Haemotology

Question 1

Heparin

Answer 1

Combines with antithrombin 3 which inactivates factor Xa and IIa

Caution with asthma

Question 2

Dalteparin

Answer 2

Low molecular wt heparin- inactivates Xa

Avoid in renal impairment

Question 3

Antithrombin III

Answer 3

Dependant and independant (fondaparinux)- inhibits factor Xa

Bivalirudin- binds directly you thrombin

Question 4

Warfarin

Answer 4

Interferes with synthesis of Vit K dependant clotting factors

Question 5

Vitamin K

Answer 5

Anticoagulant antagonist

Required for synthesis of prothrombin, factor VII, IX, X

Question 6

Thrombolytics drugs
Streptokinase- MI/PE
Urokinase- PE
Alteplase- 
Reteplase- AMI

Answer 6

Dissolved clot by converting plasminogen to plasmin

Question 7

Apixiban / Eliquis

Factor Xa inhibitor

Answer 7

Anticoagulant

Dose- 5mg BD

Decreases risk of stroke/emboli associated with AF, prevention of DVT post hip/knee surgery

Action- selective, reversible site inhibitor of factor Xa, inhibiting both free and bound factor. Does not affect platelet aggregation directly but does inhibit thrombin-induced platelet aggregation. Decreases thrombin generation and thrombus development.

Nursing responsibility- assess for symptoms of stroke, DVT, PE, bleeding or peripheral vascular disease

Contraindication- hypersensitivity, active bleeding, severe hepatic impairment, prosthetic heart valves, PE with haemodynamic instability or requiring thrombolysis or pulmonary embolectomy

Use cautiously- neuroaxial spinal anaesthesia or spinal puncture, drugs affecting haemostatsis, history of traumatic/repeated spinal puncture or spinal deformity, surgery, renal impairment, moderate hepatic impairment

Adverse effects- bleeding, hypersensitivity

Drug-drug- increases risk of bleeding with other anticoagulants, aspirin, NSAIDs, SSRI’s, St Johns wart