Exam 2- hematologic Flashcards
(46 cards)
1
Q
Anticoagulants and Antiplatelets (MOA and type of modification)
A
- prevention of clot formation
- inhibition of specific clotting factors
- inhibition of platelet actions
2
Q
Heparin- type/class
A
anticoagulant/Indirect Thrombin Inhibitor
- Heparin is the traditional drug of choice for rapid anticoagulation.
3
Q
Heparin MOA
A
Prevents clotting by activating antithrombin III, thus indirectly inactivating both thrombin and factor Xa. This inhibits fibrin formation
4
Q
Heparin- Nursing implications (antidote, risks, labs)
A
- Not absorbed by the intestinal tract and must be given by subcutaneous injection or IV infusion (Do not give IM)
- Antidote: Protamine Sulfate
- Risks: Bleeding, Heparin Induced Thrombocytopenia (HIT) (monitor platelets too)
- Monitored through parital thromboplastin time (aPTT)
5
Q
Heparin black box warning
A
Spinal/ epidural bleeding with epidural or Lumbar Puncture
6
Q
Enoxaparin (Lovenox) class/type
A
- Anticoagulants
- Low molecular weight heparin
7
Q
Enoxaparin vs. Heparin (6)
A
- More predictable anticoagulant response than heparin
- Does not require laboratory monitoring
- HIT less likely, but higher risk in someone who has had HIT from Heparin
- Given subcutaneously
- Can be administered at home
- same antidote (protamine sulfate)
8
Q
Warfarin (Coumadin) class/type
A
- Vitamin K antagonist
- Anticoagulant
9
Q
Warfarin (Coumadin) MOA
A
Inhibits Vitamin K, thereby preventing the synthesis of four coagulation factors (factor VII, IX, X, and prothrombin.)
10
Q
Warfarin (Coumadin) Nursing implications/education
A
- Given orally only
- Monitored by prothrombin time (PT) and INR (PT-INR) (must be monitored closely)
- Antidote: Vitamin K
- Foods high in vitamin K may decrease anticoagulant effects
11
Q
Warfarin (Coumadin) CI (1)
A
- Do not use in pregnancy or lactation
12
Q
Warfarin (Coumadin) Heparin bridge therapy
A
- Warfarin effects may take 8 to 12 hr, and full therapeutic effect is not achieved for 3 to 5 days.
- For clients in the hospital setting, explain the need for continued heparin infusion when starting oral warfarin
13
Q
Dabigatran (Pradaxa) class/type
A
Direct Thrombin Inhibitor
Anticoagulant
14
Q
Dabigatran (Pradaxa) MOA
A
Work by directly inhibiting thrombin, thus preventing a thrombus from developing.
15
Q
Dabigatran (Pradaxa) Nursing Implications/Antidote
A
- Stop 1-6 days prior to surgery
- antidote- Praxibind
- Take with food
16
Q
Dabigatran (Pradaxa) Side effects (4)
A
- GI discomfort
- nausea, vomiting
- esophageal reflux
- ulcer formation
17
Q
Dabigatran (Pradaxa) black box warning
A
- Premature discontinuation INCREASES risk of thrombotic events
- Epidural/spinal hematoma
18
Q
Aspirin (ASA) goal/type
A
- prevent initial clot formation
- antiplatelet
19
Q
Aspirin (ASA) MOA
A
- MOA: Blocks thromboxane
- Result is a “slippery” platelet
- Because platelets are slippery they do not clump together (aggregate)
- If things aren’t sticking together, clotting is reduced
- Irreversibly bound- once platelet bound to ASA it is done
20
Q
Aspirin (ASA) indications
A
- 81mg “baby aspirin” used in prevention of MI and stroke
- This low dose affects mostly platelets and will not have as much of an effect on COX-2 pain/fever
- Lower dose thought to have lower side effects
- In acute MI
- chew Aspirin for faster absorption and take a higher dose (325mg)
21
Q
CLOPidogrel (Plavix) goal/class/type
A
- ADP Receptor Blocker
- prevent initial clot formation
- antiplatelet
- prevents CLots, an Oral Platelet Inhibitor (CLOPI).
22
Q
CLOPidogrel (Plavix) MOA
A
- Blocks the adenosine diphosphate (ADP) receptor on the platelet membrane, preventing the platelet from “connecting” with other platelets.
- slippery platelets
23
Q
Thrombolytics goals/indications/risks
A
- Break down existing clots
- Extreme risk of bleeding
- Only used for life-threatening illnesses
- Dissolve existing intravascular clots in MI and Stroke
- Risk of bleeding with thrombolytics may outweigh benefits.
(In patients greater than age 75- research shows do not decrease mortality)
24
Q
Alteplase (Activase) class
A
thrombolytic
25
Alteplase (Activase) MOA
- Activate plasminogen and convert it to plasmin, which can dissolves fibrin clots
- Reestablish blood flow so that viable tissue may be reperfused and not be destroyed
26
Alteplase (Activase) Key points
- Should be given within 6 hours of MI symptom onset or 3 hours of thrombotic stroke (60 minute max preferred)
- With stroke, must rule out intracranial hemorrhage
27
Alteplase (Activase) Nursing implications (5)
- Follow strict manufacturer’s guidelines for preparation and administration
- Monitor IV sites for bleeding, redness, pain
- Monitor for bleeding from gums, mucous membranes, nose, injection sites
- Observe for signs of internal bleeding (decreased BP, restlessness, increased pulse)
- Hold pressure to puncture sites for at least 30 minutes
28
Aminocaproic acid (Amicar) class
hemostatics
29
Aminocaproic acid (Amicar) Use/specific indications (3)
- Hemostatics are used to promote the formation of clots.
- Hemophilia
- Post Op Cardiac Surgery
- Aplastic anemia
30
Aminocaproic acid (Amicar) MOA
Occupies binding sites on plasminogen and plasmin
| Prevents breakdown of fibrin clots by plasmin
31
Aminocaproic acid (Amicar) side effects (5)
- Muscle wasting and weakness rhabdomyolysis
- Formation of abnormal clots
- Pulmonary thrombus or embolus
- Hypotension (with rapid IV administration)
- Bradycardia (with rapid IV administration)
32
Aminocaproic acid (Amicar) CI/cautions (4)
- History of CVA in last 3 months
- Other thrombotic events
- Severe HTN
- Bleeding in the Urinary Tract
33
Aminocaproic acid (Amicar) Nursing implications (4)
- Check IV site
- Monitor labs
* Observe for signs of thrombosis/embolism
- Chest pain
- Leg pain
- Difficulty breathing
* Monitor urine
- Color
- Difficulty urinating
34
Epoetin alfa (Epogen) class
Erythropoietin/Hematopoietic growth factor
35
Epoetin alfa (Epogen) MOA
- Stimulates the division and differentiation of stem cells in the bone marrow
- Promotes the synthesis of hemoglobin and causes a shift of marrow reticulocytes into the circulation
36
Epoetin alfa (Epogen) indications
- Treatment of anemia associated with renal failure
| - Anemia associated with cancers
37
Epoetin alfa (Epogen) CI/cautions
- Hemoglobin above 12 g/dL
| - Bone marrow malignancies
38
Epoetin alfa (Epogen) Black box warning (4)
- Thromboembolic events
- Transient ischemic attack
- Myocardial infarction
- Hypertension
39
Epoetin alfa (Epogen) Nursing implications
- Assess labs closely
- Watch vital signs
- Monitor for thromboembolic events
40
Epoetin alfa (Epogen) Blood doping
- Elevating red blood cells in athletes bloodstream
- Increasing the amount of red cells increase the amount of oxygen delivered to the muscles allowing them to work more efficiently
- After 2-4 weeks of treatment effects can be seen
- Athlete can then stop taking and benefit from effects during this window without continuing to take it
- Epoetin can be metabolized within days making it difficult to detect, especially if it was stopped weeks prior
- Difficult to detect Epoetin vs Naturally occurring erythropoietin
41
Filgrastim (Neupogen) class
Colony-stimulating factor
42
Filgrastim (Neupogen) MOA
- Increase in neutrophil production in the bone marrow
| - Enhance the phagocytic and cytotoxic functions of existing neutrophils
43
Filgrastim (Neupogen) Side effects (8)
- Nausea and Vomiting very common
- Fever/chills
- Bone pain
- Spleen rupture
- Leukocytosis (too many neutrophils)
- Respiratory failure
- Retinal hemorrhage
- MI
44
Filgrastim (Neupogen) indications
- Receiving chemotherapy or radiation therapy
- Receiving bone marrow transplants
- Chronic neutropenia
- Immunosuppressive AIDS
- Severe infections
45
Filgrastim (Neupogen) CI/cautions
- Sickle-cell disease
- Pre-existing cardiac disease
- Sensitivity to e.coli (used to produce drug)
46
Filgrastim (Neupogen) Drug interactions (2 and why)
* Not administered until at least 24 hours after a chemotherapy session
- Chemo and Neupogen have opposite actions
* Lithium
- Lithium promotes neutrophil release increasing risk for leukocytosis
