Anticoagulants and Antiplatelets

Question 1

what is hemostasis?

Answer 1

the stopping of blood flow

Question 2

what are the three steps of hemostasis?

Answer 2

1. vasoconstriction
2. platelet plug
3. clotting cascade

Question 3

when does vasoconstriction happen?

Answer 3

after endothelial injury

Question 4

what does vasoconstriction consist of?

Answer 4

reduced blood flow and surfaces press together

Question 5

what triggers a platelet plug?

Answer 5

collagen exposure

collagen is adhesive and platelets aggregate on it

Question 6

what does a platelet plug consist of?

Answer 6

ACTIVATED platelets (w/ “legs” aggregate to form a plug)

activated platelets secrete stimulators triggering the clotting cascade

Question 7

what happens during a clotting cascade?

Answer 7

activated platelets change in shape, aggregate and secrete stimulators ADP and Thromboxane A2 (TXA2) which causes more aggregation and stabilizes the clot

Question 8

what is a clotting cascade triggered by?

Answer 8

intrinsic pathway: collagen exposure

extrinsic pathway: tissue factor= thromboplastin released from injured tissue

Question 9

what are the antiplatelet medications?

Answer 9

aspirin (salicylate)
clopidogrel

Question 10

what are the anti-coagulant medications?

Answer 10

rivaroxaban (xarelto)
apixaban (Eliquis)
warfarin (coumarin)

Question 11

what does acetylsalicylic acid (ASA) do?

Answer 11

prevents platelet aggregation

prevents the formation of TXA2

Question 12

what is the indication for Acetylsalicylic acid?

Answer 12

stroke and MI prophylaxis, high cholesterol (prevent clots on narrowed/vasoconstricted vein/arteries)

Question 13

what are the adverse effects of aspirin?

Answer 13

GI bleeding, dyspepsia

can take enteric coated to help prevent stomach ulcer damage (1/2 life is longer)

Question 14

what is dyspepsia?

Answer 14

heart burn

Question 15

what are the drug-drug interactions to be concerned with for aspirin?

Answer 15

increased risk of bleeding with anti-coagulant and anti-platelet medications

Question 16

why would a pt. receive both acetylsalicylic acid and clopidogrel?

Answer 16

it has been shown to be effective in pt. with cardiovascular conditions and stroke

Question 17

what does -penia mean?

Answer 17

lack of

Question 18

what is clopidogrel?

Answer 18

an ADP inhibitor

alters platelet membrane and prevents signal to aggregate

Question 19

what does ADP stand for?

Answer 19

adenosine diphosphate

Question 20

what is clopidogrel commonly paired with?

Answer 20

aspirin

Question 21

what are the indications for clopidogrel?

Answer 21

prophylaxis of stroke, TIA, MI, and post MI

Question 22

what is TIA?

Answer 22

transient ischemic attack

mini strokes

Question 23

what are the adverse effects of clopidogrel?

Answer 23

bleeding

Question 24

what is clopidogrel bound to?

Answer 24

94-98% bound to protein (albumin) for 5 days

Question 25

what health problems can cause a low platelet count?

Answer 25

cancers, and hereditary disorders

Question 26

platelet count lab test info

Answer 26

part of a CBC normal range: 150,000-400,000 platelets per mcL <150,000 = thrombocytopenia <80,000 anti-platelet therapy discontinue

Question 27

what are the anti-platelet nursing implications?

Answer 27

avoid IM injections discontinue 5-7 days before surgical procedures abrupt discontinuation may ↑ risk of CV events assess CBC (H/H, platelet count)

Question 28

what is the patient teaching info for anti-platelet medication?

Answer 28

use soft, electric toothbrush, prevent injury report for signs of bleeding food-herbal interactions cause ↑risk of bleeding

Question 29

what are food-herbal interactions for antiplatelet medications?

Answer 29

chamomile feverfew garlic ginger gingko

Question 30

the two pathways of the clotting cascade have a ______________ pathway

Answer 30

shared final pathway prothrombin → thrombin→fibrinogen→ fibrin →fibrin clot

Question 31

how do rivaroxaban and apixaban prevent coagulation?

Answer 31

has a Xa inhibitor preventing conversion of prothrombin to thrombin and therefore no fibrin mesh can form over clot

Question 32

what are the indications for rivaroxaban and apixaban?

Answer 32

prophylactic and treatment of clots used for the ↑ risk or Hx of thrombotic events

Question 33

what are the adverse effects of rivaroxaban and apixaban?

Answer 33

bleeding no routine monitoring required BUT it has a BBW for an ↑ of clots if discontinued abruptly

Question 34

what are the D-D for rivaroxaban and apixaban?

Answer 34

other anti-coagulants, anti-platelets, aspirin

Question 35

is there an antidote for rivaroxaban and apixaban?

Answer 35

yes, Andexxa (binds to and negates drug effects)

Question 36

what is an embolism?

Answer 36

a roaming piece of clot it breaks off from a large clot and travels and if it gets to smaller vessels it can block the flow

Question 37

what is an infarction?

Answer 37

blood flow blocked

Question 38

What is a thrombus?

Answer 38

a blood clot that blocks blood flow, usually in the legs

Question 39

what are the effects of warfarin?

Answer 39

inhibits four clotting factors that vitamin K depends on has no effect on a formed clot but prevents clot enlargement

Question 40

what are the indications for coumarin?

Answer 40

prophylaxis and treatment of thromboembolic events

Question 41

patients with a fib. are commonly given _________ to help with ________ because of __________

Answer 41

coumarin blood clots blood slowing and pooling due to a fib.

Question 42

warfarin is _______ bound to _________

Answer 42

80% protein

Question 43

explain the timing of warfarin's onset, therapeutic range and return to normal after discontinuation

Answer 43

onset of action is 36-72 hours 3-5 days to reach therapeutic range normal coagulation returns in 3-4 days

Question 44

because of the slow onset of action for warfarin what is commonly used?

Answer 44

a "bridge therapy" usually heparin

Question 45

D-D interactions for warfarin

Answer 45

heparin, NSAIDs, anti-platelet drugs

Question 46

What are the adverse effects of warfarin?

Answer 46

bleeding BBW

Question 47

what is the antidote for warfarin?

Answer 47

vitamin K

Question 48

how is warfarin monitored?

Answer 48

PT and INR

Question 49

what is another name for virtamin K

Answer 49

phytonadione

Question 50

vitamin K information

Answer 50

koagulation vitamin 4 clotting factors antidote for warfarin overdose if given warfarin resistance occurs for 7 days

Question 51

prothrombin time information

Answer 51

measures time it takes for blood clot to form monitor warfarin range is 12-15 sec therapuetic range 1.5-2 times baseline INR used to interpret PT

Question 52

International normalized ratio INR

Answer 52

standardized system normal range 0.8-1.2 (1) therapeutic range >2-3.5 measured daily in hospital outpatient lab testing

Question 53

when taking warfarin vitamin K food must be eaten with _________ and _________

Answer 53

moderation and consistency

Question 54

what foods are high in vitamin K and decrease warfarin's effects?

Answer 54

asparagus broccoli cabbage cauliflower kale

Question 55

what are the drug-food interactions that increase risk of bleeding with warfarin?

Answer 55

green tea, gingko, garlic, ginger, cranberry juice, chamomile and licorice

Question 56

what are the nursing implications for anticoagulants?

Answer 56

avoid IM injections (bleeding/hematomas) assess CBC, PT/INR observe for s/sx of bleeding routine time high-alert med use of NSAIDs, antiplatelets ↑ bleeding

Question 57

what is the patient teaching for warfarin?

Answer 57

soft toothbrush/no flossing electric shaver assistive devices report s/sx of bleeding prevent injury routine lab tests herbal/food interactions