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NURS 804: Pharmacology > Unit 9: Circulation and Coagulation > Flashcards

Unit 9: Circulation and Coagulation Flashcards

1
Q

Name 5 thromboembolic diseases

A 
DVT
PE
Stroke
Acute Coronary Syndrome (MI)
Arterial Occlusion (PAD)
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2
Q

What is the difference between ANTI-PLATELET and ANTI-COAGULANT?

A

Anti-Platelet: prevents platelet aggregation

Anti-Coagulant: prevents formation of fibrin by inactivating coagulation factors

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3
Q

What are Protein C?

A

naturally occurring anticoagulant

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4
Q

What is Protein S?

A

naturally occurring cofactor required to activate Protein C

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5
Q

What happens if a person is deficient in Protein C or Protein S?

A

they are more likely to make clots

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6
Q

What does Nitric Oxide have to do with clotting?

A

it is a vasodilator released by the endothelium that inhibits PLT aggregation

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7
Q

What labs monitor the effect of heparin?

A

aPTT

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8
Q

What labs monitor the effect of warfarin?

A

PT/INR

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9
Q

What do anticoagulants do?

A 
stabilize clots (prevent growth)
prevent clots

DO NOT dissolve clots

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10
Q

Name 4 classes of anticoagulants

A

heparins
warfarin
Factor Xa Inhibitors
Direct Thrombin Inhibitors

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11
Q

Name the heparins

A

unfractionated heparin

LMWH

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12
Q

Name the antidotes for unfractionated heparin

A

protamine sulfate or FFP

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13
Q

Major risk/adverse effect of heparin

A

HIT

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14
Q

Adverse effects of unfractionated heparin

A

bleeding
hyperkalemia
osteoporosis if used > 6 months
antigenic (lots of allergic reactions, including HIT)

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15
Q

Name 2 LMWH drugs

A

enoxaparin (Lovenox)

dalteparin (Fragmin)

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16
Q

What makes enoxaparin preferred over unfractionated heparin?

A

longer half life –>
less frequent dosing
more predictable anticoagulant effect

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17
Q

What anticoagulant is preferred in pregnancy

A

enoxaparin preferred over heparin

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18
Q

Why is enoxaparin not recommended for renal impairment?

A

enoxaparin is renally excreted

if GFR < 30, takes longer to reverse and bleeding risk is increased

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19
Q

Adverse effects of enoxaparin

A

bleeding
hyperkalemia
HIT

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20
Q

Antidote for enoxaparin

A

protamine sulfate

BUT reversal is not complete as heparin works in factor III and enoxaparin works mostly on Xa

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21
Q

What kind of drug is fondaparinux (Arixtra)?

A

indirect inhibitor of factor Xa (anticoagulant)

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22
Q

Why is fondaparinux preferable over enoxaparin?

A

does not inhibit thrombin –>
less likely to cause thrombocytopenia
good for patients with HIT or prior HIT

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23
Q

Major issue with fondaparinux

A

no antidote

24
Q

What is HIT?

A

heparin induced thrombocytopenia

allergic reaction and adverse event

25
Q

Name the types of thrombocytopenia

A 
Type 1:  direct effect on PLT --> 
     cause clumping 
     PLT > 100K
Type 2:  LIFE THREATENING
    immune-mediated
    heparin-PLT factor IV antibody complex
    hyper coagulable state
26
Q

Name 2 direct thrombin inhibitors

A

argatroban

lepirudin

27
Q

How does warfarin work?

A

inhibits vitamin K epoxide reductase and therefore interferes with production of vitamin-K dependent clotting and anticlotting factors (II, VII, IX, X)

28
Q

Antidotes for warfarin

A

vitamin K

FFP

29
Q

How is the thrombosis in early warfarin therapy managed?

A

ALWAYS BRIDGE warfarin with heparin/LMWH

30
Q

Interactions with warfarin

A

A TON…lots of drugs increase the INR, others decrease the INR
PPIs

31
Q

What are DOACs?

A

direct oral anticoagulants

32
Q

Name 4 DOACs

A

rivoroxaban (Xarelto)
apixaban (Eliquis)
edoxaban (Savaysa)
betrixaban (Bevyxxa)

33
Q

What is nonvalvular A-Fib, and what is the risk?

A

patients with no prior valve replacement who have A-Fib, and it can cause stroke

34
Q

Why is it important to know half life with DOACs?

A

help with knowing washout time prior to invasive procedures

35
Q

Name 2 anticoagulants that are not DOACs but get confused with them

A

fondaparinux

dabagatran (Pradaxa)

36
Q

What is dabagatran (Pradaxa)?

A

direct thrombin inhibitor

37
Q

Name 3 direct thrombin inhibitors

A

dabagatran (Pradaxa) [PO]
bivalrudin (Angiomax) [IV]
argatroban (Acova) [IV]

38
Q

Name the reversal agent for dabigatran (Pradaxa)

A

Idarucizumab (Praxbind)

39
Q

Name 4 categories of anti platelet agents

A

NSAIDs/ASA
Glycoprotein IIb/IIIa Inhibitors
ADP Receptor Antagonists
Phosphodiesterase Inhibitors

40
Q

Major adverse effects of the NSAIDs/ASA

A

GI upset

nephrotoxicity

41
Q

Name 6 NSAIDs/ASA

A 
ASA
ibuprofen
naproxen
diclofenac
meloxicam
ketorolac
42
Q

Name 3 glycoprotein IIb/IIIa inhibitors, and how they are given

A

IV only

abciximab (Reopro)
eptifibatide (Integrilin)
tirofiban (Aggrastat)

43
Q

Name 3 ADP Receptor Antagonists

A

clopidigrel (Plavix)
prasugrel (Effient)
ticagrelor (Brilinta)

44
Q

Genetic issue to be aware of regarding clopidigrel

A

decreased efficacy in poor metabolizers of CYP450 enzymes

45
Q

Interactions to be aware of with ADP Receptor Antagonists like clopidogrel

A

increased risk of GIB with NSAIDs

46
Q

What does the FDA recommend for patients on clopidogrel

A

genetic testing for CYP2C19 phenotype as some types are poor metabolizers and experience decreased effectiveness

47
Q

For whom is prasugrel (Effient) contraindicated?

A

if prior TIA or stroke

48
Q

What is important to remember about ASA and ticagrelor?

A

For patients on a maintenance dose of ASA > 100mg, effectiveness of Brilinta is decrased

49
Q

Name some adverse effects of ticagrelor (Brilinta)

A

hyperuricemia
14% will feel SOB
2-6% will experience a brief ventricular pause on EKG

50
Q

Name some drugs used in bleeding disorders

A

tranexamic acid
DDAVP
vitamin K
4FPCC (Kcentra)

51
Q

For what bleeding disorders are desmopressin (DDAVP) used?

A

mild hemophilia A

von Willebrand’s disease

52
Q

For what bleeding disorder is vitamin K used?

A 
reversing supratherapeutic INR
liver disease (as clotting factors are made in the liver)
nutritional deficiency of vitamin K
53
Q

How is vitamin K given? Via which route is it best absorbed?

A

SQ, PO, IV

absorbed more consistently: PO

54
Q

For what is 4FPCC (Kcentra) used?

A

rapid reversal of warfarin in bleeding patients

for bleeding in patients not on vitamin K antagonists (off label)

55
Q

Why can Kcentra cause a hypersensitivity reaction?

A 
it is human blood product containing clotting factors
   II
   VII
   XI
   X
   Protein S
   Protein C

NURS 804: Pharmacology (42 decks)

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