Coagulation Modifiers

Question 1

Intrinsic Pathway has clotting factors convert _______ to ______

Answer 1

prothrombin, thrombin

Question 2

Extrinsic Pathway releases ________ which activates factors _____ and ______

Answer 2

Thromboplastin, VII. X

Question 3

The clotting factor produced by the liver is ______?

Answer 3

fibrin

Question 4

Fibrin binds with _____ which converts to _____ which will then break down ______ into degradation products.

Answer 4

plasminogen, plasmin, fibrin

Question 5

Antiplatelet drugs will..?

Answer 5

inhibit platelet aggregation and prevent platelet plugs.

Question 6

Thrombolytic drugs will?

Answer 6

lyse existing clots.

Question 7

Antifibrinolytic drugs are also called ______ and will..?

Answer 7

hemostatic, promote blood coagulation.

Question 8

Anticoagulants will inhibit the action or formation of c_____ f____ and will ultimately prevent _____ formation.

Answer 8

clotting factors, clot

Question 9

Anticoagulants have no effect on _____ ______

Answer 9

present clots

Question 10

Anticoagulants used prophylactically to prevent ____ formation and an ______

Answer 10

thrombus, embolus

Question 11

Anticoagulants Indicated for these three scenarios

Answer 11

1. A fib
2. Indwelling devices, like mechanical heart valves.
3. Major orthopedic surgery

Question 12

Heparin is an ______ drug class and works by blocking the conversion of ______ to ______

Answer 12

anticoagulants, fibrinogen, fibrin.

Question 13

heparin SQ has an onset of ____, and a duration of _____

Answer 13

20-60 minutes, 8-12 hours

Question 14

Heparin IV has an onset of _____ and a duration of ______

Answer 14

5 minutes, 2-6 hours.

Question 15

Heparin has laboratory monitoring every ____ hours and is ______ _______. The _____ test is used and should have a normal range of 20-40 seconds.
Therapeutic ranges are ____ to ____ times pre-treatment level.

Answer 15

6 hours, dose dependent, aPTT, 1.5-2.5 times.

Question 16

Low-molecular weight heparins target more ____ clotting factors therefore= _n_____ m_______ is _n_____

Answer 16

specific, no monitoring is needed.

Question 17

Enoxaparin (Lovenox) is which class of drug?
Which route do we give it?

Answer 17

LMWH or anticoagulant, SQ

Question 18

What is the antidote of heparin?

Answer 18

Protamine sulfate

Question 19

IV doses of Heparin should be ______
Preferrable spots for injection_____
list the places you absolutely shouldn’t inject within 2 inches of:
aspirating or massaging the area causes:

Answer 19

double checked with another nurse, only in deep SQ spots.
stoma, abdominal incisions, scars, drainage tubes, umbilicus, open wounds.
hematoma

Question 20

_______ laboratory values are done daily to monitor coagulation effects of heparin.

Answer 20

aPTT

Question 21

Avoid these foods _____, _____, ______, and ______ when taking warfarin.

Answer 21

green leafy vegetables, pork, fish, milk products

Question 22

Which class of drug is warfarin?

Answer 22

anticoagulant

Question 23

onset of warfarin is ______?

Answer 23

24-72 hours

Question 24

PT range for warfarin?
INR therapeutic range?

Answer 24

9.5-12 seconds
2.0-3.5

Question 25

For severe bleeding while on warfarin give transfusions of _____ ______ or c_____ f_____ c____s

Answer 25

human plasma, clotting factor concentrates.

Question 26

Since the full therapeutic effect of _____ takes several days, we wait until PT and INR levels are adequate to stop giving _____ which was giving anticoagulant effects in place of ______.

Answer 26

warfarin, heparin, warfarin.

Question 27

High doses of vitamin K (___mg) IV will reverse the effects of ______ within _____ hours.

Answer 27

10, warfarin, 6.

Question 28

When vitamin K is given while taking warfarin, there will be ______ resistance for up to ____ days.

Answer 28

warfarin, 7.

Question 29

These herbal products (7 items) increase the risk of bleeding with this medication:

Answer 29

1. capsicum pepper 2. ginger 3. garlic 4. gingko 5. St. John's wort 6. Feverfew 7. dong quai while taking with warfarin.

Question 30

Dabigatran (Pradaxa) is this class of drug____, and this category: ________. you must have good ____ function. the antidote is _____ The route is ___

Answer 30

anticoagulant, direct thrombin inhibitor, renal, Praxbind. PO

Question 31

A direct thrombin inhibitor will inhibit _____ also called _____

Answer 31

IIa, fibrin.

Question 32

Fondaparinux (Arixtra) is this class of drug _____ and this category________. A major side effect is _______. Monitoring or not? route?

Answer 32

anticoagulants, selective factor inhibitor, thrombocytopenia, no monitoring, and SQ.

Question 33

Selective factor inhibitors will inhibit ________

Answer 33

Xa

Question 34

Direct oral anticoagulants have action against factor ___ and the drugs are ______ and ______. Both of their routes are _____ _____ has a counterindication for ______ ________.

Answer 34

Xa, Rivaroxaban (Xarelto), Apixaban (Eliquis), grapefruit juice

Question 35

Rivaroxaban has an antidote of _______ injection.

Answer 35

andexxa

Question 36

LMWHs are contraindicated in patients with an..? Due to risk of ________ _________

Answer 36

indwelling epidural catheter, epidural hematoma.

Question 37

Warfarin should never be taken in ______?

Answer 37

pregnancy

Question 38

Bleeding risks should be avoided with _______ and can happen with both _____ and _____.

Answer 38

warfarin, warfarin and heparin.

Question 39

Type 2 HIT is an acute fall in platelets of >___% and can lead to p_______ t__________ continued drug therapy can be _____.

Answer 39

50, paradoxical thrombosis, fatal.

Question 40

Warfarin can cause what two skin problems?

Answer 40

skin necrosis and "purple toes" syndrome.

Question 41

treatment of type 2 HIT?

Answer 41

thrombin inhibitors (lepirudin and argatroban)

Question 42

If any of these five symptoms occur while taking heparin then stop drug immediately.

Answer 42

hematuria, melena, petechiae, ecchymosis, gum or mucous membrane bleeding.

Question 43

___mg of protamine sulfate can reverse the effects of ____ units of heparin.

Answer 43

1, 100

Question 44

Antiplatelets work to prevent platelet _____ at the site of blood vessel injury.

Answer 44

adhesion

Question 45

High doses of aspirin can lead to...?

Answer 45

metabolic acidosis, respiratory alkalosis, tinnitus, and fluid and electrolyte imbalances.

Question 46

aspirin is contraindicated for ____ symptoms in children and teens because of this syndrome..?

Answer 46

flu, Reye's

Question 47

Dipyridamole (Persantine) is an _________ drug and causes _____ changes. Often used with what drug?

Answer 47

antiplatelet, EKG, aspirin.

Question 48

Clopidogrel (Plavix) is what class of drug and what category?

Answer 48

antiplatelet, Adenosine diphosphate antagonist

Question 49

Eptifibatide (Integrilin) is what class of drug and what category?

Answer 49

antiplatelet, Glycoprotein IIb/IIIa receptor antagonist

Question 50

Which route of Eptifibatide is used? Where is it usually used at? What is it used for?

Answer 50

IV, ICU, cardiac catheterization.

Question 51

Thrombolytic drugs only work on ____-formed clots.

Answer 51

pre-formed

Question 52

older thrombolytic drugs are strepto_____ and uro_____

Answer 52

streptokinase, urokinase

Question 53

current thrombolytic drugs used?

Answer 53

t-plasminogen activators (tpa)

Question 54

Alteplase (Activase) is which class and category of drug? the route is a ____ followed by a 90 min ____ infusion.

Answer 54

thrombolytic, tpa, bolus, IV

Question 55

Alteplase is indicated in _______ _____ _______. Since this drug is weight based, give within ____ hours and for MI, only adults > ___ kg are qualified. ____ cost of drug.

Answer 55

acute ischemic stroke, 3, 67, high.

Question 56

Tenecteplase (TNKase) is what class and category of drug? route? indication? must start this drug within ____ hours of symptom onset.

Answer 56

thrombolytic, tPa, single IV bolus, MI, 6.

Question 57

thrombolytic drugs break down ____ into ____ which will dissolve the ____ network.

Answer 57

plasminogen, plasmin, fibrin.

Question 58

Thrombolytic drugs are indicated for a_____ t______, _____, o_____ of ____ or ______, and p_______ e_______

Answer 58

arterial thrombolysis, DVT, occlusion of shunts or catheters, pulmonary embolus.

Question 59

Three types of bleeding can happen with thrombolytic drugs. Name them.

Answer 59

1. superficial 2. intracranial 3. internal

Question 60

three adverse effects of thrombolytic drugs?

Answer 60

n/v, cardiac dysrhythmias, hypotension.

Question 61

Name the two antifibrinolytic drugs?

Answer 61

tranexamic acid and desmopressin

Question 62

Antifibrionlytic drugs will _____ clot formation.

Answer 62

promote

Question 63

Antifibrinolytic drugs will prevent and treat excessive bleeding resulting from h________s or _______ complications.

Answer 63

hyperfibrinolysis, surgical.

Question 64

antifibrinolytic drugs are indicated in ________ and ____ _____ disease.

Answer 64

hemophilia, von Willebrand's

Question 65

Desmopressin is a s______ p______e and indicated for which two conditions? similar to which drug? which is an _____ hormone. Nasal spray is used for n______ e_______s.

Answer 65

synthetic polypeptide, hemophilia, and diabetes insipidus, vasopressin, antidiuretic, nocturnal enuresis.

Question 66

Tranexamin acid the _________ drug class will form a _______ complex that displaces _______ from ________ resulting in inhibition of f________s

Answer 66

antifibrionlytic, reversible, plasminogen, fibrin, fibrionlysis.

Question 67

Tranexamic acid is indicated for what? Can cause what with rapid IV injection.

Answer 67

used IV prior to surgery, hypotension.