Immunity and coagulation 4

Question 1

Anticoagulant Medications

Answer 1

group of medications that decrease clotting

Question 2

Heparin & Low Molecular Weight Heparins (LMWH) examples

Answer 2

Enoxaparin(Clexane)

Dalteparin (Fragmin)

Question 3

Heparin & Low Molecular Weight Heparins (LMWH) mechanism action

Answer 3

Acts by increasing function of antithrombin III which inhibits factor IXa, Xa, Xia & XIIa
Given parenterally only (usually IV or S/C)

Question 4

Uses:Heparin & Low Molecular Weight Heparins (LMWH)

Answer 4

Prophylaxis: to prevent thromboembolism in high risk clients
Pulmonary embolism (PE) and deep venous thrombosis (DVT)
Prevent coagulation in heart-lung machine in open heart surgery
Prosthetic heart valves, haemodialysis

Question 5

Adverse Effects: :Heparin & Low Molecular Weight Heparins (LMWH)

Answer 5

Most common: Haemorrhage Manifested by such symptoms as nose bleeds, black stools, bruising from unknown cause, bleeding gums
Less common effects: osteoporosis, alopecia, thrombocytopenia

Question 6

Antidote:

Heparin and LMWH

Answer 6

Protamine sulphate (prepared from salmon sperm) is effective heparin antagonist if administered slowly. Fast administration can lead to anaphylaxis. 
Close monitoring of blood coagulation tests is required

Question 7

Heparin and LMWH

Clinical Considerations:

Answer 7

Initiation of anticoagulant therapy can involve commencing heparin (SC/IV) and warfarin (oral) together then heparin can be ceased
While patient is receiving heparin therapy, the activated partial thromboplastin time (aPTT) must be monitored
Heparin is high-molecular-weight which can cause thrombocytopenia
Low-molecular-weight alternatives do not have these side effects of bleeding.

Question 8

Warfarin example

Answer 8

, Coumadin and Marevan

Question 9

Mechanism of action:

warfarin

Answer 9

Structurally similar to vitamin K
Vitamin K is involved in synthesis of prothrombin and factors II, VII, IX and X
Warfarin interrupts effect of vitamin K and depletes stores of vitamin K in liver
Takes several days to exert its effect

Question 10

Uses:warfarin

Answer 10

Long term anticoagulation therapy
Administered orally
Similar to heparin

Question 11

Adverse effects:

warfarin

Answer 11

Bleeding if not monitored closely

Less common effects: alopecia

Question 12

Warfarin antidote

Answer 12

Vitamin K is a useful antagonist to warfarin eg. in cases of bleeding

Question 13

Client Education:

Answer 13

Take medication at same time every day
Keep an anticoagulation book to document doses
Client to notify doctor if any signs of bleeding
Limit foods that are high in vitamin K
Eg. Green leafy vegetables such as cabbage

Question 14

Non-vitamin K Oral Anti Coagulants(NOACs)

Answer 14

Direct Thrombin inhibitor

Direct Factor Xa inhibitor

Question 15

Direct Thrombin inhibitor

Answer 15

. Dabigatran (

Question 16

Direct Factor Xa inhibitor

Answer 16

Rivaroxaban, Apixaban, Edoxaban
Options for reversal: Prothombincomplex concentrate (PCC), Recombinant Factor VIIa (rFVIIa), activated PCC

Question 17

Uses: Non-vitamin K Oral Anti Coagulants(NOACs)

Answer 17

Prevention of stroke in AF
Treatment of venous thromboembolism
Thromboprophylaxis after elective hip and knee surgery

As effective as warfarin, no need for INR

Question 18

Thrombolytic (fibrinolytic) Drugs:
mechanism of action
Use:

Answer 18

Streptokinase
Potent plasminogen activator (which digests or dissolves fibrin clots)
Dissolves clots (PE, DVT, other clots

Question 19

Adverse effects:

Clinical considerations:

Answer 19

Will dissolve clots formed from normal anticoagulation activity such as wound from injection
Uncontrolled haemorrhage
Allergic reaction, ie. anaphylaxis
Fever
Discontinue heparin before using streptokinase
Treatment likely to be ineffective if client has received streptokinase therapy within last 12 months or after severe streptococcal infection (ie. rheumatic fever)

Question 20

-Antiplatelet Drugs -
Mechanism of action
uses

Answer 20

Aspirin
Stops platelet activity, renders platelets ineffective
Use: Angina, acute myocardial infarction, post cardiac bypass surgery, reduction of strokes (CVA)

Question 21

Adverse reactions:

Clinical considerations:

Answer 21

Gastrointestinal problems
Allergic reaction (mainly to salicylates)
Clinical considerations:
Adjunct in thrombolytic therapy
Anticoagulant prophylaxis
Cease aspirin 1 week before surgery/dental procedures
Keep tablets in packaging until immediately before use (unless enteric coated)

Question 22

Clopidogrel
Use
examples

Answer 22

Inhibits platelet aggregation
Inhibits platelet aggregation

Prevention of thromboembolic strokes in clients who are high risk, ischaemic heart disease

Question 23

Adverse reactions
Clinical considerations
clopidogrel

Answer 23

Possible neutropenia
Similar to aspirin minus gastrointestinal effects and no salicylate side effects

Monitor FBC
Do not administer with other anticoagulants
Monitor for signs of bleeding