Anticoags

Question 1

Anticoagulants

Answer 1

• prevent the formation of clots
• best for DVTs
• reducing formation of fibrin

Question 2

Anticoagulants MOA

Answer 2

Inhibit synthesis cloting factors (factor x and thrombin)

- inhibits the activity of clotting factors ( Xa, thrombin)

Question 3

Anticoagulant Uses

Answer 3

• Prevention of venous thrombosis

- DVT, pulmonary embolism, A-Fib

Question 4

If Clot is life threatening

Answer 4

• IV or SQ admin

- Change to oral drug for long term use

Question 5

Does it actually thin the blood ?

Answer 5

• It doesn’t make blood less viscous

Question 6

Prototype for Heparin

Answer 6

Heparin (unfractured)

Question 7

Heparin MOA

Answer 7

• inactivates several clotting factors
• inhibits thrombin activity
• suppresses formation of fibrin

Question 8

Heparin measured in…..

Answer 8

units

Question 9

Must be given what routes?

Answer 9

SQ (prophylaxis) or IV (immediate)

• IV is immediate
• SQ up to 1 hour for effect

Question 10

Half-Life of Heparin is

Answer 10

90 minutes

Question 11

Uses of Heparin

Answer 11

• Preferred Rapid anticoagulation (open heart surgery, DVT, renal dialysis)
• Prophylaxis of Venous thrombi

Question 12

What happens if pt is too anticoagulated

Answer 12

• you can just stop heparin drip due to short half-life

Question 13

What is the antidote for Heparin?

Answer 13

protamine sulfate (onset 5 mins)

• hardly ever used
• slow IV push

Question 14

Some things to know lab monitoring

Answer 14

• monitor aPTT
• in the hospitial
• intrinsic factor
• Normal PTT is 40 sec
• Therapeutic level is 1.5-2x baseline (60-80 sec)
  -IV heparin: measure aPTT Q 6 hours
• gets 4 half lives to get to therapeutic
  4 x 1.5 = 6 hours

Question 15

Heparin SE

Answer 15

SE: bleeding, heparin induced thrombocytopenia (HIT)
After 4 days body creates antibodies causing platelets to drop
- For HIT monitor platelets. IF <100,00 or platelets reduce by 50% then stop heparin

Question 16

Administration of Heparin

Answer 16

• SQ abdomen

- IV intermittent or continuous

Question 17

How to know if a patient is bleeding

Answer 17

• pettechaie, lumbar pain, bruising, perotineal bleeding

- never give when somone has epidural

Question 18

Low Molecular Weight Heparin

Answer 18

• LMWH: same mechanism of action but a little diff, but safer, better bioavailability
• no frequent blood tests
• dosage based on weight
• Can be administered at home
• MOA activates factor Xa, lot less able to activate thrombin
• Half life is 6x a longer

Question 19

Low Molecular Weight Heparin is DOC for

Answer 19

DVT prevention

Question 20

Side effects of LMWH

Answer 20

Bleeding, HIT

-check platelets before admin

Question 21

Antidote for LMWH

Answer 21

Protamine Sulfate

Question 22

LMWH Admin

Answer 22

Abdomen anterior or post abdominal wall

• 45-90 deg
• SQ
• don’t expel bubble

Question 23

LMWH Prototype

Answer 23

enoxaparin (Lovenox)

Question 24

Vitamin K antagonist Warfarin (Coumadin) MOA

Answer 24

MOA: inhibits hepatic synthesis of vitamin K dependent clotting factors (VII, IX,IX, X) and prothrombin

Question 25

Antidote for Coumadin

Answer 25

Vitamin K (decrease effects in 6 hours) - given IV risk of anaphylaxis - can be given oral and SQ

Question 26

Warfarin uses

Answer 26

-Prevent DVT, PE, prevent clots in patients with Afib, prosthetic heart valves or had TIA or recurrent MI

Question 27

Problems with Warfarin

Answer 27

- highly protein bound - lots of drug-drug interactions - Drug- Food interactions: a lot of green leafy veggies - Pregnancy category X (not safe) - Have a consistent amount of green leafy veggies - Narrow theurapeutic index

Question 28

WArfarin SE

Answer 28

Hemorrhage

Question 29

Gentic variants can be tested for WArfarin Response

Answer 29

VKORC1 and CYP2C0 | - These variants lead to increase risk of bleeding

Question 30

Lab monitoring for Warfarin

Answer 30

- Half life of 1.5-2 days - 4 half lives to get to therapeutic level - PT or INR (extrinsic pathway) outpatient - PT normal 12 sec - Therapeutic : 1-2x baseline (12-24 sec) - PT varies in diff labs so INR is used - Internationalized ratio: 2.0- 3.0 therapeutic - Mechanical heart valve higher

Question 31

Nursing Consideration for Warfarin

Answer 31

- Take same time everyday - Balance Vit K foods - Watch s/s bleeding: check labs - soft toothbrush - No staight edge razor - Pain control drugs dont take asprin or ibuprofen - Tylenol is better for pain drug - hold pressure if blood is drawn - must stop before surgery 1 week - Medic alert bracelet - Garlic and Gingko

Question 32

Direct Thrombin inhibitors ( MOA, route, uses, AE)

Answer 32

MOA: direct, reversible inhibitor of thrombin Route: IV, SQ, and ORAl Uses: Afib, hip/knee replacement AE: bleeding, GI - take with food or protein pump inhibitor or H2 blocker

Question 33

Prototype for direct thrombin

Answer 33

dabigatran (Pradaxa) - Oral - no lab monitroing - Lower risk of bleeding - few drug-drug/ drug-food interactions - rapid onset - set dose

Question 34

Antidote fro direct thrombin

Answer 34

idarucizumab ( Praxbind)

Question 35

Should direct thrombin be stopped before surgery

Answer 35

YES!

Question 36

Direct factor Xa inhibitors

Answer 36

``` ACtion: binds with factor Xa and inhibits thrombin Route: ORal -Rapid onset - No lab monitoring - Rapid onset - fixed dose - lower bleeding risk - Few drug interactions (CYP3A4) ```

Question 37

Direct Factor Xa inhibitors prototypes

Answer 37

Rivaroxaban (Xarelto) | Apixaban (Eliquis)

Question 38

Antidote for direct factor Xa

Answer 38

Andexanant alfa (AndexXa)

Question 39

Uses for Direct Factor Xa

Answer 39

- Post hip/knee replacement, afib, tx of DVT/ PE

Question 40

SE for Driect FActor Xa inhibitor

Answer 40

Bleeding; spinal/epeidural hematoma | -contrraindicated; liver dz; pregnancy

Question 41

What happens when going from IV heparin -> oral agent

Answer 41

- Stop heparin and immediately start oral doses - Rivaroxaban or apixaban - May see doubled up doses for a couple of days, then see once a day dosing

Question 42

IV heparin -> Coumadin

Answer 42

- typically, 2-3 days simultaneous admin - Takes a couple of days for warfarin to take effect - No effect on clotting factors already in circulation - increased risk of bleeding - monitor both PTT and PT/INR