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Pharm Exam 4 > CH 31: Drugs for Coagulation Disorders > Flashcards

CH 31: Drugs for Coagulation Disorders Flashcards

1
Q

Drugs for Coagulation Disorders

A

 Anticoagulants
 Antiplatelet
 Thrombolytics
 Hemostatic
 Clotting Factor Concentrates

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2
Q

hemostasis

A

 to stop blood flow
 protects the body from external and internal injury
 without it any bleeding would lead to death
 too much hemostasis (clotting) is dangerous too

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3
Q

Causes of alterations of hemostasis

A

 MI
 Stroke
 Venous or arterial thrombosis
 Sepsis
 Cancer

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4
Q

How do we achieve Hemostasis

A

 Requires clotting factors in sequential steps
 The clotting process needs platelets, thrombin, thromboxane, platelet receptor sites (glycoprotein IIb/IIa), von Willebrand’s factor, fibrin strands
 this results in coagulation,
 fibrin threads create a meshwork, traps the cells and then
 the formation of a clot

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5
Q

the liver needs ____ to make several of the clotting factors

A

Vitamin K

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6
Q

The most common bleeding disorder in women is:

A

von Willebrand’s disease (vWD)

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7
Q

women with vWd are at risk for:

A

anemia, menstrual pain, and limitations in activities of daily living.

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8
Q

Clot removal =

A

fibrinolysis – usually starts within 24 to 48 hours of clot formation

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9
Q

steps to removing a clot

A
  1. blood vessel cells secrete enzyme tissue plasminogen activator (TPA)
  2. TPA converts the inactive protein plasminogen to its active enzymatic form, plasmin
  3. Plasmin then digests the fibrin strands to remove the clot
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10
Q

diagnostics for hemostasis

A

 lab tests that measure coagulation
 PT prothrombin time
 aPTT activated partial thromboplastin time
 Platelet count

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11
Q

what happens with thromboembolic disorders

A

the body forms undesirable clots – they can break away with bad consequences

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12
Q

what happens with coagulation disorders

A

body experiences too much clotting – usually caused by decreased platelets and deficiencies in clotting factors

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13
Q

deficiency of platelets

A

thrombocytopenia

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14
Q

possible causes of thrombocytopenia

A

 condition that suppresses bone marrow function
 immunosuppressant drugs
 and most of the medications used for cancer chemotherapy.
 Other common causes of decreased platelet production are folic acid or vitamin B12 deficiencies and liver failure.

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15
Q

deficiency of clotting factors may:

A

May prolong coagulation and lead to excess bleeding

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16
Q

deficiency of one clotting factor

A

hemophilia

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17
Q

inhibit specific clotting factors in the coagulation cascade.

A

Anticoagulants

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18
Q

act by inhibiting the clotting action of platelets.

A

antiplatelet medication

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19
Q

remove clots quickly and used for life-threatening clots

A

Thrombolytics

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20
Q

administration of anticoagulants

A

Can have a rapid onset of action and given IV or subcutaneously in an emergency – then usually switched to oral anticoagulant therapy

21
Q

heparin (anticoagulant) therapeutic effects

A

-Prevention of coagulation
-Inactivates thrombin
-Slows the formation and enlargement of fibrin clots
-Used to prevent clots and treat clots that have formed

22
Q

heparin (anticoagulant) adverse effects

A

Nausea,
vomiting,
transient thrombocytopenia (heparin),
anemia (fondaparinux)
Hemorrhage,
anaphylaxis,
heparin-induced thrombocytopenia

23
Q

heparin (anticoagulant) what to monitor for

A

-aPTT closely!
-Hematocrit
-Monitor platelet count every 2 to 3 days HIT may develop on day 8
-Heparin-induced thrombocytopenia (HIT_
-Signs and symptoms of bleeding!*

24
Q

heparin (anticoagulant) safety precautions

A

-Interacts with warfarin lead to serious bleeding
-Do not take with aspirin or ibuprofen and other “blood
thinning” meds
-Protamine sulfate is the antidote

25
Q

warfarin (Vitamin K antagonists) therapeutic effects

A

-Inhibits the action of vitamin K and suppresses coagulation
factors
-Prevention of thrombotic events – by preventing thrombus formation
-Prevention of stroke, MI, DVT, PE post surgery
-Management of MI – decreases risk of death, another MI

26
Q

warfarin (Vit K antagonists) adverse effects

A

Abnormal bleeding
fatal bleeding

27
Q

warfarin (Vit K antagonists) what to monitor

A

-PT and INR!!!
-*Signs and symptoms of bleeding
-Keep close watch of INR when new medications are
added or d/c’d

28
Q

warfarin (Vit K Antagonists) safety precautions

A

-Takes several days to have max effect
-DO NOT double doses if pt misses a dose
-NO alcohol
-Pt needs Med ID
-Overlap heparin with warfarin 2 to 3 days
-Vitamin K in antidote for overdose
-Anticoagulant effect can last up to 10 days after the drug is discontinued
-Increased effect with alcohol, NSAIDs, diuretics, SSRI, steroids, antibiotics,
-No OTC meds without provider approval
-Do not change diet to more vitamin K-rich foods

29
Q

enoxaparin (Low molecular weight heparins (LMWHS) therapeutic effects

A

-prevention of coagulation – thrombus formation
-Inhibition of factor x
-Slows the formation and enlargement of fibrin clots
-Last 2 to 4 times longer than heparin
-More stable response
-Can be given by caregivers or patient
-Less likely to cause thrombocytopenia

30
Q

enoxaparin (Low molecular weight heparins (LMWHS) adverse effects

A

Minor bleeding,
nausea,
vomiting,
hematoma,
local pain,
fever
Hemorrhage,
thrombocytopenia,
pancytopenia,
anaphylaxis

31
Q

enoxaparin (Low molecular weight heparins (LMWHS) what to monitor

A

-Monitor for bleeding, thrombo-cytopenia
-CBC, platelet, stools for occult blood

32
Q

enoxaparin (Low molecular weight heparins (LMWHS) safety precautions

A

-Risk of bleeding increased with concurrent use of drugs that affect platelet aggregation
-Protamine sulfate for overdose

33
Q

dabigatran (direct thrombin inhibitors) therapeutic effects

A

-Prevent the formation of fibrin clots
-Prevent thrombocytopenia induced by heparin therapy
-Reduce the risk of stroke or embolism for patients with a fib
-Given after IV heparin

34
Q

dabigatran (direct thrombin inhibitor) adverse effects

A

Fever,
nausea,
allergic skin reactions,
hepatic impairment,
minor bleeding,
back pain (bivalirudin)
Serious internal hemorrhage,
hemoptysis,
hematuria,
sepsis
heart failure

35
Q

dabigatran (direct thrombin inhibitor) what to monitor

A

-Assess for stroke
-aPTT NOT INR
-sign and symptoms of bleeding
-hyper-sensitivity reactions
-angioedema

36
Q

dabigatran (direct thrombin inhibitor) safety precautions

A

Can interact with other anticoagulants
Take same time each day

37
Q

apixaban (factor Xa inhibitors) therapeutic effects

A

-Inhibit factor Xa
-Prevention of DVT following surgery, reduction of chance for stroke, and embolism associated with a fib
-Do not require INR monitoring
-Fewer interactions

38
Q

apixaban (factor Xa inhibitors) adverse effects

A

Minor bleeding,
rash
Major bleeding,
including stroke;
hypersensitivity reactions

39
Q

apixaban (factor Xa inhibitors) what to monitor

A

hypersensitivity reactions
stroke,
DVT,
PE,
bleeding

40
Q

apixaban (factor Xa inhibitors) safety precautions

A

-DO NOT D/C abruptly
-Can interact with other anticoagulants
-No not double missed doses

41
Q

signs of bleeding

A

bleeding gums,
nosebleed,
unusual bruising,
black tarry stools,
hematurea,
fall in hemacrit or BP

42
Q

aspirin (antiplatelet) therapeutic effects

A

Interfere with platelet aggregation

43
Q

aspirin (antiplatelet) adverse effects

A

nausea
vomiting,
diarrhea,
abdominal pain,
headache (anagrelide)
Increased clotting time,
GI bleeding (aspirin),
central nervous system (CNS)
effects (dipyridamole)
anaphylaxis (aspirin),
cardiac toxicity (anagrelide)

44
Q

aspirin (antiplatelet) what to monitor

A

GI bleeding
Allergic reactions
Tinnitus

45
Q

aspirin (antiplatelet) safety precautions

A

-Take after meals or with food
-Report tinnitus
-Caution with alcohol
-Avoid acetaminophen or NSAIDs

46
Q

clopidogrel (ADP receptor blockers) therapeutic effects

A

-Prevent thrombi formation in patients with the recent event
(stroke or MI)
-Prevent DVT
-Given with aspirin

47
Q

clopidogrel (ADP receptor blockers) adverse effects

A

Minor bleeding,
dyspepsia,
abdominal pain,
dizziness,
headache
Increased clotting time,
GI bleeding,
blood dyscrasias,
angina

48
Q

clopidogrel (ADP receptor blockers) what to monitor

A

Monitor for bleeding.
cbc with diff (anemia) and platelet count
thrombocytopenia
Monitor for GI bleeding
Test effectiveness for Asian patients

49
Q

clopidogrel admin precautions

A

Do not crush or split tablets
Avoid other antiplatelet drugs such as NSAIDs

Pharm Exam 4 (7 decks)

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