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Perfusion Part 2 Flashcards

1
Q

4 types of anticoagulants

A

Heparins

Vitamin K antagonists

DTIs

Direct factor Xa inhibitors

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2
Q

MOA of heparin

A

Combines with natural anticoagulant to inactivate clotting factors and prevent thrombus formation

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3
Q

Heparin uses

A

Prophylaxis: DVT/PE
Therapeutic: treatment of acute thromboembolic disorders
Prevention of clotting during surgery, ECMO, dialysis, blood transfusions

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4
Q

Considerations for heparin

A

Children: dosed by weight- high alert medication: 2 RN check

Pregnancy: anticoagulation of choice in pregnancy/lactation

Older adults: commonly on anticoagulation- more prone to bleeding


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5
Q

Adverse effects of heparin

A

Heparin induced thrombocytopenia



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6
Q

Heparin contraindications

A

G.I. Ulcers

Intracranial bleeding

Severe Renal/hepatic impairment/hypertension

Recent surgery

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7
Q

Heparin assessment

A

Bleeding, unusual bruising, heparin induced thrombocytopenia (platelets drop significantly)

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8
Q

Heparin monitoring

A

Study to regulate heparin dosing: PTT’s and antifactor 10A levels

CBC with platelet count

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9
Q

What do you do if somebody has heparin induced thrombocytopenia

A

Stop the heparin and look at HIIT studies 

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10
Q

Heparin teaching

A

Risk of bleeding risk: injury prevention

Routine lab testing

Signs and symptoms of bleeding 

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11
Q

Protamine sulfate drug class

A

Reversal agent for standard heparin and LMWH

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12
Q

Protamine sulfate uses

A

Reversal of heparin and low molecular weight heparins (LMWH)

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13
Q

Adverse effects of protamine sulfate

A

Given IV over 10 minutes to avoid- Dyspnea, hypotension, bradycardia, and anaphylaxis

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14
Q

Protamine sulfate black box warning

A

Black box warning: risk of severe hypotension, cardiovascular collapse, pulmonary edema, pulmonary vasoconstriction, and pulmonary hypertension

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15
Q

Contraindications for protamine sulfate

A

Hypersensitivity or fish allergy

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16
Q

Protamine sulfate assessment

A

Bleeding stopping

HR, BP, RR, sats

Pulmonary edema 

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17
Q

Warfarin drug class

A

Vitamin K antagonist (anticoagulant)

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18
Q

Warfarin MOA

A

Prevents synthesis of vitamin k dependent clotting factors

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19
Q

Warfarin uses

A

Long-term prevention/management of DVT and PE

Clot prevention in a-fib and prosthetic heart valves

Post MI to decrease risk of another MI, stroke, DVT, and death

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20
Q

Warfarin special population considerations

A

Children: used after cardiac surgery, close monitoring of levels and safety precautions

Older adults: lower dose usually due to drug metabolism, caution in liver impairment: hepatic metabolism

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21
Q

Adverse effects of warfarin

A

Hemorrhage

Black box warning: fatal bleeding

N/v, abdominal pain, alopecia, urticaria, dizziness, joint/muscle pain

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22
Q

Warfarin contraindications

A

G.I. ulcers, bleeding disorder, severe kidney/liver disease, severe hypertension, recent surgery, and pregnancy 

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23
Q

Warfarin assessment

A

PT INR’S- check every couple of weeks even at home

Long term- where bleeding can happen- unusual bruising, bleeding gums, blood in urine/stool

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24
Q

Warfarin education

A

PT/INR tests as ordered

Avoid injections when possible, avoid contact sports, use electric razor

Signs and symptoms of bleeding- unusual bruising, bleeding gums, blood in urine/stool

Avoid foods high in vitamin K (will decrease effect of warfarin)- broccoli, Brussels sprouts, cabbage, cauliflower, green leafy veggies, tomatoes, turnips

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25
Vitamin K class
Reversal agent for warfarin
26
Vitamin k MOA
Synthesis of vitamin K dependent clotting factors
27
Vitamin k use
Antidote for warfarin overdose
28
Vitamin k considerations/monitoring
K centra is reversal med Give with INR levels too high or for bleeding
29
Rivaroxaban drug class
Direct factor Xa inhibitor (anticoagulant)
30
MOA of Rivaroxaban
Inhibits platelet activation and Formation of fibrin clotting by inhibition of factor Xa
31
Rivaroxaban uses
Treatment/prevention of venous thromboembolism Stroke prevention in patient with a-fib 
32
Special population consideration for Rivaroxaban
Older adults: caution in Renal/hepatic impairment
33
Adverse effects of Rivaroxaban
Bleeding- intracranial, gastric and retinal Anaphylaxis, Angioedema, Stevens-Johnson syndrome
34
Rivaroxaban contraindications
Pregnancy and hypersensitivity
35
Rivaroxaban assessment/monitoring
Improvement in DVT No bleeding, clots? Angioedema, anaphylaxis, stevens- Johnson syndrome (terrible skin reaction) Don’t need to check levels
36
Rivaroxaban teaching
Report bleeding or bruising to Dr. Stop before surgery or invasive procedures Immediately inform Dr. of pregnancy
37
Clopidogrel drug class
Anti platelet drugs: Adenosine diphosphate receptor agonist
38
Clopidogrel MOA
Irreversibly blocks adenosine diphosphate (ADP) on the platelet cell surface Lasts for lifespan of platelets (7-10 days)
39
Clopidogrel uses
Reduction of MI, stroke, vascular death in patients with atherosclerosis or after placement of coronary stents A-fib patients who are unable to take warfarin Antiplatelet drug for those who cannot tolerate aspirin
40
Special populations considerations for clopidogrel
Older adults: higher likelihood of bleeding- used for thrombotic stroke prevention but increases the risk of hemorrhagic stroke
41
Adverse effects of clopidogrel
Pruritis, rash purpura, diarrhea Rare: thrombotic thrombocytopenia, hemorrhage, severe neutropenia
42
Clopidogrel contraindications
Hypersensitivity and active bleeding
43
Clopidogrel assessment/monitoring
Skin reactions, diarrhea, improvement/absence of vascular ischemic events Monitor: CBC (for thrombocytopenia, neutropenia 
44
Clopidogrel teaching
Take once daily Risk of bleeding Safety precautions to prevent injury May need to take aspirin with this Hold med 5-7 days before surgery Report excessive bleeding, bruising, fever, chills, sore throat
45
Aspirin drug class
Antiplatelet drugs: Salicylates 
46
Aspirin MOA
Inhibits platelet aggregation- Lasts for the life of the platelet
47
Aspirin uses
Reduce risk of TIAs and cerebrovascular accidents Decrease risk of death from MI
48
Adverse effects of aspirin
G.I. bleeding Aspirin toxicity Nausea, heartburn, dyspepsia Renal/respiratory failure in high doses Bruising/Petechiae
49
Contraindications for aspirin
Known sensitivity and at risk for bleeding
50
Aspirin assessment
Signs of bleeding/bruising, pain, fever No GI irritation Resp/skin check for reaction Cross sensitivity with ibuprofen and aspirin 
51
Aspirin monitoring
Toxicity Bleeding/signs of bleeding Skin reaction
52
Signs of aspirin toxicity
Nausea/vomiting fever, fluid/electrolyte deficiencies visual changes, drowsiness hyperventilation delirium, coma, and seizures
53
Aspirin overdose treatment (mild toxicity)
Stop treatment and symptoms improve
54
Severe aspirin toxicity treatment
Treat symptoms Correct fluid, electrolyte, acid-base imbalances Prevent further absorption in GI tract with activated charcoal/lavage Alkalinize urine with IVF containing sodium bicarbonate to rapidly excrete salicylates Hemodialysis if necessary 
55
Aspirin teaching
Avoid alcohol, take with food to prevent G.I. irritation Report bruising or bleeding May require direct pressure to superficial bleeding 3 to 5 minutes or longer to stop bleeding Avoid taking two weeks before or after major surgery or dental procedures If pregnant stop two weeks before estimated due date keep out of reach of children
56
Alteplase drug class
Thrombolytic drugs
57
Alteplase MOA 
lyses unwanted fibrin clots
58
Alteplase uses
Acute MI massive pulmonary embolism Ischemic stroke- within three hours of onset Restore function of occluded venous catheters
59
Alteplase special populations
Children: venous catheter clearance Older adults- not recommended for pts over 80
60
Alteplase adverse effects
Bleeding Brain hemorrhage- 3% mortality rate, 6-8% risk of symptomatic brain hemorrhage
61
Alteplase contraindications
Uncontrolled hypertension, aneurysm, AVM Known coagulopathy, internal bleeding, intracranial or intraspinal surgery/trauma within three months, intracranial mass, recent surgery, oral anticoagulant use
62
Where is Alteplase given (setting)
ICU or ED
63
Alteplase assessment/monitoring
Stroke- back to normal mentation, bleeding Cardiac- back to baseline rhythm, stable Labs: coags (PTT, INR, platelets) BP & HR
64
Alteplase teaching
Informed consent regarding purpose of drug Discharge teaching to emphasize management of underlying disease (MI or stroke)

Pharm (9 decks)

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