Thomboembolism Flashcards
Where does Heparin work?
anticoagulant
where does Alteplase work?
at the clot
where does aspirin work?
antiplatelets
where does clopidogrel work?
thrombolytic
a patient started heparin therapy. “can this be administered in a pill?
no, heparin can only be admin by injection
a pt with a history of CVD will receive therapy to prevent arterial thrombosis. what class of drug will they most likely be prescribed?
what about if it were venous thrombosis?
anti platelet for arterial thrombosis like aspirin
anti-coagulant for venous thrombosis like Heparin
what labwork will the nurse monitor for pt on heparin? What will the nurse do if she suspects HIT?
Anti-Xa, aPtt,
we are trying to prevent over-medication
-send an HIT immunoassay which will detect the presence of antibodies
what labwork will the nurse monitor for pt on warfarin?
PT & INR
What is PTT?
partial thromboblastin time
how long does the clot take to form
What is anti-Xa?
(anti factor ten a)
indirectly measure activity of heparins
an acceptable level would be 0.3-0.7 U/ml
heparin routes
subQ or IV infusion
a pt is on warfarin for a-fib. What is the recommended INR range for a therapeutic effectiveness?
2-3
(Normal INR is .8-1.2)
Pt has been on long term heparin therapy and will continue to use at home? what nurse education to prevent common ADRs of this drug?
void contact sports or vigorous exercise
Which of the following will the nurse include in teaching for the pt on anti-thrombotics?
avoid alcohol, use a soft toothbrush, avoid tattooing, use an electric razor for shaving
overall goal: avoid risk of excessive bleeding
what is the reversal agent for heparin? nclex
protamine sulphate
which of the following is a low molecular weight heparin?
clopidogrel
dalteparin
warfarin
bivalrudin
dalteparin
what are the advantages of enoxaparin over heparin?
enoxaparin is a low molecular weight heparin (LMWH)
-has greater bioavalibility, a fixed dose, does not require frequent monitoring
what is the priority to clairfy if the pt has been on LMWH for a pt scheduled for orthopedic surgery
a) warfarin is also ordered to start 3 days after surgery
b) K+ of 3.3 with PO supplements
c) Spinal anesthesia is considered for surgery tomorrow
d) INR of 1.2
spinal anesthesia needs to be clarified
pt on heparin for DVT prophylaxis after open reduction and internal fixation of a tibial fracture. what would be the greatest concern to the nurse after beginning this therapy?
a) bruising at injection site
B. headache and confusion
c. pain and body temp of 37.8
pink saliva after brushing teeth
headache and confusion –> we are worried that they have a bleed in their head
a nurse is caring for a pt receiving heparin therapy
HR of 98, blood pressure of 110/72. fingertips are purple, and platelets are low. what is happening?
heparin induced thrombocytopenia
the body makes antibodies against it so the blood starts clotting
-will clot int he periphery first
what is the antidote to excess warfarin dose?
vitamin K! (phytonadione)
match the following to dabigatran or warfarin:
Delayed onset
Rapid onset
direct thrombin inhibitor
vitamin K antagonist
delayed - warfarin
vitamin K antagonist is warfarin
rapid is Dabigatran
direct thrombin inhibitor is Dabigatran
PO clopidogrel (Plavix) to a pt iwth Coronary Artery Disease. pt asks “why am I getting this”
a) it is anti-platelet, so it will prevent your blood from clotting in the arteries
match the following to warfain or dabigatran
a) fixed dose with no coagulation testing
b) fixed dose with few drug-food interation
c) lower risk of hemorrhagic stroke or other bleeds
d) vitamin K as reversal
e) take with empty stomach for increased absorption
Dabigatran
a) fixed dose with no coagulation testing
b) fixed dose with few drug-food interation
c) lower risk of hemorrhagic stroke or other bleeds
e)take on empty stomach for increased absorption
warfarin:
vitamin K as reversal
what is the antidote to Dabigatran
idarucizumab (praxbind)
can warfarin be used in pregnancy?
no
the anticoagulant you can use during pregnancy is (low dose aspirin )
if a pt is taking warfarin they should not use mayo, canola oil, or spinach T/F
false –
they can still have vitamin k rich foods, just keep it constant
T/F: one 325mg tab of aspirin can double bleeding time for up to 10 days
true
pt will go to surgery this week and is on a direct thrombin inhibitor. what will the nurse recommend to the provider
stop the direct thrombin inhibitor for 1-3 days prior to surgery
T/F Alteplase (tPA) and other thrombolytic drugs are use used to prevent thrombi from forming
false, they just dissolve existing thrombi
what is the greatest concern for bleeding?
intracranial hemorrhage
matching:
Clopidogrel, Tirofiban (GP 11b receptor blocker), Rivaroxaban, Aspirin
with
A) The most effective anti-platelet drug available
B) oral anticoagulants that work by direct inhibition of factor Xa
C) suppresses platelet aggregation by irreversible inhibition of cyclooxyrgenase
D) suppresses platelet aggregation by irreversible blockade of P2Y12ADP receptor of the platelet surface
*aspirin inhibits cyclooxyrgenase
*GP 2b/3a receptor blocker is the most effective anti-platelet drug
*Rivaroxaban is an anticoagulant and works by direct inhibition of factor Xa
*Clopidogrel suppresses platelet aggregation by blockade of P2Y12ADP receptors of platelet surface
a pt will need injectable vitamin K:
what might the nurse do first:
A) dilute the solution
B) give IV slowly
C) provide RBC infusions first
D) push quickly with a fast IV flush
E) A and B
F) C and D
A and B
what is the reversal for Rivaroxaban (Xarelto)?
Andexnet (andexxa)
the nurse is caring for a pt with a hemorrhagic stroke. which medication order should the nurse question:
A) Mannitol
B) Clopidogrel
C) nifedipine
D) Dexamethasone
E) Furosemide
clopidogrel, and mannitol
the pt is in traction on bedrest and has a red edematous calf. which medication should the nurse prepare to administer
A. IV Heparin
B. Oral Warfarin
C. SQ clopidogrel
D. Oral Aspirin
