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Pharmacology Test 2 > Test 2 Anticoagulants > Flashcards

Test 2 Anticoagulants Flashcards

1
Q

argatroban: class

A
  • anticoagulant
  • direct thrombin inhibitor
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2
Q

argatroban: MOA

A
  • directly inhibits thrombin
    • Inhibition of thrombin prevents activation of factors V, VIII, and XII; the conversion of fibrinogen to fibrin; platelet adhesion and aggregation.
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3
Q

argatroban: indications

A
  • prophylaxis and tx of thrombosis in pts with HIT
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4
Q

argatroban: SEs

A
  • dyspnea
  • cough
  • rash
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5
Q

argatroban: ADRs

A
  • bleeding
  • anaphylaxis
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6
Q

argatroban: nursing implications

A
  • monitor treatment by measuring aPTT
  • short half life b/c of rapid metabolism by liver
  • only give thru IV
  • watch BP: if unexplained hypoTN, look for bleeding
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7
Q

bivalirudin: class

A
  • hirudin analog
  • direct thrombin inhibitor
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8
Q

bivalirudin: MOA

A
  • direct, reversible inhibitor of thrombin
  • drug binds with and inhibits thrombin that is free in the blood as well as thrombin that is bound to clots
    • prevents conversion of fibrinogen to fibrin
    • prevents activation of factor XIII, so it prevents conversion of soluble fibrin into insoluble fibrin
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9
Q

bivalirudin: indications

A
  • given in combination with aspirin, clopidogrel, or prasugrel to prevent clot formation in pts undergoing coronary angioplasty
  • prevents ischemic complications
    • MI, abrupt vessel closure, death
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10
Q

bivalirudin and heparin

A
  • bivalirudin is at least as effective as heparin at preventing ischemic complications
  • bivalirudin causes less bleeding
  • bivalirudin more effective than heparin in pts with postinfarction angina
  • bivalirudin works independently of antithrombin and inhibits clot bound thrombin and free thrombin
  • bivalirudin: more expensive
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11
Q

bivalirudin: SEs

A
  • back pain
  • nausea
  • hypoTN
  • headache
  • vomiting
  • abdominal pain
  • pelvic pain
  • anxiety
  • nervousness
  • insomnia
  • bradycardia
  • fever
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12
Q

heparin: class

A
  • rapid acting anticoagulant
  • antithrombin activator
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13
Q

heparin: MOA

A
  • enhances the activity of antithrombin which is a protein that inactivates thrombin and factor Xa
    • so, production of fibrin is reduced, and hence clotting is suppressed
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14
Q

heparin: indications

A
  • prophylaxis of venous thrombosis
  • used during pregnancy b/c does not cross placenta
  • in situations that require rapid anticoagulation:
    • pulmonary embolism
    • massive CVT
  • pts with open heart surgery and renal dialysis
  • disseminated intravascular coagulation
  • MI
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15
Q

heparin: SEs

A
  • chills
  • fevers
  • urticaria
  • local irritation
  • hematoma
  • osteoporosis
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16
Q

heparin: ADRs

A
  • hemorrhage
  • spinal/epidural hematoma:
    • pressure due to this type of bleed can cause paralysis
    • risk inc by: indwelling catheter, other anti-coagulants, antiplatelet drugs,
  • heparin induced thrombocytopenia (HIT)
    • inc risk of DVT, PE, MI
17
Q

heparin: nursing implications

A
  • contraindications:
    • thrombocytopenia
    • uncontrollable bleeding
    • if pt had surgery of eye, brain, spinal cord
    • lumbar puncture
    • regional anesthesia
  • effects develop quickly (w/in min of IV admin)
  • monitor for signs of blood loss: reduced BP, inc HR, bruises, petechiae, black stools, hematomas, pelvis pain, headache
  • overdose treated with protamine sulfate
  • monitor for signs of neurologic impairment
  • monitor for signs of thrombosis and reduction of platelets
  • administer through a heparin lock every 4-6 hours
  • determine aPTT before administration and before each dose
18
Q

warfarin: class

A
  • anticoagulant (oral)
  • vitamin K antagonist
19
Q

warfarin: MOA

A
  • suppresses coagulation by decreasing production of factors VII, IX, X, and prothrombin (all are vitamin K dependent clotting factors)
  • works by inhibiting vitamin K epoxide reductase complex I (VKORCI) which is needed to convert vitamin K to its active form
20
Q

warfarin: indications

A
  • long term prophylaxis of thrombosis
  • prevention of venous thrombosis and PE
  • prevention of thromboembolism in pts with prothetic heart valves
  • prevention of thrombosis in pts with atrial fibrillation
  • reduce risk of recurrent transient ischemic attacks and recurrent MI
21
Q

warfarin: SEs

A
  • skin necrosis
  • alopecia
  • urticaria
  • dermatitis
  • fever
  • GI distress
  • red orange colored urine
22
Q

warfarin: ADRs

A
  • hemorrhage
  • fetal hemorrhage and teratogenesis
    • can cross placenta
    • can cause gross malformation, CNS defects, optic atrophy
23
Q

warfarin: contraindications

A
  • contraindications:
    • severe thrombocytopenia
    • uncontrollable bleeding
    • pts undergoing lumbar puncture, regional anesthesia, or surgery or eye/brain/SC
    • hemophilia
    • dissecting aneurysms
    • GI ulcers
    • severe HTN
    • women anticipating abortion
    • vitamin K deficiency
    • liver dz
    • alcoholism
    • pregnancy/lactation
      • category X
24
Q

warfarin: nursing implications

A
  • Vitamin K1 (phytonadione) is used for warfarin overdose
    • should be given orally or IV
  • don’t administer with heparin usually b/c inc bleeding too much
  • don’t take aspirin or acetaminophen with it, b/c inc effects of hemorrhage
  • monitor PT and INR
  • make sure pt sticks to dosing schedule
  • advise pt to
    • avoid prolonged immobility
    • elevate legs when sitting
    • avoid tight garments on legs
    • participate in exercise
    • wear support hose
  • watch for signs of bleeding: dec BP, inc HR, discolored urine/stool, bruises, petechiae
    • if bleeding occurs, do not administer
  • avoid excess alcohol
  • use soft toothbrush to prevent bleeding gums
  • make sure to discontinue before major surgery (not dental)
25
Q

difference b/w warfarin and heparin

A
  • heparin:
    • activates antithrombin, which then inactivates thrombin and factor Xa
    • route: IV or subQ
    • onset: rapid (minutes)
    • duration: brief (hours)
    • monitoring: aPTT
      • normal is 40 sec, but heparin should make it about 60-80 sec
    • antidote: protamine
  • warfarin:
    • inhibits synthesis of vitamin K dependent clotting factors including prothrombin and factor X
    • route: PO
    • onset: slow (hours)
    • duration: prolonged
    • monitoring: PT (INR)
    • antidote: vitamin K1
26
Q

protamine sulfate: class and indication

A
  • antidote for severe heparin overdose
27
Q

protamine sulfate: MOA

A
  • small protein that binds to heparin to form a complex that can’t do anticoagulant activity
  • neutralization of heparin occurs immediately and lasts for 2 hours
28
Q

protamine sulfate: SEs

A
  • dyspnea
  • bradycardia
  • flushing
29
Q

protamine sulfate: ADRs

A
  • anaphylaxis
  • angioedema
  • PE
30
Q

protamine sulfate: nursing implications

A
  • avoid activity that could make them bleed
  • IV only
    • give 1 mg for every 100 units of heparin
  • make sure pt reports recurrent bleeding
31
Q

phytonadione: class

A
  • vitamin K
  • antidote to warfarin
32
Q

phytonadione: MOA

A
  • antagonizes warfaron and can reverse warfarin induced inhibition of clotting factor synthesis
33
Q

phytonadione: indications

A
  • tx of overdose of warfarin
  • sometimes give to liver pts
34
Q

phytonadione: SEs

A
  • flushing
  • rash
  • erythema
35
Q

phytonadione: ADRs

A
  • anaphylaxis (flushing, hypoTN, CV collapse)
    • especially if given by IV, so administer slowly
36
Q

phytonadione: nursing implications

A
  • avoid activity that can cause bleeding
  • report any unusual bleeding

Pharmacology Test 2 (9 decks)

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