Anticoagulants

Question 1

Pt time

Answer 1

12-15 seconds, prothrombin time

Question 2

INR

Answer 2

0.8-1.2 person not receiving anticoagulants

Question 3

INR for PE, DVT, A-Fib

Answer 3

2.0-3.0

Question 4

INR for mechanical valves

Answer 4

3.0-4.0

Question 5

PTT

Answer 5

25-35 seconds

Question 6

How is heparin given?

Answer 6

With a 5/8in. needle 25 to 28 g, at a 90 degree angle

Question 7

What is the antidote to heparin?

Answer 7

protamine sulfate

Question 8

What is the antidote to lovenox?

Answer 8

protamine sulfate

Question 9

What is the antidote for warfarin?

Answer 9

vitamin k

Question 10

warfarin dietary guidelines

Answer 10

avoid alcohol, leafy greens eat consistently

Question 11

Pradaxa antidote

Answer 11

No specific antidote, dialysis may remove

Question 12

Do NOT administer heparin

Answer 12

IM

Question 13

What intrinsic factor does coumadin act on?

Answer 13

IX

Question 14

What intrinsic factors does heparin act on?

Answer 14

X & Xa

Question 15

What factor does Coumadin act on?

Answer 15

X

Question 16

What factor does Eliquis & Xarelto act on?

Answer 16

Xa

Question 17

What factor does Pradaxa act on?

Answer 17

Thrombin

Question 18

Clotting Sequence

Answer 18

X-Xa-Prothrombin-Thrombin-Fibrinogen-Fibrin

Question 19

Process of Hemostasis

Answer 19

Injury to vessel, vessel spasm, formation of platelet plug, formation of fibrin clot, clot retraction, clot dissolution

Question 20

What are indications for Anticoagulant therapy?

Answer 20

DVT, PE, MI, ischemic CVA, Chronic Atrial Fibrillation, Valve Replacement, DVT prophylaxix

Question 21

Routes of Anticoagulants

Answer 21

Oral, IV, SQ

Question 22

Route of Thrombolytics

Answer 22

IV

Question 23

How does warfarin work?

Answer 23

Inhibits vitamin K dependent factors

Question 24

Indications for warfarin

Answer 24

a-fib, mechanical valve replacement, history of PE, VTE

Question 25

What do you do if you miss a dose of warfarin?

Answer 25

Take as soon as possible on same day, but do not double the next dose

Question 26

Notify physician when on warfarin if..

Answer 26

Serious fall or injury, red, dark brown urine or black, tarry stools

Question 27

What is Pradaxa?

Answer 27

Direct thrombin inhibitor

Question 28

How often is Pradaxa taken?

Answer 28

Twice a day

Question 29

How quickly does Pradaxa reach therapeutic levels?

Answer 29

30 min to 2 hours after PO administration

Question 30

What are indications for Pradaxa?

Answer 30

Afib not caused by heart valve problem (75-150mg 2X/day) | VTE prevention after hip/knee replacement (150-220mg 1X/day)

Question 31

Dietary restrictions Pradaxa?

Answer 31

No

Question 32

What does Pradaxa interact with?

Answer 32

Rifampin decreases effectiveness of Pradaxa

Question 33

Does Pradaxa require regular monitoring of blood levels?

Answer 33

No

Question 34

How is Xarelto taken?

Answer 34

Orally 1X/day

Question 35

Antidote for Xarelto

Answer 35

None

Question 36

Xarelto indications

Answer 36

A-fib not caused by heart valve problem (20 mg/evening meal), VTE prevention after hip/knee surgery (10 mg 1X day with or without food)

Question 37

What meds increase bleeding with Xarelto/

Answer 37

Aspirin, Nsaids, warfarin, heparin, plavix, effient, brilinta

Question 38

Eliquis-when taken? What for?

Answer 38

2X/day, 5 mg, for A-fib not caused by heart problem

Question 39

Teaching r/t anticoagulants

Answer 39

soft bristle brush, waxed floss, electric razor, medic alert bracelet, inform HCPs of use

Question 40

What does Heparin do?

Answer 40

1. Prevents the activation of clotting factors of X and Xa | 2. It inhibits the action of thrombin in forming fibrin threads

Question 41

Heparin indications

Answer 41

prevention and treatment of VTE (venous thromboembolus) | treatment of VTE, PE, CVA or TIA

Question 42

How is heparin dosed?

Answer 42

5,000-10,000 Units q 8-12 h, IV: 4,000-5,000 Units initially & then continuous infusion of 20,000-40,000/24 h IV patency: 10-100 units

Question 43

What do you monitor prior to and during administration heparin

Answer 43

PTT

Question 44

When injecting heparin remember..

Answer 44

Do not aspirate, do not massage site, ensure that injection is given in fatty area of abdomen at least 2 in away from the umbilicus

Question 45

When giving heparin monitor..

Answer 45

for bleeding gums, hematuria, nosebleeds, bloody sputum, and petechiae

Question 46

Protamine Sulfate each mg neutralizes how much heparin?

Answer 46

1 mg protamine sulfate neutralizes 100 units heparin

Question 47

No more than this much Protamine sulfate should be administered in any 10 min period

Answer 47

no more than 50 mg in any 10 min period or 100 mg in 2 hour period

Question 48

Why are LMWH used

Answer 48

action more predictable, less monitoring, can be used outpt, lower incidence of HIT

Question 49

Platelet Aggregate inhibitors or Antiplatelets ex

Answer 49

ASA, Plavix, Brilinta, Aggrenox,Persantine, effient

Question 50

Indications for antiplatelets

Answer 50

CAD/ACS, Hx of MI, Post cardiac surgery (valve replacements & CABG), CVA, TIA, PVD, PAD

Question 51

S/E antiplatelets

Answer 51

headache, dyspnea, nausea

Question 52

Purpose of thrombolytics

Answer 52

Dissolve thrombi and restore blood flow to heart or brain during CVA or AMI

Question 53

When to initiate thrombolytics

Answer 53

Within 3 hrs

Question 54

Most common thrombolytic

Answer 54

tPA (also Streptokinase, Urokinase, Reteplase

Question 55

CONTRAindications thrombolytics

Answer 55

recent head injury, bleeding probs, bleeding ulcer, pregnancy, surgery, trauma, UNcontrolled high blood pressure

Question 56

Nursing interventions thrombolytics

Answer 56

Hold pressure at site when drawing blood, assess for bleeding & hematomas at puncture sites, avoid IM injections