Unit 4: Ch 55 Flashcards by Taya Schreiter

what is hemostasis?

physiologic process by which bleeding is stopped

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what is stage 1 of hemostasis?

formation of platelet plug (platelet aggregation)

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is a stage 1 blood clot stable?

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what is stage 2 of hemostasis?

coagulation: production of fibrin

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is a stage 2 blood clot stable?

Yes

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what is an intrinsic coagulation pathway?

contact activation pathway

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what is an extrinsic coagulation pathway?

tissue activation pathway

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What is factor Xa?

accelerates the thrombin formation which then leads to acceleration of fibrin formation

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What are the three major groups of drugs that work on clotting?

anticoagulants
anti platelet drugs
thrombolytic drugs

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what is the purpose of plasmin?

digests fibrin

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Arterial thrombi is best prevented with what drugs?

anti platelet

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what are the anti platelet drugs?

Aspirin
Clopidogrel
Plavix

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what drugs best prevent venous thrombi?

Warfarin
Heparin
Dabigatran
Lovenox

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what is the purpose of anticoagulants?

reduce fibrin formation

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what are the mechanisms of action for anticoagulants?

inhibit synthesis of clotting factors
(days to peak and days to replace)
inhibit activity of clotting factors
(quick action and short duration)

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What is Unfractioned Heparin?

rapid acting anticoagulant

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what is the mechanism of action for unfractioned heparin?

promote action of anti-thrombin
inactivates thrombin and factor Xa

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How is unfractioned heparin administered?

Parenteral

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What is the antidote for unfractioned heparin?

Protamine Sulfate

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How does unfractioned heparin antidote work?

binds to heparin for 2 hours
1mg will inactivate 100u of heparin

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What are the therapeutic uses of unfractioned heparin?

used in pregnancy (doesn’t cross placenta)
stroke evolving
pulmonary embolism
Deep Vein Thrombosis
Open heart surgery
Low-dose therapy post-op

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How is the dosage of Heparin determined?

Body weight

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What lab should be monitored while on Heparin?

aPTT levels (activated partial thromboplastin time)

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What are the normal and therapeutic levels of aPTT?

Normal: 25-40 sec
Therapeutic: 60-80 sec

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What are the adverse effects of heparin?

Hemorrhage heparin induce thrombocytopenia (HIT) Hypersensitivity reactions

what are the contraindications of heparin?

thrombocytopenia uncontrollable bleeding during and immediately after surgery of eye, brain, or spinal cord recent surgery (can impact stitches and cause bleeding)

How is LMW Heparin different from unfractioned heparin?

LMW is a smaller molecule

What are the advantages of LMW Heparin?

fixed dose schedule no lab testing can be used at home less thrombocytopenia

What drug is the first line of therapy for DVT?

LMW Heparin

what are the therapeutic uses of LMW heparin?

prevention of DVT after hip/knee surgery treatment of established DVT prevention of ischemia w/unstable angina or after MI

How is LMW heparin administered?

SubQ based on body weight

what is the antidote for LMW heparin?

Protamine sulfate

What are the adverse effects of LMW heparin?

bleeding thrombocytopenia neuro injury

What med class is warfarin apart of?

anticoagulant

What is the route of administration for warfarin?

Oral

what is the antidote for warfarin?

Vitamin K (since warfarin is a vitamin K antagonist)

What is the mechanism of action for warfarin?

blocks biosynthesis

Which lab tests should be monitored while on warfarin?

international normalized ratio (INR) Prothrombin time (PT)

How often do you have to monitor INR?

Never stop monitoring it! (daily first 5 days, then less frequent checks, every 2-4 weeks or longer)

What is the therapeutic range of INR?

2-3

What are the adverse effects of warfarin?

Hemorrhage

What are the precautions and interactions of warfarin?

Teratogenic No foods rich in vit. K MANY interactions Interacts with heparin, aspirin, and acetaminophen !!!!! Make sure pt is hydrated

What med class is Dabigatran Etexilate a part of?

anticoagulant, direct thrombin inhibitor

what is Dabigatran Etexilate's route of administration?

oral

what is the mechanism of action for Dabigatran Etexilate?

binds to thrombin and inhibits free thrombin and thrombin in clots stops fibrinogen from converting to fibrin and prevents activation of factor XIII

what is the antidote for Dabigatran Etexilate?

Idarucizumab

is Dabigatran Etexilate dosed by body weight?

What are the advantages of Dabigatran Etexilate to warfarin?

rapid onset no lab work monitoring needed few drug-food interactions less risk of major bleeding predictable: same dose for all

what are the therapeutic uses of Dabigatran Etexilate?

prevention of stroke prevention of systemic embolism in atrial fibrillation pts prevention of venous thromboembolism after knee or hip replacement surgery

what are the adverse effects of Dabigatran Etexilate?

bleeding dyspepsia

what are the drug interactions of Dabigatran Etexilate?

drugs that inhibit p-glycoprotein (results in higher systemic drug levels)

which med class is Rivaroxaban apart of?

anticoagulant, direct factor Xa inhibitor

what is Rivaroxaban's mechanism of action?

directly inhibit production of thrombin through selective inhibition of factor Xa

what is Rivaroxaban's antidote?

Andexanet alfa

what are the therapeutic effects of Rivaroxaban?

DVT and PE prevention in knee and hip replacement pts prevention of stroke in pts w/artrial fibrillation

which med class is Aspirin a part of?

antiplatelet drugs

what is aspirin's mechanism of action?

irreversible inhibition of cyclooxygenase

what are the uses of aspirin?

primary and secondary prevention of MI prevention of stroke in pts w/hx TIA

what is the dosing of aspirin?

low: to inhibit COX but not synthesize prostacyclin

what are the adverse effects of aspirin?

increased risk for bleeding GI bleeding hemorrhagic stroke

which med class is Clopidogrel a part of?

antiplatelet drug

what is Clopidogrel's mechanism of action?

ADP receptor antagonist prevents platelet aggregation

what are the therapeutic uses of Clopidogrel?

!!!!! prevents blockage of coronary artery stents reduce thrombotic events in pts w/acute coronary syndromes

which med class is Eptifibatdie a part of?

antiplatelet drug, glycoprotein IIb/IIIa receptor

what is the use of Eptifibatide?

prevent ischemic events in pts with ACS and pts undergoing PCI (reduces risk of rapid re-occlusion)

what are the adverse effects of Eptifibatide?

thrombocytopenia !!! bleeding

which med class is Alteplase a part of?

thrombolytic drug, tissue plasminogen activator (tPA)

what is the use of Alteplase?

acute MI massive PE Ischemic stroke

what are the adverse effects of Alteplase?

bleeding

A patient is receiving an intravenous infusion of heparin to treat a pulmonary embolism. What laboratory value will the nurse monitor to evaluate the treatment with this medication? A. Activated partial thromboplastin time (aPTT) B. Prothrombin time (PT) or INR C. Platelets D. Hemoglobin and hematocrit

A patient is receiving coumadin (warfarin) for DVT prevention. What laboratory value will the nurse monitor to evaluate the treatment with this medication? A. Activated partial thromboplastin time (aPTT) B. Prothrombin time (PT) or INR C. Platelets D. Hemoglobin and hematocrit

Which of the following patients may need an increased dose of warfarin (Coumadin) to have the same anticoagulant effect? A patient taking: A. acetaminophen (Tylenol) for back pain. B. cimetidine (Tagamet) to prevent gastric ulcers C. oral contraceptives to prevent pregnancy D. prednisone (Deltasone) for rheumatoid arthritis

A patient is being discharged home on enoxaparin (Lovenox) injections for treatment of a deep vein thrombosis. Which of the following statements made by the patient indicates the need for further teaching? A. “I will inject the enoxaparin into the fatty tissue of my abdomen.” B. “I hate needles, but I know enoxaparin doesn’t come in pill form.” C. “I will need to go to my doctor’s office each week to have my blood drawn to see if the enoxaparin is working .” D. “I will call my physician immediately if I experience any uncontrolled bleeding while on enoxaparin.”