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Anticoagulants Flashcards

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0
Q

Heparin-induced thrombocytopenia

  • potentially fatal
  • caused by antibody development
  • reduce platelet counts
  • paradoxical increase in thrombotic events
A

Heparins adverse effects

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1
Q

Bleeding
Localized bruising,petichiae, purpura
Nose bleeds, gum bleeding
Black tarry stool

Systemic hemorrhage
-tachycardia, hypotension

A

Heparin adverse effects

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2
Q

Low platelet count

A

Thrombocytopenia

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3
Q

Heparins contraindications

A
  • Thrombocytopenia
  • uncontrollable bleeding
  • surgery on eye, brain or spinal cord
  • spinal puncture/epidural
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4
Q

Heparins general info. How to give…

A
  • Give it subcutaneous not IM
  • inject in fatty areas- abdomen
  • rotate sites
  • don’t give injections within 2” of incisions, umbilicus,scars etc.
  • don’t aspirated or massage injection site
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5
Q

Massaging or aspirating injection sites for heparins causes

A

Hematoma formation

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6
Q

Heparin IV doses are double checked with…

A

Another nurse

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7
Q

Labs run for heparin to monitor…

A

Coagulation effects

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8
Q

Normal Coagulation values are

A

25-35 seconds

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9
Q

Coagulation values goal w/ heparin…

A

1.5-2.5 times the norm. 45-70 sec.

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10
Q

What is the antidote for excessive anti coagulation?

A

Protamine

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11
Q

Prototype low-molecular-weight heparins

A

Enoxaparin ( Lovenox )

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12
Q

How is Enoxaparin ( Lovenox ) given?

A

1-2x/day subcutaneous

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13
Q

Does Enoxaparin require labs?

A

No. Can be given at home.

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14
Q

General info on Enoxaparin

A

Synthetic Heparin
Provides a more predictable response than Heparin.
Inactivates Xa(10a), less able to inactivate thrombin

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15
Q

What is hemostasis?

A

The process that halts bleeding.

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16
Q

How many stages to hemostasis?

A

2

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17
Q

Hemostasis stage 1 is

A

Formation of platelet plug

-platelet aggregation

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18
Q

Stage 2 hemostasis

A

Coagulation

  • intrinsic coagulation
  • extrinsic coagulation
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19
Q

Result of coagulation system

A

Fibrin… A clot forming substance

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20
Q

Conditions that cause clot (thrombus) formation

A

Stroke
MI
Deep vein thrombosis
Pulmonary embolism

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21
Q

What are the coagulation modifier drugs?

A

Anticoagulants
Antiplatelets
Thrombolytics

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22
Q

What are the different Anticoagulants?

A 
Heparin
Low Molecular Weight Heparin
    -Enoxaparin (Lovenox)
Selective Factor Xa(10a) Inhibitors
    -Fondaparinux (Arixtra)
Warfarin(Coumadin)
Direct Thrombin Inhibitors
    -Dibigatran (Pradaxa)
Direct Factor Xa (10a) Inhibitors
    -Rivaroxaban (Xarelto)
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23
Q

Low molecular weight heparin drug…

A

Enoxaparin (Lovenox)

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24
Selective factor Xa drug
Fondaparinux (Arixtra)
25
Direct thrombin inhibitors drug
Dibigatran (Pradaxa)
26
Direct factor Xa inhibitors
Rivaroxaban (Xarelto)
27
Heparin (Unfractionated) mechanism of action
Inhibits clotting action IIa & Xa which enhances antithrombin and inhibits the formation of fibrin
28
Heparins indications
``` Prevention & Treatment of Low dose therapy postoperatively Deep vein thrombosis Pulmonary embolism Stroke MI Unstable angina Atrial fibrillation Mechanical devices like valves ```
29
Basic info on Heparin unfractionated
Rapid acting Half life only 1-2hrs Effects seen immediately IV or SC only
30
Reversal agent for Heparin
Protamine Sulfate | It binds with Heparin given IV
31
Fondaparinux general info
Indirectly enhances activation of antithrombin It suppresses coagulation Given SC once a day
32
Fondaparinux does not affect
Prothrombin time, aPTT, bleeding time or platelet aggregation
33
General info in Warfarin
Inhibits vitamin K synthesis | Inhibits vitamin K-dependent clotting factors
34
Therapeutic uses of Warfarin
Prevention of clot formation Not useful in emergencies due to slow onset -half life 6hrs-2.5 days
35
Warfarin adverse effects
Bleeding
36
Warfarin contraindications
Pregnancy cat X Thrombocytopenia Eye, brain,spinal cord surgery Vitamin K deficiency, liver disorder
37
Warfarin interactions-anticoagulant effects increased
Acetaminophen, sulfonamides, cephalosporins,heparin, aspirin....these all increase anticoagulant effects
38
Warfarin interactions-decreased anticoagulant effects
Phenobarbital, carbamazepine, phenytoin, rifampin, oral contraceptives, vitamin k
39
Labs to monitor for warfarin
Prothrombin time (PT) - normal: 11-13 sec - goal: 18 sec INR - normal:1 - goal: 2-3.5
40
Give ________for warfarin toxicity or OD.
Vitamin K
41
Warfarin nursing implications
``` Can be started while on heparin Full therapeutic effects take several days Monitor PT-INR regularly Avoid foods high in vitamin K -dark green leafy vegi -cabbage, broccoli, Brussels sprouts -mayo, canola oil, soybean oil ```
42
Dabigatran (Pradaxa) general info
Directly inhibit thrombin Given orally twice daily Does not require monitoring
43
Dibigatran indication
A fib
44
Dibigatran adverse effects
Bleeding | GI discomfort
45
Other Direct Thrombin Inhibitors
Argatroban, Bivalirudin, Lepirudin which is off the market now
46
Rivaroxaban general info
Directly binds with Factor Xa which inhibits thrombin production and suppresses coagulation Does not require drug monitoring Given orally twice a day
47
Rivaroxaban indication
Prevention of venous thromboembolism in adults undergoing elective hip or knee replacement
48
Rivaroxaban contraindications
Renal failure
49
Antiplatelets drugs prototypes
``` Aspirin Clopidogrel (plavix) ```
50
Aspirin general info
``` Inhibits cyclooxygenase in the platelet Prevents formation of TAX2 Reduces vasoconstriction & platelet aggregation 1 dose lasts for life of platelet-7 days 81mg/day ```
51
Clopidogrel (plavix)
ADP inhibitor Inhibits platelet aggregation More expensive than aspirin
52
Antiplatelets drug indications
Stroke prevention TIA prevention Reduce risk of MI prevention of reinfarction after MI
53
Antiplatelet contraindications
``` Thrombocytopenia Active bleeding Leukemia Injury GI ulcer Brain bleed Recent stroke ```
54
Aspirin adverse effects
``` Dizziness, tinnitus, hearing loss GI Bleeding Thrombocytopenia Stroke ```
55
Clopidogrel adverse effects
GI | Bleeding-less than aspirin
56
Antiplatelet drug interactions
Drugs that cause bleeding such as | Heparin warfarin aspirin NSAIDs
57
Antiplatelet nursing implications
Discontinue 7 days before surgery
58
What do Thrombolytics do?
Clot busters Break down Lyse clots that are already formed Converts plasminogen to plasmin which destroys fibrin
59
Thrombolytic prototype drug
Alteplase (Cathflo Activase)
60
General info on alteplase
Given IV Streptokinase -increase risk of allergic reactions & hypotension -less risk of brain bleed
61
Alteplase indications
``` Acute MI Arterial Thrombolysis DVT Pulmonary Embolus Acute ischemic stroke Occlusion of shunts or catheters ```
62
Alteplase adverse effects
Serious risk of bleeding | Nausea, vomiting, hypotension
63
Alteplase contraindications
``` Prior brain bleed Structural cerebral vascular lesion Active internal bleeding Brain tumor Suspected aortic dissection ```
64
Alteplase nursing implications
Monitor IV sites for bleeding redness pain Bleeding from mucus membranes Watch for increased pulse, restlessness
65
Risk of Coronary Heart Disease if cholesterol is higher than 300 is 3-4x greater than if less than 200
.
66
Cholesterol screening
Every 5 years Total less than 200 LDL less than 100 Tri less than 150
67
Antilipemic treatment info
Used to lower lipid levels in combo with diet & exercise
68
HMG-CoA reductase Inhibitors prototype drug
Statins...Atorvastatin (Lipitor)
69
HMG-CoA mech of action
Inhibit HMG-CoA reductase used by liver to make cholesterol Liver increase LDL receptors Takes 6-8 weeks to see max results
70
HMG-CoA contraindications
Pregnancy-cat X | Hepatitis
71
HMG-CoA adverse effects
GI Liver enzyme elevation Muscle pain-myopathy
72
HMG-CoA interactions
Fibrates & oral antidiabetic drugs increase risk of Rhabdomyolysis Grapefruit juice & Erythromycin increase levels of statins
73
Bile Acid Sequestrants prototype drug
Colesevelam (WelChol) | 2nd line drug
74
Colesevelam (WelChol) mech of action
Prevent resorption of bile acids from small intestine which are necessary for absorption of cholesterol. Liver tries to compensate by adding more LDL receptors thus less LDL in circulation
75
Colesevelam (WelChol) interactions
Hyperlipoproteinemia Relief of puritis Can be used with statins
76
Colesevelam (WelChol) adverse effects
Constipation Heartburn, nausea, belching, bloating -tend to go away in time
77
Colesevelam (WelChol) contraindications
Biliary or bowel obstruction
78
Colesevelam (WelChol) interactions
Other drugs taken at the same time | Take other drugs 1 hr before or 3-4 hrs after
79
Niacin general info
Nicotinic Acid Vitamin B3 Lipid lowering requires much higher dose than vitamin Effective, inexpensive, used in combo with other drugs Start low initial dose and gradually increase
80
Niacin Indications
Lowers triglycerides & LDL | Increases HDL better than any other drugs
81
Niacin adverse effects
``` Flushing-diminishes after a few weeks, can take aspirin 30 min before Puritis GI distress Hepatotoxic Hyperglycemia Hyperuricemia ```
82
Niacin contraindications
Liver disease | Gout
83
Niacin interactions
HMG-CoA (statin) causes Rhabdomyolysis
84
Fibrates prototype drug
Gemfibrozil (Lopid)
85
Gemfibrozil (Lopid) Fibrates indications
Decrease triglycerides - most effective drug for this | Increase HDL by 25%
86
Gemfibrozil (Lopid) Fibrates adverse effects
GI distress are mild gallstones Myopathy-muscle pain Hepatotoxicity
87
Gemfibrozil (Lopid) Fibrates contraindications
Severe liver or kidney disease Cirrhosis Gallbladder disease
88
Gemfibrozil (Lopid) Fibrates interactions
Oral anticoagulants increase risk of bleeding Statin increase risk of rhabdomyosis Take before eating
89
Cholesterol Absorption Inhibitor prototype drug
Ezetimibe
90
Cholesterol Absorption Inhibitor Ezetimibe general info
Inhibits absorption from the small intestine Reduces total cholesterol, LDL & tri levels Increases HDL Clinical usefulness is currently questioned. New trials underway
91
Cholesterol Absorption Inhibitor Ezetimibe nursing implications
Before therapy: Assess lifestyle & history, contraindications & interactions Get baseline level labs

Pharm Anticoagulant (1 decks)

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