeps the thrombus localized to prevent it from becoming an embolus
plasmin
Inhibit the action or formation of clotting factors and prevent clot formation
anticoagulants
Inhibit platelet aggregation and prevent platelet plug formation
antiplatelet drugs
Lyse (break down) existing clots
thrombolytic drugs
Promote blood coagulation
antifibrinolytic or hemostatic
also known as antithrombotic drugs
HAVE NO DIRECT EFFECT ON A BLOOD CLOT THAT HAS ALREADY FORMED
Prevent intravascular thrombosis by decreasing blood coagulability
Used prophylactically to prevent
Clot formation
An embolus
anticoagulants
what are the indications for anticoagulants?
used to prevent clot formation in certain settings in which clot formation is likely:
MI, unstable angina, atrial fibrillation, indwelling devices, such as mechanical heart vales, conditions in which blood flow may be slowed and blood may pool (e.g., major orthopedic surgery)
what are the contraindications for anticoagulants?
Any acute bleeding process or high risk of such an occurrence
Warfarin is strongly contraindicated in pregnancy, other anticoagulants are rated in lower pregnancy categories
Low-molecular-weight heparins are contraindicated in pts with an indwelling epidural catheter risk of epidural hematoma
what are the AE of anticoagulants?
Bleeding
Risk increases with increased dosages
May be localized or systemic
May also cause
Heparin-induced thrombocytopenia
N/V, abdominal cramps, thrombocytopenia…warfarin
Bleeding ‘lethargy
Muscle pain
Skin necrosis
“Purple toes” syndrome
Natural anticoagulants obtained from the lungs or intestinal mucosa of pigs
DVT prophylaxis
heparin
what are the heparin toxic effects?
Aimed at reversing the underlying cause
Symptoms: hematuria, melena, petechiae, ecchymoses, and gum or mucous membrane bleeding
Stop the drugs immediately
**INTRAVENOUS (IV) PROTAMINE SULPHATE IS AN ANTIDOTE
Frequent laboratory monitoring for bleeding times such as aPTT
Heparin must be checked by 2 nurses prior to admin
unfractionated heparin
Frequent laboratory monitoring of bleeding times using tests such as aPTT are not needed
enoxaparin
Commonly prescribed oral anticoagulant
Inhibit vitamin K-dependent clotting factors II, VII, IX, and X which are normally synthesized in the liver
Final effects is the prevention of clot formation
Careful monitoring of the prothrombin time (PT) and international normalized ration (INR) are necessary
There may be diet restrictions of vitamin K high foods (many greens)
A normal INR (without warfarin) is 0.8 to 1.2, but a therapeutic INR (with warfarin) ranges from 2-3.5
Bleeding, lethargy, skin necrosis, “purple toes” syndrome
Discontinue the warfarin
May take 36 to 42 hrs before the liver can resynthesize enough clotting factors to reverse the warfarin effects
Vitamin K1 can speed the return to normal coagulation
High doses (10mg) of vitamin K given IV will reverse the anticoagulation within 6 hrs
Caution: when vitamin K is given, warfarin resistance will occur for up to 7 days
warfarin
prevent platelet adhesion and aggregation
Aspirin
Clopidogrel
antiplatelet drugs
break down, or lyse clots in the coronary arteries
Alteplase (activase)
Tenecteplase (TNKase)
They activate the fibrionlytic system to breakdown the clot in the BV quickly
Mimics the bodys own process of clot destruction, used for…
Acute MI, arterial thrombolysis, DVT, occlusion of shunts or catheters, pulmonary embolism, acute ischemic (blockage) stroke
thrombolytic drugs
what are the AE of thrombolytic drugs>
Bleeding
Internal, intracranial, superficial
Monitor for bleeding gums, mucous membranes, nose, and injection sites
Neuro signs checked as per policy
Watch for signs for internal bleeding (decreased BP, restlessness, increased pulse)
Other effects
N/V, hypotension, hypersensitivity, anaphylactic reactions
Cardiac dysrhythmias that can be dangerous
Prevents the lysis of fibrin, results in promoting clot formation
Used for prevention and treatment of excessive bleeding resulting from hyperfibrinolysis or surgical complications
Treatment of hemophilia A or type 1 Von Willebrands disease
Desmopressin
Adverse effects are uncommon and mild
antifibrinolytic drugs
