Blood Thinners-MJ

Question 1

How do platelets work?

Answer 1

Tissue injury occurs and arachnodinic acid is released causing platelet recruitment and aggregation (TxA2 and ADP). This forms a weak clot. The coagulation cascade is triggered and that creates fibrin that wraps around the clot to make it strong.

Question 2

What dose of aspirin is needed for anti-platelet effects?

Answer 2

Baby aspirin (81mg)

Question 3

What does aspirin prevent?

Answer 3

MI and stroke

Question 4

What is the MOA of aspirin?

Answer 4

Blocks COX1

COX1 converts arachidonic acid to TxA2. When we take aspirin, we block that action, so TxA2 is not created–so no platelet recruitment and aggregation and no coagulation so no fibrin clot–all leads to making you bleed

Question 5

What are the adverse effects of aspirin?

Answer 5

GI problems (dyspepsia, ulcers, bleeding)
Tinnitus (dose dependent)

Question 6

What kind of antagonist is clopidogrel?

Answer 6

ADP P2Y12

Question 7

What are the indications for taking clopidogrel?

Answer 7

MI and ischemic stroke

Question 8

What is the MOA of clopidogrel?

Answer 8

Blocking the production of ADP

ADP is not created, so we don’t get platelet recruitment and aggregation..so no coagulation cascade…so no fibrin clot formed..so you bleed

Question 9

Clopidogrel is ineffective for __% of people due to _____.

Answer 9

40% of people due to genetic variations

Question 10

Clopidogrel has many _____ interactions.

Answer 10

CYP

Question 11

What do we teach our patient to look for to know they are having a GI bleed?

Answer 11

Black, tarry stool (melena)

Coffee ground emesis

Question 12

What happens if a patient abruptly stops taking clopidogrel?

Answer 12

Can cause clotting to occur too fast–thrombotic event

Question 13

What is the clotting cascade?

Answer 13

An injury occurs and stuff happens that activates factor X, which activates factor II (thrombin). That works together with fibrinogen to form a fibrin clot

Question 14

Who gets blood thinners?

Answer 14

DVT and PE (prevention and treatment)
A-fib
MI
Mechanical heart valve

Question 15

Is warfarin highly variable or highly predictable?

Answer 15

Highly variable

Question 16

Does warfarin have a low or high therapeutic index?

Answer 16

LOW

Question 17

What can affect warfarin levels?

Answer 17

Diet (vitamin K) and genetics

Question 18

What is the MOA of warfarin?

Answer 18

The liver makes clotting factors X and II by using VITAMIN K. After it makes them, vitamin K is deactivated until they are needed to be made again. Warfarin blocks that reactivation of vitamin K. Eventually there is no more clotting factors.

Question 19

How long does it typically take for there to be no more clotting factors in the body after warfarin deactivates vitamin K?

Answer 19

5 days

Question 20

If a patient eats a lot of vitamin K, do they need a low or high dose of warfarin to be an effective blood thinner?

Answer 20

High dose

Question 21

What lab tests do we look at for warfarin?

Answer 21

PT and INR

Question 22

What does PT tell us?

Answer 22

Nothing; it just gives us the number we need to get the INR

Question 23

What does INR correct?

Answer 23

The PT level

Question 24

What is a normal INR?

Answer 24

1

Question 25

What is the INR for most clients?

Answer 25

2-3

Question 26

What is the INR for a patient with mechanical heart valves?

Answer 26

2.5-3.5 (needs thinner blood)

Question 27

What do we teach our client who is taking warfarin?

Answer 27

1. Consistency in VITAMIN K foods 2. Interactions 3. S&S of bleeding (melena, bloody urine, coffee ground emesis)

Question 28

What pregnancy category is warfarin?

Answer 28

X

Question 29

Can we give warfarin to a patient with impaired renal function?

Answer 29

Yes; warfarin is eliminated by the liver, so you don't need good renal function to take warfarin

Question 30

Is heparin rapid acting or slow acting?

Answer 30

Rapid

Question 31

Does heparin have a long or short half life?

Answer 31

Short (1.5 hours)

Question 32

Is heparin lipid soluble or polar?

Answer 32

Highly polar

Question 33

Since heparin is highly polar, how can we administer it?

Answer 33

IV and SQ only

Question 34

Is heparin highly variable or highly predictable?

Answer 34

Highly variable--must get lab work!!

Question 35

How do we monitor heparin?

Answer 35

Look at the PTT levels

Question 36

What does the PTT levels tell us?

Answer 36

How long it takes blood to clot

Question 37

How long does it take blood to clot in a normal person?

Answer 37

40 seconds

Question 38

How long does it take blood to clot if you are on anti-coagulant therapy?

Answer 38

60-80 seconds

Question 39

What are some of the safety issues with heparin? (4)

Answer 39

- Bleeding risks - Heparin-induced-thrombocytopenia - Don't take with anti-platelet meds - Heparin dose vs. heparin lock

Question 40

What is the antidote for heparin toxicity?

Answer 40

Protamine sulfate

Question 41

What is the MOA of enoxaprin?

Answer 41

Inhibits factor X

Question 42

Is enoxaparin polor or lipid soluble?

Answer 42

Polar

Question 43

How do we administer enoxaparin?

Answer 43

Sub Q ONLY

Question 44

Is enoxaparin variable or predictable?

Answer 44

Predictable

Question 45

How enoxaparin have a long or short half life?

Answer 45

Long

Question 46

What is special about administering enoxaparin?

Answer 46

Enoxaparin comes in a prefilled syringe that has a bubble in it. You get the bubble to the top of the syringe so that it is the last part to be injected in. The purpose of the bubble is to help seal off the injection site to prevent bruising

Question 47

What blood count needs to be watched with enoxaparin? What other level needs to be watched?

Answer 47

Platelets; anti-Xa levels

Question 48

How is enoxaparin excreted? What does this mean?

Answer 48

Excreted renally; monitor renal function