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S1: Pharm & Med Safety > U2: Anti-Coagulant Drugs > Flashcards

U2: Anti-Coagulant Drugs Flashcards

1
Q

How do anticoagulants function?

A

Inhibits clog formation and prevents new clots from forming

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2
Q

What are the four classes of anticoagulant drugs?

A

Heparin, warfarin, low molecular weight heparins and factor Xa inhibitors

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3
Q

How is heparin dispensed? (What route?)

A

Sub Q or IV

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4
Q

How is warfarin dispensed? (What route?)

A

Oral

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5
Q

Which anticoagulant is used prophylactically to prevent thrombus or to treat acute thrombus, usually in the hospital?

A

Heparin

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6
Q

Which anticoagulant is used for established patients?

A

Warfarin

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7
Q

Which anti-coagulant has a longer half-life?

A

Warfarin

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8
Q

Which anti-coagulant is highly protein bound, which can heighten adverse effects?

A

Warfarin

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9
Q

What are side effects of heparin?

A

Itching, chills, headache, nosebleeds, vomiting blood, skin redness, hematoma, alopecia, elevated hepatic enzymes, N/V, injection site reaction, priapism

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10
Q

What are contraindications for heparin?

A

Heparin-induced thrombocytopenia, hypersensitivity

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11
Q

Patients with which conditions should use caution when taking heparin?

A

Peptic ulcer, hepatic or renal disease, hemophilia, disseminated intravascular coagulation, diverticulitis, head trauma, asthma, aneurism, endocarditis, thrombocytopenia, pregnancy/breastfeeding, older adults.

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12
Q

What are adverse effects of heparin?

A

Bleeding, intracranial bleeding, ocular hemorrhage, anemia, bone fracture, osteoporosis, hyperkalemia, vitamin d deficiency, GI bleeding, stroke, hyperlipidemia, thrombocytopenia, heparin-induced thrombocytopenia, anaphylaxis

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13
Q

Which drugs interact poorly with heparin?

A

Increased effect: Aspirin, NSAIDs, thrombolytics, probenecid, antibiotics, SSRI
Decreased effect: nitroglycerin, protamine sulfate (antidote)

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14
Q

Which lab monitors the effect of heparin and what is the normal range?

A

PTT (Partial thromboplastin time). 60-70 seconds

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15
Q

What is the antidote for heparin?

A

Protamine sulfate

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16
Q

What are the side effects of warfarin?

A

Headache, alopecia, fever, weakness, priapism, petechiae, ecchymosis (discoloration of the skin)

17
Q

What are adverse effects of warfarin?

A

Purple toe syndrome, bone fracture, hypotension, angina, hematuria, ocular hemorrhage, intracranial / vaginal / GI bleeding and hemorrhage.

18
Q

What are contraindications for warfarin?

A

Pregnancy, hematologic disorders, eclampsia, alcohol abuse, stroke, bleeding, head trauma, aneurism

19
Q

Patients with which conditions should use caution when taking warfarin?

A

Type 2 diabetes (DM), leukemia, anemia, thyroid disease, hepatic and renal impairment, peptic ulcer, atrial fibrillation, heart failure, cerebrovascular disease, breastfeeding

20
Q

What are drug interactions of warfarin?

A

Increased effects: aspirin, NSAIDs, sulfonamides, thyroid drugs, allopurinol, histamine 2 blockers, oral hypoglycemics, metronidazole, miconazole, methyldopa, diuretics, oral antibiotics, vitamin E

Decreased effects: Barbituates, laxatives, phenytoin, estrogen, vitamin C, vitamin K, oral contraceptives, rifampin

21
Q

Would a smoker get an increased or decreased dose of warfarin?

A

Increased

22
Q

Which lab monitors the effect of warfarin and what is the normal range?

A

INR (International Normalized Ratio)
Normal: 1.3 - 2
With anticoagulant: 2-3
With prosthetic heart valves: up to 3.5

23
Q

What is the antidote for warfarin?

A

Vitamin K (Dietary restriction on leafy greens, etc.)

24
Q

What are the names of low molecular weight heparins?

A

Enoxaparin (Lovenox) and Dalteparin (Fragmin)

25
Q

Low molecular weight heparins are give via what route?

A

Sub Q

26
Q

What should you observe for in patients using low molecular weight heparins or Factor Xa inhibitors?

A

Petechiae, bruising, tarry stools and other signs of bleeding

27
Q

What are contraindications for low molecular weight heparins?

A

Stroke, peptic ulcers, brain / spinal surgeries

28
Q

What medications should be avoided with low molecular weight heparins?

A

Aspirin and other NSAIDs

29
Q

Why are low molecular weight heparins or Factor Xa Inhibitors preferable?

A

Less monitoring than warfarin or heparin, produces more stable results with less bleeding risk

30
Q

What education should you provide for patients using low molecular weight heparins or Factor Xa Inhibitors?

A

Look for signs of bleeding and use a soft bristle toothbrush

31
Q

What are the names of Factor Xa Inhibitors?

A

Rivaroxaban (Xarelto) and Apixaban (Eliquis)

32
Q

What is the antidote for Factor Xa inhibitors?

A

Andexanet Alfa

33
Q

Factor Xa Inhibitors are given via what route?

A

Oral

34
Q

Should you continue/discontinue Factor Xa Inhibitors for surgery?

A

Discontinue 1-2 days prior

35
Q

What is the weight limit for Factor Xa Inhibitors?

A

less than 50 kg

S1: Pharm & Med Safety (8 decks)

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