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Pharm > Thromboembolic meds > Flashcards

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
Q

LMWH

A

low molecular weight heparins
enoxeparin
dalteparin
fondaparinux

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26
Q

Advantage of LMWH

A

fixed dose and less lab monitroing

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27
Q

LMWH admin

A

SQ
post op 5-10 days

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28
Q

LMWH ADR

A

bleeding (less than normal though)
HIT
neurologic injury with spinal puncture or epidural anesthesia

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29
Q

Warfarin is a

A

vitamin K antagonist

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30
Q

Warfarin is an

A

anticoagulant

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31
Q

prevention of Vitamin K causes

A

blocked synthesis of dependent clotting factors (VII, IX, X, and prothrombin)

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32
Q

Warfarin indications

A

longterm prophylaxis + thrombosis and PE
prevents A-fib, and in prosthetic heart valves
adjunct with MI or TIA

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33
Q

Is warfarin used in emergency

A

no

34
Q

warfarin ADR

A

hemorrhage
teratogen

35
Q

can warfarin be used in pregnancy?

A

no

36
Q

Warfarin warnings and contrainndications

A

spinal surgery
hemophilia
aneurysm
ulcer
liver disease
ETOH

37
Q

Warfarin interactions

A

anticoagulants
avoid taking new meds
call provider before starting new meds

38
Q

what decreases the effect of warfarin

A

carbamazepine, phenytoin, oral contraceptives, rifampin

39
Q

Drugs that increase the effect of warfarin

A

antifunglas (azoles), cimetidine, amiodarone

40
Q

objective of warfarin monitoring

A

raise INR showing a longer time for blood to clot

41
Q

Warfarin toxicity

A

increased bleeding
control by omitting one or two doses (not stopping abruptly)

42
Q

Warfarin antidote

A

phytonadione (vitamin K)

43
Q

Phytonadione route

A

IV or PO
if IV dilute first and infuse slowly

44
Q

Phytonnadione ADR

A

anaphylactic reaction
flushing
hypotension
CV collapse

45
Q

Heparin and warfarin together

A

when pt needs anticoagulant and PO meds for home therapy
Heparin inhibits thrombin
warfarin inhibits Vit K clotting factors

46
Q

When is heparin discontinued in combined use with warfarin?

A

when INR is within therapeutic range

47
Q

Aspirin inhibits

A

cyclooxyrgenase

48
Q

ADR of inhibiting cyclooxyrgenase

A

GI bleed

49
Q

ADP receptor antagonists

A

clopidogrel
ticlopidine
ticagrelor

50
Q

eating precautions with warfarin

A

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
Q

Aspirin inhibits … which inhibits … which is necessary for …

A

COX
synthesis of TXA2
platelet activation and vasoconstriction of VSM

52
Q

Warfarin onset

A

delayed

53
Q

Dabigatran onset

A

rapid (direct thrombin inhibitor)

54
Q

Aspirin indications

A

ischemic stroke
angina
MI in pts with angina
acute MI
bypass surgery
stenting

55
Q

Aspirin ADR

A

bleeding, hemorrhagic stroke

56
Q

Asa can double bleeding for

A

7 days because the life of a platelet is 7-10 days

57
Q

stop ASA how long before surgery

A

one week

58
Q

Clopidrogrel (plavix) is an

A

antiplatelet

59
Q

Clopidogrel activation

A

Prodrug; converted to active form by CYP

60
Q

Clopidrogrel action

A

ADP antagonist (block ADP receptor on platelets)

61
Q

drug in PAD

A

clopidogrel is used in peripheral arterial disease

62
Q

Idarucizumab

A

dabigatran reversal agent

63
Q

Clopidogrel ADR

A

abd pain, dyspepsia, D, rash
hemorrhage
TTP

64
Q

Clopidogrel interactions

A

anticoagulatants
CYP2 inhibitors
herbal drugs

65
Q

reduces clopidogrel effect

A

PPI

66
Q

Poor metabolizers

A

have a genetic inability to convert clopidogrel to active form
blood and saliva tests

67
Q

Glycoprotein IIB IIIA receptor antagonist MOA

A

most effective anti platelet
causes a reversible blockage of platelet GP receptors

68
Q

GP IIb/IIIa RA example

A

Abciximab
tirofiban
eptifibatide

69
Q

GPIIbIIIa use

A

prevent ischemic events in acute coronary syndrome pts

prevents re occlusion durring coronary interventions

70
Q

Abciximab/tirofiban

A

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
Q

Alteplase and thrombolytic drugs are used to dissolve existing thrombi

A

true

72
Q

Fibrinolytic drugs

A

alteplase, reteplase, tenecteplase

73
Q

Fibrinolytic action

A

promote conversion of plasminogen to plasmin (dissolves fibrin matrix dissolving clotting)

74
Q

fibrinolytic use

A

severe thrombotic disease
acute MI
PE
Stroke
vascular line clearance (low dose)

75
Q

fibrinolytic ADR

A

bleeding

76
Q

Alteplase (tPA)

A

complex catalyzes the conversion of plasminogen into plasmin that digests fibrin meshwork

Used in MI, ischemic stroke, massive PE

77
Q

tPA ADR

A

Bleeding

if this occurs, give whole blood products
or IV aminocapr

78
Q

VItamin K admin instructions

A

dilute and give slowly

79
Q

advantages to alteplase

A

does not cause allergic reactions
does not cause hypotension

80
Q

Rivaroxaban reversal

A

andexnet

81
Q

insert IV or venipuncture ….

A

before thrombolytics

Pharm (9 decks)

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