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

CH 31: Drugs for Coagulation Disorders Flashcards

(49 cards)

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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

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
A

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

23
Q

heparin (anticoagulant) what to monitor for

Study These Flashcards
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

Study These Flashcards
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
warfarin (Vitamin K antagonists) therapeutic effects
-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
warfarin (Vit K antagonists) adverse effects
Abnormal bleeding fatal bleeding
27
warfarin (Vit K antagonists) what to monitor
-PT and INR!!! -*Signs and symptoms of bleeding -Keep close watch of INR when new medications are added or d/c’d
28
warfarin (Vit K Antagonists) safety precautions
-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
enoxaparin (Low molecular weight heparins (LMWHS) therapeutic effects
-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
enoxaparin (Low molecular weight heparins (LMWHS) adverse effects
Minor bleeding, nausea, vomiting, hematoma, local pain, fever Hemorrhage, thrombocytopenia, pancytopenia, anaphylaxis
31
enoxaparin (Low molecular weight heparins (LMWHS) what to monitor
-Monitor for bleeding, thrombo-cytopenia -CBC, platelet, stools for occult blood
32
enoxaparin (Low molecular weight heparins (LMWHS) safety precautions
-Risk of bleeding increased with concurrent use of drugs that affect platelet aggregation -Protamine sulfate for overdose
33
dabigatran (direct thrombin inhibitors) therapeutic effects
-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
dabigatran (direct thrombin inhibitor) adverse effects
Fever, nausea, allergic skin reactions, hepatic impairment, minor bleeding, back pain (bivalirudin) Serious internal hemorrhage, hemoptysis, hematuria, sepsis heart failure
35
dabigatran (direct thrombin inhibitor) what to monitor
-Assess for stroke -aPTT NOT INR -sign and symptoms of bleeding -hyper-sensitivity reactions -angioedema
36
dabigatran (direct thrombin inhibitor) safety precautions
Can interact with other anticoagulants Take same time each day
37
apixaban (factor Xa inhibitors) therapeutic effects
-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
apixaban (factor Xa inhibitors) adverse effects
Minor bleeding, rash Major bleeding, including stroke; hypersensitivity reactions
39
apixaban (factor Xa inhibitors) what to monitor
hypersensitivity reactions stroke, DVT, PE, bleeding
40
apixaban (factor Xa inhibitors) safety precautions
-DO NOT D/C abruptly -Can interact with other anticoagulants -No not double missed doses
41
signs of bleeding
bleeding gums, nosebleed, unusual bruising, black tarry stools, hematurea, fall in hemacrit or BP
42
aspirin (antiplatelet) therapeutic effects
Interfere with platelet aggregation
43
aspirin (antiplatelet) adverse effects
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
aspirin (antiplatelet) what to monitor
GI bleeding Allergic reactions Tinnitus
45
aspirin (antiplatelet) safety precautions
-Take after meals or with food -Report tinnitus -Caution with alcohol -Avoid acetaminophen or NSAIDs
46
clopidogrel (ADP receptor blockers) therapeutic effects
-Prevent thrombi formation in patients with the recent event (stroke or MI) -Prevent DVT -Given with aspirin
47
clopidogrel (ADP receptor blockers) adverse effects
Minor bleeding, dyspepsia, abdominal pain, dizziness, headache Increased clotting time, GI bleeding, blood dyscrasias, angina
48
clopidogrel (ADP receptor blockers) what to monitor
Monitor for bleeding. cbc with diff (anemia) and platelet count thrombocytopenia Monitor for GI bleeding Test effectiveness for Asian patients
49
clopidogrel admin precautions
Do not crush or split tablets Avoid other antiplatelet drugs such as NSAIDs

Pharm Exam 4 (7 decks)

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