Hematologics: Antiplatelet, Anticoagulant, Antithrombotic Flashcards Preview

Pharmacology > Hematologics: Antiplatelet, Anticoagulant, Antithrombotic > Flashcards

Flashcards in Hematologics: Antiplatelet, Anticoagulant, Antithrombotic Deck (38):
1

Coagulation

Formation of an insoluble clot

2

What disease processes need to be Tx c hematologic medications?

1. DVT
2. Hx of stroke/MI
3. Pulmonary Emboli

3

Steps of coagulation

1. Local vasoconstriction
2. Formation of platelet aggregation
3. Formation of blood clot/4 subcategories
4. Clot retraction and dissolution

4

Formation of blood clotting

1. Intrinsic
2. Extrinsic
3. Common pathway
4. Conversion of prothrombin to thrombin

5

Intrinsic

Belonging naturally
Essential

6

Extrinsic

Not part of the essential nature of someone or something
Coming or operating from outside

7

Fibrinolysis

1. Clot removal
2. Initiated by release of tissue plasminogen activator (tPA)
3. Circulation restored

8

Antiplatelet Medication

1. Interferes c platelet aggregation
2. Prolongs bleeding time
3. Platelet aggregation occurs p vasoconstriction
3. Platelet enzymes cause increased platelet activity
4. Affects ADP & TXA2

9

Name 3 antiplatelet medications

1. Aspirin (ASA)
2. Ticlopidine (Ticlid)
3. Clopidogrel (Plavix)

10

Therapeutic uses for antiplatelet medication

1. Prevent clot formation
2. Tx thrombosis- clot in particular area
3. Tx emboli- clot breaks off & travels

11

Contraindications for antiplatelet medication

1. Underlying bleeding disorders
2. Severe liver impairment
3. Active bleeding
4. pregnancy
5. ASA

12

Antiplatelet Rx Interaction

1. Anticoagulant= Increase risk of bleeding
2. Antigout medications
3. NSAID's c clopidogrel= Iincrease antiplatelet

13

Antiplatelet adverse effects

1. Bruising & petechiae
2. GI: N/V/D & pain
3. Headache/dizziness/weakness
4. ASA= Hearing changes

14

RN implication/Teaching for antiplatelet

1. H&P
2. Monitor I&O (dehydration)
3. Watch for bleeding
4. D/C MED 7-10 DAYS PRIOR TO SURGERY, DENTAL WORK
5. Monitor for hearing loss/dizziness/LOC
6. Take c food to decrease stomach upset
7. Avoid activities c possible increase bleeding

15

Anticoagulant medication

1. Prolongs bleeding time by interfering c clotting
2. Given when pt has a high risk of developing thrombosis

16

Name 3 Anticoagulant medications:

1. Warfarin (Coumadin)
2. Heparin
3. Enoxaparin (Lovenox)

17

Warfarin Action

Interferes c vitamin K
Reduces synthesis of vitamin K

18

Heparin Action

Prevents conversion of prothrombin to thombin & conversion of firbrinogen to fibrin.

19

Warfarin Specific points

1. Atrial fib
2. CHF
3. Valvular disease
4. Pulmonary embolus
5. DVT
6. Take 3-5 days for therapeutic dose
7. Long term Tx use oral
8. Eat balanced meal
9. Monitor c PT= 1.5-2 x baseline=Therapeutic range

20

Heparin specific points

1. Quick onset
2. DIC
3. IV/Subcut
4. Antidote=Protamine sulfate
5. PTT=1.5-2.5 x baseline= therapeutic range

21

Enoxaparin specific points

1. same as Heparin, 1/2 life is longer
2. Subcut
3. Monitor for DVT
4. Monitor for bruising
5. Antidote= Protamine sulfate

22

Anticoagulant Contraindication

1. Active bleeding
2. Head injury
3. Recent injury
4. Advanced liver & renal disease

23

Anticoagulation Rx Interaction

1. Other antiplatelet/antithrombotic med
2. Spinal-epidural anesthesia
3. Foods c vita K
4. Some herbs
5. warfarin
6. Alcohol

24

Anticoagulation Adverse Effects

1. Bleeding
2. Hypersensitivity
3. N/V/D
4. Heparin=HITT

25

Anticoagulation RN Implication/Teaching

1. Know labs associated
2. Appropriate route
3. Have antidote available
4. Teach pt to watch for signs of bleeding
5. Use soft tooth brush
6. Warn pt of effects of alcohol

26

Anticoagulation Assessment

1. Health Hx
2. Assess coagulation studies initially

27

Anticoagulant RN Dx

1. Risk for injury(Bleeding)
2. Activity Intolerance(Contact sports)
3. Ineffective tissue perfusion
4. Impaired tissue integrity
5. Risk for infection
6. Deficient knowledge, related to Rx therapy

28

Anticoagulant Planning

Client goals & expected outcome
1. Reduction in blood coagulation
2. Verbalizes understanding of anticoagulation therapy

29

Anticoagulant Implementation

1. Monitor for adverse clotting reaction & skin necrosis
2. Monitor bleeding values

30

Anticoagulant labs to monitor

1. PT
2. INR
3. PTT
4. CBC

31

Thrombolytics

1. Breaks down/Dissolves existing clots
2. Prevents clots
3. Converts plasminogen to plasmin(breaks down fibrin)
4. Used in some life-threatening situations

32

Name 1 Antithrombolytic

Alteplace

33

Antithrombolytic usage

1. Acute MI
2. Massive PE
3. DVT

34

Antithrombotic Contraindication

1. Active bleeding
2. Recent CVA
3. Severe HTN
4.Recent surgery
5. Pregnancy/postpartum
6. End stage renal/Liver disease

35

Antithrombotics Interaction

1. Anticoagulant
2. Antiplatelet
3. Aminocaproic acid is antidote

36

Antithrombolytic Adverse Effect

1. Hemorrhage
2. Anemia
3. Hypersensitivity

37

Antithrombolytic RN Implication/Teaching

1. Hx
2. Given only IV
3. Monitor for bleeding
4. Monitor for anaphylactic reaction
5. Have antidote ready

38

Antithrombolytic Assessment

1. Hx
2. Vital signs
3. Assess lab vlues