Week 11 Coagulation

Question 1

Children Considerations

Answer 1

• Little research available; if used, monitor closely; calculate the dose based on wt and always perform independent double check
• Need to understand the importance of safety precautions and preventing injuries

Question 2

Adult considerations

Answer 2

• Instructed in ways to prevent injuries and what to do if bleeding occurs
• Inform provider of any drugs or alternative therapies; many drug interactions
• Carry or wear medicAlert notification
• Understand the importance of regular, periodic blood tests to evaluate the effects of the drugs

Question 3

Older Adult considerations

Answer 3

• More likely to encounter drug-drug interactions because they typically take more drugs
• More likely to have impaired kidney and liver function which impacts drug metabolism and excretion
• Start therapy at the lowest possible dose and adjust accordingly in response to lab result

Question 4

Alter platelet aggregation and the formation of the platelet plug

Answer 4

antiplatelets

Question 5

interfere w/ the clotting cascade and thrombin formation

Answer 5

anticoagulants

Question 6

break down the thrombus or clot that has been formed by stimulating the plasmin system

Answer 6

thrombolytics

Question 7

Antiplatelet prototype drug

Answer 7

Aspirin

Question 8

Anticoagulation prototype drug

Answer 8

Heparin

Question 9

thrombolytic prototype drug

Answer 9

UROKINASE

Question 10

Therapeutic Action: Aspirin

Answer 10

• Inhibits platelet aggregation by inhibiting platelet synthesis of thromboxane A2
• Decrease the formation of the platelet plug

Question 11

indication: Aspirin

Answer 11

• reduction of risks of recurrent TIA/ strokes
• reduction of death or nonfatal MI in pts w/ hx of MI or unstable angina

Question 12

pharmacokinetics: Aspirin

Answer 12

• Metabolism in liver
• excreted in urine
• enters breastmilk
• oral administration

Question 13

adverse effects: Aspirin

Answer 13

• Bleeding and bruising
• fever, coma, CV collapse; toxicity
• GI bleed, nausea, occult blood loss, dizziness, tinnitus, difficulty hearing, heartburn

Question 14

Contraindications: Aspirin

Answer 14

• Allergy
• recent surgery
• presence of known bleeding disorder or active bleeding
• closed head injuries
• hx of thrombocytopenia

Question 15

Drug-drug interaction: Aspirin

Answer 15

• excessive bleeding risk is increased when combined with another drug that affects blood clotting

Question 16

Nursing considerations: Aspirin

Answer 16

• Labs; clotting factors, plt count
• pt is more at risk for bleeding; longer pressure to stop, limit contact sports, soft bristle toothbrush, electric razor only
• seek medical care if pt falls
• saftey measures to stop bleeding
• stop taking med if having surgery
• check for bleeding and brusing often

Question 17

Therapeutic action: heparin

Answer 17

Inhibits thrombus and clot production by blocking the conversation of prothrombin to thrombin and fibrinogen to fibrin

Question 18

Indication: heparin

Answer 18

• prevention & treatment of venous thrombosis and pulmonary embolism
• treatment of atrial fibrillation w/ embolization\

Question 19

Pharmacokinetics: heparin

Answer 19

• IV & SubQ as well
• metabolized in the liver and the cells
• excreted in the urine
• DOES NOT ENTER BREASTMILK

Question 20

Adverse Effects: heparin

Answer 20

• BLEEDING
• loss of hair, bruising, chills, fever, osteoporosis, suppression of renal function

Question 21

Contraindications: heparin

Answer 21

• Allergy
• any conditions that could be compromised by bleeding tendencies
• Heparin is preferred during pregnancy

Question 22

Drug-drug interactions: heparin

Answer 22

• Increased bleeding can occur if combined w/ oral anticoags, penicillins, cephalosporins, or salicylates
• decreased anticoag if taken w/ nitroglycerin

Question 23

Nursing considerations: heparin

Answer 23

• in case of a heparin overdose; the antidote protamine sulfate
• watch for s/s of bleeding
• safety measures to decrease bleeding risks
• know if pt has hx of bleeding disorders
• keep the antidote on standby
• monitor blood test/ clotting times
• any acute bleeds?

Question 24

Therapeutic Action: UROKINASE

Answer 24

Converts endogenous plasminogen to plasmin, which breaks down fibrin clots, fibrinogen, and other plasma proteins; lyses & emboli

Question 25

Indication: UROKINASE

Answer 25

• If a thrombus has already formed in a vessel; acute MI, ischemic stroke, PE
• Dissolves the clot to open the vessel and restore blood flow to the tissue

Question 26

pharmacokinetics: UROKINASE

Answer 26

• IV; onset immediate
• metabolized in the plasma
• excretion unknown
• crosses placenta

Question 27

Adverse Effect: UROKINASE

Answer 27

BLEEDING
- headache, edema, hypotension, skin rash, bleeding, breathing difficulties, pain, fever, bronchospasms

Question 28

Contraindications: UROKINASE

Answer 28

• Allergy
• any condition that would be worsened by the dissolution of clots; surgeries, CVA, internal bleeding, ect
• pregnancy & lactation

Question 29

Drug-drug interactions: UROKINASE

Answer 29

• Risk of hemorrhage increases if thrombolytic agents are used with any anticoag or antiplatelet drug
• stop platelet drips before administering thrombolytics

Question 30

Nursing considerations: UROKINASE

Answer 30

• check for s/s of bleeding
• if pt has sign of MI/PE give immediately
• only give if clot is already formed
• d/c heparin before giving
• monitor clotting times
• arrange type and cross match blood

Question 31

A thrombolytic agent would be most indicated for which circumstance?

Answer 31

pulmonary embolism