Anticoagulants, Antiplatelets, Thrombolytics

Question 1

in plasma

Answer 1

H2O and electrolytes (Sodium, magnesium, potassium), proteins (albumines, globulino, fibrogen), wastes, nutrients (vitamins, hormones), gases (O2, N2, CO2)

Question 2

formed elements

Answer 2

platelets, red blood cells, white blood, cells

Question 3

white blood cell types

Answer 3

neutrophils and monocytes are the 1st to site; eosinphils and basophils are for allergic reaction; lymphocytes - immunity

Question 4

thrombus =

Answer 4

clot

Question 5

Anticoagulants, Anti-platelets, Thrombolytics are used to treat

Answer 5

THROMBOTIC and THROMBOEMBOLC disorders

Question 6

Embolus

Answer 6

traveling clot (so it breaks loose and travels)

Question 7

THROMBI and EMBOLI that lodge in vital organs can cause

Answer 7

death

Question 8

How Clotting Occurs

Answer 8

When injury to a blood vessel occurs, within seconds, PLATELETS travel to the site and within 1-2 minutes, form a platelet plug to stop the bleeding; • The platelet cell membrane immediately begins to disintegrate allowing contents to leak that cause VASOCONSTRICTION; and Release of THROMBOPLASTIN

Question 9

THROMBOPLASTIN with calcium ions causes the conversion of PROTHROMBIN to **

Answer 9

THROMBIN

Question 10

THROMBIN converts FIBRINOGEN to **

Answer 10

FIBRIN

Question 11

After 24 hours, FIBRIN replaces

Answer 11

platelets at the site of the blood clot

Question 12

so goal to prevent the release of thromboplastin so you would need

Answer 12

anticoagulant

Question 13

anticoagulants DO NOT

Answer 13

DO NOT dissolve clots; DO NOT improve blood flow in the surrounding tissue of the clot; DO NOT prevent ischemic damage to tissues beyond the clot; DO NOT “thin” the blood

Question 14

anticoagulants are given to

Answer 14

PREVENT CLOT EXTENSION AND FORMATION (so given to prevent clot formation)

Question 15

“By definition, anticoagulants are drugs

Answer 15

that reduce formation of fibrin.”

Question 16

2 TYPES OF ANTICOAGULANTS

Answer 16

1. Parenteral Heparins 2. Oral warfarin (Coumadin)

Question 17

anticoagulants are different than anti platelets by working on

Answer 17

clotting factors not the platelets

Question 18

Parenteral Heparins inhibits **

Answer 18

thrombin, thus blocking conversion of fibrinogen to fibrin

Question 19

Parenteral Heparins helps

Answer 19

antithrombin inactivate clotting factors, thrombin and factor Xa

Question 20

now draw blood to check

Answer 20

anti Xa levels for people on heparin

Question 21

all heparins are given

Answer 21

parenterally - subq or IV

Question 22

Oral warfarin (Coumadin) blocks

Answer 22

the synthesis of vitamin k-dependent clotting factors

Question 23

vitamin k

Answer 23

helps make clotting factors

Question 24

Oral warfarin (Coumadin) acts as

Answer 24

as a competitive antagonist to hepatic use of Vitamin K

Question 25

so if decrease vitamin k then

Answer 25

decrease clotting factors

Question 26

Heparin is great for

Answer 26

emergencies because it has a very short half life

Question 27

Heparin MOA

Answer 27

Inhibits thrombin–mediated conversion of fibrinogen to fibrin AND inhibits active factor X

Question 28

Heparin is metabolized and excreted by

Answer 28

Metabolized in liver, excreted by kidney

Question 29

half life of heparin

Answer 29

Half life of 1-2 hours; increases with increasing dosage

Question 30

heparin does not cross _______ and not secreted in ________

Answer 30

Does not cross placental barrier; not secreted in breast milk

Question 31

Heparin: Uses/Indications

Answer 31

Prophylaxis and treatment of clots; Maintains patency of catheters; Prevents clotting during surgery or vascular procedures; Prevents clotting around prosthetic heart valves

Question 32

Prophylaxis and treatment of clots with heparin

Answer 32

Deep vein thrombosis; pulmonary emboli; Atrial fibrillation with clots

Question 33

adverse effects of heparin

Answer 33

BLEEDING; Anemia, thrombocytopenia; Local pain or discomfort at subcutaneous injection site; Long term use: alopecia, osteoporosis

Question 34

so if any pt on heparin use what

Answer 34

bleeding precautions ex. apply pressure longer

Question 35

(interaction of heparin) Increased bleeding if used concurrently with:

Answer 35

anti-platelet drugs: aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs); clopidogrel (Plavix); quinidine, cephalosporins; thrombolytic drugs

Question 36

(interaction of heparin) • Anticoagulant effect may be INCREASED if heparin combined with:

Answer 36

digoxin, tetracyclines, nicotine and alcohol, antihistamines

Question 37

Contraindications- Do not use heparin if:

Answer 37

Active Bleeding; Gastrointestinal ulcers; Hemophilia, thrombocytopenia; Severe liver or kidney disease; Uncontrolled hypertension; Recent CNS surgery, spinal cord injury, brain surgery; Recent eye surgery

Question 38

Use Heparin Cautiously if:

Answer 38

Mild hypertension; Severe diabetes; Renal or hepatic disease; Alcoholism; Presence of drainage tubes; Malignancy; Last trimester of pregnancy or immediate

Question 39

with Heparin check pt's history for

Answer 39

for bleeding disorders or any pre-existing condition that would increase risk for bleeding

Question 40

Check activated partial thromboplastin time (aPTT):

Answer 40

Normal value is 40 seconds. At therapeutic levels, heparin INCREASES the aPTT by a factor of 1.5 to 2 times

Question 41

On heparin therapy, the aPTT should be

Answer 41

60-80 seconds (prolonged aPTT

Question 42

If aPTT is too long (>80 seconds), the heparin dose should be

Answer 42

decreased (pt has too much heparin, put infusion on hold for a few hours and resume at a lower rate)

Question 43

If aPTT is 50 seconds, the heparin dose should be

Answer 43

increased (great risk for clotting so increase dose)

Question 44

If patient is bleeding excessively or aPTT is extremely prolonged

Answer 44

Stop the heparin; Administer Protamine sulfate: antidote or antagonist for heparin-neutralizes heparin activity

Question 45

for pt on heparin assess pt for

Answer 45

bleeding gums, nosebleeds, unusual bruising , hematuria, guaiac-positive stools, prolonged bleeding from needle puncture sites, or wounds.

Question 46

for pt on heparin avoid

Answer 46

needle sticks; apply pressure for 2 minutes for venous sticks; 5minutes for arterial sticks

Question 47

for pt on heparin monitor for low

Answer 47

hemoglobin hematocrit, platelet counts

Question 48

When administering SC heparin

Answer 48

use 25-26 gauge needles, administer 2 inches from umbilicus in abdomen, do not aspirate or apply pressure.

Question 49

pt teaching with heparin

Answer 49

Use soft bristled tooth brush, electric shavers only, protective gear with physical activity; Wear Medic Alert identification; Avoid vigorous activities leading to injury that might cause bleeding

Question 50

Low Molecular Weight Heparins

Answer 50

Lovenox (enoxaparin), Innohep

Question 51

Low Molecular Weight Heparins are

Answer 51

• Molecules shorter than regular heparin; have greater bioavailability and longer half-lives

Question 52

with Low Molecular Weight Heparins plasma levels are

Answer 52

predictable** for any given dose: do not require laboratory monitoring although will increase activated partial thromboplastin time

Question 53

Low Molecular Weight Heparins have less risk of

Answer 53

bleeding: safe for outpatient use

Question 54

Low Molecular Weight Heparins work mostly at inactivating

Answer 54

factor Xa rather than thrombin; response more stable and effect two to four times longer than that of heparin

Question 55

Low Molecular Weight Heparins cost

Answer 55

more than twice that of heparin

Question 56

Low Molecular Weight Heparin are the first line therapy for

Answer 56

prevention and treatment of deep vein thrombosis

Question 57

Low Molecular Weight Heparins can cause severe

Answer 57

neurologic injury (paralysis) when given to patients undergoing spinal puncture or epidural anesthesia