Quiz 5 Flashcards
Anticoagulants
Role of Thrombin and the development of the clot
General diffference between intrinsic/extrinsic pathway
How does ASA work as an anti-platelet?
-Decreases aggregation and formation of the platelet clot (Blocks Cox-1)
-Inhibits prostaglandin production
How is Clopidogrel a different type of medication? Who takes this medication?
-It keeps platelets in your blood from attaching to each other and making blood clots
-Used for post stent/Post MI
Nursing considerations for pt on anti-platelets
Should be stopped at least 1 week before surgery
Who can discontinue anti-platelet therapy?
A Qualified healthcare provider
How does warfarin work?
Inhibits the production of Vit K
Who might take warfarin?/ Why does warfarin have so many drug interactions?
Used in atrial fibrillation, Valvular heart disease, CVA, DVT and PE prevention, post joint replacement (People at risk of blood clot)
- Due to the drug being highly protein-bound
What is the lab test which monitors warfarin therapy and what is the desired level?
PT/INR
Want INR at 2 to 3
For mechanical heart valve = 2.5 to 3.5
When is Warfarin started and administered? How many days until therapeutic levels are
achieved?
Takes 4-7 days for take effect
What is the antidote for warfarin? List all potential options
Phytonadione (Vitamin K)/ or protamine..? not sure
Nursing considerations for warfarin? How long does it take to clear the body?
-Takes 4-7 days to take effect
-Should be taken in the evening
-Requires frequent lab monitoring (PT/INR)
-Narrow therapeutic range
-Works slowely compared to heparin
How do Factor Xa inhibitors work? (DOAC)
-Prevent factor Xs from changing prothrombin to thrombin. They bind directly to factor Xa
Why is dabigatran different from the others?
What are special nursing considerations (patient teaching) for dabigatran?
it directly blocks thrombin, the enzyme responsible for clot formation, whereas the others are direct factor Xa inhibitors.
Twice daily dosing
Dabigatran:
Antidote?
Which patient group should take with caution/have reduced dose?
-Praxbind
-Must reduce in renal failure
Common Coagulation tests
PTT (prothrombin time)
International Normalized Ratio (INR)
Activated partial thromboplastin tine (aPTT)
Why is this drug class different than warfarin?
Which patients should NOT receive this medication?
-Do not take with Clopidogrel
-Must reduce in renal failure
What is the antidote for the DOAC class of medications?
Which of these medications are once daily dosing and which are twice daily dosing?
Andexanet (not for dibigatran)
Why might warfarin be a better choice for some patients than the DOAC class?
How does heparin work?
Anti-thrombin inhibitor- interferes with conversion of thrombin to prothrombin
How long does heparin take to work and how long does it take to clear the body after it is turned off?
online: Heparin works quickly, with IV heparin taking effect within minutes, and subcutaneous heparin within 1-2 hours. The anticoagulant effect of therapeutic doses of heparin is mostly eliminated within 3-4 hours after stopping continuous IV administration, with a half-life of about 60-90 minutes.
What lab value is used to monitor heparin therapy?
Monitored by aPTT usually 1.5-2.5 times baseline control
How is heparin dosed?
Antidote?
Starts by administering an IV bolus dose, followed by continuous dripL
Bolus usually 5000units
Followed by 1000-1300units/hour
Or
80u/kg (can be less) bolus and then 18u/kg/hour
Antidote: Protamine sulfate
ALWAYS CHECK DOSE WITH ANOTHER NURSE
A patients’ aPTT after 6 hour is 45 seconds. What action should the nurse take?
What is the difference between unfractionated heparin and low molecular weight
heparin?
Why would someone receieve one over the other?
How long does it take for enoxaparin (lovanox) to reach a steady state?
What are special considerations which need to be taken when administering
enoxaparin?
inject into “love handles”
Alternate between sites
Do not inject air bubble prior to injection
Do Not just injection site after
why would tPA be administerd?
What are the criteria or contraindications which must be met before administration?
Only given IF within 3-4 hours of onset of symptoms.
Only give through a peripheral IV, not a central line (so you can compress the site)
NO injections
No SQ, or IM
No ABGs (blood gas)
Monitor vital signs and neurologic status
If possible CVA, must do head CT before administering
Place patient on bleeding precautions
