Quiz 6 #2 Anticoagulants

Question 1

Prothrombin time (PT)

Answer 1

Measures how long it takes a clot to form in a sample of blood

• Normal 11-15 seconds
• Monitored when using Warfarin (Coumadin)

Question 2

Hemostasis

Answer 2

The process that stops bleeding after injury to a blood vessel

Question 3

Difference between coagulation, thrombus, and embolus

Answer 3

• Coagulation: the process of blood clot formation
• Thrombus: intravascular blood clot
• Embolus: name for a thrombus that travels from its site of origin

Question 4

Contrast fibrin and plasmin

Answer 4

Fibrin: clot forming substance
Plasmin: degrades blood plasma proteins

Question 5

Heparin MOA/Drug Effects

Answer 5

MOA: binds to a substance called antithrombin III which turns off three main activating factors (II, IX, X).

Effect: the overall effect is that it turns off the coagulation pathway and prevents clots from forming.

Question 6

Heparin Nursing Implications

Answer 6

• Short half life (1-2 hrs)
• Monitor coagulation effects (aPTT)
• Monitor for heparin induced thrombocytopenia (HIT)
• Med delivery has to be signed off by 2 RNs (“double check medication”)
• Antidote: protamine sulfate

Question 7

Activated partial thromboplastin time (aPTT)

Answer 7

Measures how long it takes a clot to form in a sample of blood

• Normal 40 seconds
• Therapeutic 1.5-2.0 times normal

Question 8

Low Molecular Weight Heparins (LMWH) MOA/Drug Effects

Answer 8

MOA: synthetic with smaller molecular structure. More specific for factor X.

Effects: anticoagulant response

Question 9

Low Molecular Weight Heparins administration/nursing implications

Answer 9

Given by 25 to 28 gauge needle in the abdomen.

Question 10

Low Molecular Weight Heparins Examples

Answer 10

enoxaparin (Lovenox), dalteparin (Fragmin)

Question 11

Warfarin MOA/Drug Effects

Answer 11

MOA: inhibits vitamin K synthesis by bacteria in the GI tract. This in turn inhibits production of clotting factors II, VII, IX, X. These factors are normally synthesized in the liver and are known as vitamin K-dependent clotting factors.

Effects: prevent clot formation. Does not lyse clot.

Question 12

Warfarin Nursing Implications

Answer 12

• Given orally only,
• Monitored by prothrombin time (PT) and INR.
• Antidote=Vitamin K

Question 13

International Normalization Rate (INR)

Answer 13

A standardized measure of coagulation achieved by drug therapy.

• Normal 1.0
• Therapeutic Coumadin level INR=2.0-3.0
• Monitored when using Warfarin (Coumadin)

Question 14

Warfarin Patient Education

Answer 14

• Take exactly as directed
• If a dose is missed take as soon possible
• Do not double up on doses
• Review food high in vitamin K
• Must keep follow up appointments
• Instruct on brushing teeth with soft brush
• Report any unusual bleeding or bruising

Question 15

Anticoagulants Adverse Effects

Answer 15

Bleeding, nausea, vomiting, abdominal cramps, thrombocytopenia

Question 16

Anticoagulants Contraindications

Answer 16

• Severe uncontrolled hypertension
• Hemorrhagic stroke
• Bleeding disorders
• GI bleeding / ulcers
• Recent spinal cord surgery or ophthalmologic surgery

Question 17

Antiplatelet Drugs MOA/Drug Effects

Answer 17

MOA: suppress platelet aggregation. A platelet core constitutes the bulk of an arterial thrombosis so the principle indication for the antiplatelet drugs is prevention of thrombosis in arteries.

Effects: prevention of MI, acute MI, ischemic strokes, and coronary stenting.

Question 18

Antiplatelet Examples

Answer 18

ASA
Clopidogrel (Plavix)