chapter 9- coagulation Flashcards by Madison Gibbons

what is hemostasis

halt of blood
-natural process in response to injury to tissue

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how does hemostasis occur

vasoconstriction, formation of a platelet plug, activation of clotting factor, reparation of the opening in a damaged vessel

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what do plasminogen and fibrin do

form a clot

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what does Plasmin do

dissolves a clot

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what do capillaries do

connect veins and arteries

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what organ affects clotting the most

the liver

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define intrinsic and extrinsic

I: blood vessel damage
E: tissue damage

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what is thrombogenisis

formation of and dissolving of clot

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what is arterial thrombosis, an incomplete blockage, complete blockage and the cause.

obstruction of arterial blood flow
-caused by damaged arterial endothelium, causing platelet activation
In: deficient blood flow, causing ischemia
C: obstruction, causing necrosis
Causes: atherosclerosis, HTN, turbulent arterial blood flow

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what is venous thrombosis and DVT and the cause

result of venous stasis, thrombin, and procoagulant substances become concentrated
-easily detached
DVT, PE if detached
-common in lower extremities, will block the right side of the heart
Assessment: pain redness, swollen, hot, some will be asymptomatic
caused by: decreased activity

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what is atherosclerosis

elevated lipid levels, causing plaques to form
-progressive
-causes MI and TIA, CVA and strokes

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what is TIA

transient ischemic effect, occurs before CVA and strokes

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what are anticoagulants used for

thrombotic disorders, prevent venous thrombus
-thrombophlebitis, DVT and PE, A fib

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what are antiplatelets used for

prevent arterial thrombosis

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what are thrombolytics used for

dissolve thrombi and limit tissue damage

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what is thrombophlebitis

vein inflammation

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main adverse effect of anticoagulants

bleeding

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challenge with anticoagulants

dosing for therapeutic levels is challenging

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what do you have to do if administering IV heparin

draw labs every six hours until the therapeutic dose is achieved
-aPTT/PTT
-levels should be 60-80

the primary use for SQ heparin

DVT prevention for in-bed restricted Pts, 5000u is a common dose

what is the antidote for heparin

protamine sulfate

why is enoxaparin not used often

price

what are warfarin levels measured by

INR and PT

what is the antidote for warfarin, and what foods affect it

Vitamin K
-green leafy veggies, green tea, grapefruit juice, cranberry, alcohol

how does fondaparinux work and how is it given

xa inhibitor Sub Q and IV

when is fondaparinux used and why only then

when heparin causes thrombocytopenia PRICE

how does dabigatran work and how is it administered

direct thrombin inhibitor, treats complications of Afib and stroke prevention PO twice daily

what is the antidote to dabigatran

idarucizumab

why is dabigatran not used often

compliance issues with taking twice daily

how does rivaroxaban work and how is it given

Xa inhibitor treats Afib complications and stroke and DVT prevention PO once daily

how does apixaban work and how is it given

The most common Xa inhibitor, used to treat Afib complications and stroke prevention PO twice daily

benefit of taking something other than warfarin

does not require regular testing, could lead to higher complications -DO NOT STOP TAKING

side effects other than bleeding for anticoagulants and possible complications

GI upset Should not take NSAIDS lots of dietary and drug interactions such as... allopurinol, -cillin antibiotics, and birth control

what is ecchymosis

increased bruising, bleeding episodes, dizziness, lightheadedness, hypotension, low hgb/hct, bloody urine, chest pain, SOB, hemoptysis SIGNS DOSE IS TOO HIGH

ways antiplatelets work

-inhibit activation -inhibit adhesion -inhibit aggregation -inhibit the procoagulant activity

how does clopidogrel work

inhibits ADP receptor on platelets NO ANTIDOTE Long first pass effect

side effects of clopidogrel

rash and diarrhea

what can clopidogrel be used with

aspirin

how does aspirin work, and when is it used

thromboxane A2 inhibitor prevents platelet aggregation and thrombus formation 81 mg, for MI, CVA, pts with prosthetic valves, and stents NO ANTIDOTE

how does abciximab work, and when is it used

glycoprotein antagonist prevents binding of fibrinogen, stopping platelet aggregation for interventional procedures with aspirin and heparin

how does cilostazol work and when is it used

phosphodiesterase inhibitor inhibits platelet aggregation and causes vasodilation -used for intermittent claudication-- pain caused by PAD/PVD -know it is caused by this if it is relieved by rest should improve within 2-4 weeks up to 12 weeks

how does anagrelide work and when is it used

inhibits platelet aggregation induced by CAMp, phosphodiesterase, ADP, and collagen. used to reduce platelet counts -- thrombocythemia

when are thrombolytic agents used

only in emergencies, large risk/benifit

what labs are needed for thrombolytics

INR, aPTT, platelet count, fibrinogen

how does alteplase work and when is it used

recombinant plasminogen activator used for: post CVA, massive PE

side effects to alteplase and other thrombolytics and when should it not be used

SYSTEMIC BLEEDING, kidney and liver function -intracranial/spinal surgery -severe hypotension -active bleeding/coagulation issues/anticoagulation meds -recent surgery -stroke aneurysm in last 2 months