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Thromboembolic meds Flashcards

1
Q

Anticoagulant

A

against blood clot formation

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2
Q

Anti platelet

A

against aggregation and platelet plug

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3
Q

thrombolytics

A

destroys blood clots

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4
Q

Anticoagulants examples

A

heparin
LMWH
Vitamin K antagonists (warfarin)
Factor Xa inhibitors

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5
Q

Antiplatelets

A

aspirin
clopidogrel
ticagrelor
abcixmab

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6
Q

thrombolytics examples

A

alteplase
reteplase
tenecteplase

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7
Q

Antidotes

A

protamine sulfate
vit K
idarucizumab
andexnet

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8
Q

labs monitored on heparin infusion

A

aPtt
Anti-xa

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9
Q

lab work for warfarin

A

PT/INR

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10
Q

Heparin inactivates

A

thrombin and Factor Xa

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11
Q

Heparin Admin

A

SQ or IV only

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12
Q

Heparin therapeutic use

A

PE, CVA, DVT
procedures (heart surgery, ECMO, MI)
dialysis

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13
Q

Can heparin be used in pregnancy?

A

yes, it does not cross the BBB

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14
Q

Does heparin dissolve clots?

A

no, only prevention

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15
Q

Heparin ADR

A

bleeding (internal, spinal, hematoma)
HIT
hypersensitivity
irritation, bruising, hematoma

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16
Q

PT

A

how long it takes to form a clot

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17
Q

Heparin Contraindication

A

thrombocytopenia
uncontrolled bleeding
surgery
new trauma
lumbar puncture anesthesia
PUD, aneurysm, HTN, possible abortion, liver and renal diseases

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18
Q

Recommended INR for warfarin with a fib

A

2-3

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19
Q

lab of choice for pts. taking vitamin K antagonists

A

INR

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20
Q

Heparin interactions

A

antiplatelets including aspirin
other anticoagulants

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21
Q

antidote for heparin

A

Protamine Sulfate

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22
Q

Heparin considerations

A

RN double check

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23
Q

HIT

A

typically over 4 days on heparin
discontinue heparin
Check platelets 2-3 times a week in beginning infusions
HIT immunoassay detects antibodies

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24
Q

Heparin dose/levels setting

A

sliding scale,
IV loading dose, plus set rate and surveillance labs
measured in units

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25
LMWH
low molecular weight heparins enoxeparin dalteparin fondaparinux
26
Advantage of LMWH
fixed dose and less lab monitroing
27
LMWH admin
SQ post op 5-10 days
28
LMWH ADR
bleeding (less than normal though) HIT neurologic injury with spinal puncture or epidural anesthesia
29
Warfarin is a
vitamin K antagonist
30
Warfarin is an
anticoagulant
31
prevention of Vitamin K causes
blocked synthesis of dependent clotting factors (VII, IX, X, and prothrombin)
32
Warfarin indications
longterm prophylaxis + thrombosis and PE prevents A-fib, and in prosthetic heart valves adjunct with MI or TIA
33
Is warfarin used in emergency
no
34
warfarin ADR
hemorrhage teratogen
35
can warfarin be used in pregnancy?
no
36
Warfarin warnings and contrainndications
spinal surgery hemophilia aneurysm ulcer liver disease ETOH
37
Warfarin interactions
anticoagulants avoid taking new meds call provider before starting new meds
38
what decreases the effect of warfarin
carbamazepine, phenytoin, oral contraceptives, rifampin
39
Drugs that increase the effect of warfarin
antifunglas (azoles), cimetidine, amiodarone
40
objective of warfarin monitoring
raise INR showing a longer time for blood to clot
41
Warfarin toxicity
increased bleeding control by omitting one or two doses (not stopping abruptly)
42
Warfarin antidote
phytonadione (vitamin K)
43
Phytonadione route
IV or PO if IV dilute first and infuse slowly
44
Phytonnadione ADR
anaphylactic reaction flushing hypotension CV collapse
45
Heparin and warfarin together
when pt needs anticoagulant and PO meds for home therapy Heparin inhibits thrombin warfarin inhibits Vit K clotting factors
46
When is heparin discontinued in combined use with warfarin?
when INR is within therapeutic range
47
Aspirin inhibits
cyclooxyrgenase
48
ADR of inhibiting cyclooxyrgenase
GI bleed
49
ADP receptor antagonists
clopidogrel ticlopidine ticagrelor
50
eating precautions with warfarin
you can eat a regular amount of vitamin K as long as it is steady when diet changes then INR changes and vitamin k levels change so therapy must be adjusted
51
Aspirin inhibits ... which inhibits ... which is necessary for ...
COX synthesis of TXA2 platelet activation and vasoconstriction of VSM
52
Warfarin onset
delayed
53
Dabigatran onset
rapid (direct thrombin inhibitor)
54
Aspirin indications
ischemic stroke angina MI in pts with angina acute MI bypass surgery stenting
55
Aspirin ADR
bleeding, hemorrhagic stroke
56
Asa can double bleeding for
7 days because the life of a platelet is 7-10 days
57
stop ASA how long before surgery
one week
58
Clopidrogrel (plavix) is an
antiplatelet
59
Clopidogrel activation
Prodrug; converted to active form by CYP
60
Clopidrogrel action
ADP antagonist (block ADP receptor on platelets)
61
drug in PAD
clopidogrel is used in peripheral arterial disease
62
Idarucizumab
dabigatran reversal agent
63
Clopidogrel ADR
abd pain, dyspepsia, D, rash hemorrhage TTP
64
Clopidogrel interactions
anticoagulatants CYP2 inhibitors herbal drugs
65
reduces clopidogrel effect
PPI
66
Poor metabolizers
have a genetic inability to convert clopidogrel to active form blood and saliva tests
67
Glycoprotein IIB IIIA receptor antagonist MOA
most effective anti platelet causes a reversible blockage of platelet GP receptors
68
GP IIb/IIIa RA example
Abciximab tirofiban eptifibatide
69
GPIIbIIIa use
prevent ischemic events in acute coronary syndrome pts prevents re occlusion durring coronary interventions
70
Abciximab/tirofiban
used with aspirin and heparin for pts undergoing PCI Accelerates revascularization in pts undergoing thrombolytic therapy for MI Antiplatelet effects 24-48 hrs after infusion
71
Alteplase and thrombolytic drugs are used to dissolve existing thrombi
true
72
Fibrinolytic drugs
alteplase, reteplase, tenecteplase
73
Fibrinolytic action
promote conversion of plasminogen to plasmin (dissolves fibrin matrix dissolving clotting)
74
fibrinolytic use
severe thrombotic disease acute MI PE Stroke vascular line clearance (low dose)
75
fibrinolytic ADR
bleeding
76
Alteplase (tPA)
complex catalyzes the conversion of plasminogen into plasmin that digests fibrin meshwork Used in MI, ischemic stroke, massive PE
77
tPA ADR
Bleeding if this occurs, give whole blood products or IV aminocapr
78
VItamin K admin instructions
dilute and give slowly
79
advantages to alteplase
does not cause allergic reactions does not cause hypotension
80
Rivaroxaban reversal
andexnet
81
insert IV or venipuncture ....
before thrombolytics

Pharm (9 decks)

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