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Pharm > Perfusion Part 2 > Flashcards

Perfusion Part 2 Flashcards

1
Q

4 types of anticoagulants

A

Heparins

Vitamin K antagonists

DTIs

Direct factor Xa inhibitors

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2
Q

MOA of heparin

A

Combines with natural anticoagulant to inactivate clotting factors and prevent thrombus formation

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3
Q

Heparin uses

A

Prophylaxis: DVT/PE
Therapeutic: treatment of acute thromboembolic disorders
Prevention of clotting during surgery, ECMO, dialysis, blood transfusions

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4
Q

Considerations for heparin

A

Children: dosed by weight- high alert medication: 2 RN check

Pregnancy: anticoagulation of choice in pregnancy/lactation

Older adults: commonly on anticoagulation- more prone to bleeding


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5
Q

Adverse effects of heparin

A

Heparin induced thrombocytopenia



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6
Q

Heparin contraindications

A

G.I. Ulcers

Intracranial bleeding

Severe Renal/hepatic impairment/hypertension

Recent surgery

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7
Q

Heparin assessment

A

Bleeding, unusual bruising, heparin induced thrombocytopenia (platelets drop significantly)

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8
Q

Heparin monitoring

A

Study to regulate heparin dosing: PTT’s and antifactor 10A levels

CBC with platelet count

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9
Q

What do you do if somebody has heparin induced thrombocytopenia

A

Stop the heparin and look at HIIT studies 

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10
Q

Heparin teaching

A

Risk of bleeding risk: injury prevention

Routine lab testing

Signs and symptoms of bleeding 

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11
Q

Protamine sulfate drug class

A

Reversal agent for standard heparin and LMWH

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12
Q

Protamine sulfate uses

A

Reversal of heparin and low molecular weight heparins (LMWH)

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13
Q

Adverse effects of protamine sulfate

A

Given IV over 10 minutes to avoid- Dyspnea, hypotension, bradycardia, and anaphylaxis

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14
Q

Protamine sulfate black box warning

A

Black box warning: risk of severe hypotension, cardiovascular collapse, pulmonary edema, pulmonary vasoconstriction, and pulmonary hypertension

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15
Q

Contraindications for protamine sulfate

A

Hypersensitivity or fish allergy

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16
Q

Protamine sulfate assessment

A

Bleeding stopping

HR, BP, RR, sats

Pulmonary edema 

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17
Q

Warfarin drug class

A

Vitamin K antagonist (anticoagulant)

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18
Q

Warfarin MOA

A

Prevents synthesis of vitamin k dependent clotting factors

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19
Q

Warfarin uses

A

Long-term prevention/management of DVT and PE

Clot prevention in a-fib and prosthetic heart valves

Post MI to decrease risk of another MI, stroke, DVT, and death

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20
Q

Warfarin special population considerations

A

Children: used after cardiac surgery, close monitoring of levels and safety precautions

Older adults: lower dose usually due to drug metabolism, caution in liver impairment: hepatic metabolism

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21
Q

Adverse effects of warfarin

A

Hemorrhage

Black box warning: fatal bleeding

N/v, abdominal pain, alopecia, urticaria, dizziness, joint/muscle pain

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22
Q

Warfarin contraindications

A

G.I. ulcers, bleeding disorder, severe kidney/liver disease, severe hypertension, recent surgery, and pregnancy 

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23
Q

Warfarin assessment

A

PT INR’S- check every couple of weeks even at home

Long term- where bleeding can happen- unusual bruising, bleeding gums, blood in urine/stool

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24
Q

Warfarin education

A

PT/INR tests as ordered

Avoid injections when possible, avoid contact sports, use electric razor

Signs and symptoms of bleeding- unusual bruising, bleeding gums, blood in urine/stool

Avoid foods high in vitamin K (will decrease effect of warfarin)- broccoli, Brussels sprouts, cabbage, cauliflower, green leafy veggies, tomatoes, turnips

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25
Q

Vitamin K class

A

Reversal agent for warfarin

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26
Q

Vitamin k MOA

A

Synthesis of vitamin K dependent clotting factors

27
Q

Vitamin k use

A

Antidote for warfarin overdose

28
Q

Vitamin k considerations/monitoring

A

K centra is reversal med

Give with INR levels too high or for bleeding

29
Q

Rivaroxaban drug class

A

Direct factor Xa inhibitor (anticoagulant)

30
Q

MOA of Rivaroxaban

A

Inhibits platelet activation and Formation of fibrin clotting by inhibition of factor Xa

31
Q

Rivaroxaban uses

A

Treatment/prevention of venous thromboembolism
Stroke prevention in patient with a-fib 

32
Q

Special population consideration for Rivaroxaban

A

Older adults: caution in Renal/hepatic impairment

33
Q

Adverse effects of Rivaroxaban

A

Bleeding- intracranial, gastric and retinal

Anaphylaxis, Angioedema, Stevens-Johnson syndrome

34
Q

Rivaroxaban contraindications

A

Pregnancy and hypersensitivity

35
Q

Rivaroxaban assessment/monitoring

A

Improvement in DVT

No bleeding, clots?

Angioedema, anaphylaxis, stevens- Johnson syndrome (terrible skin reaction)

Don’t need to check levels

36
Q

Rivaroxaban teaching

A

Report bleeding or bruising to Dr.

Stop before surgery or invasive procedures

Immediately inform Dr. of pregnancy

37
Q

Clopidogrel drug class

A

Anti platelet drugs: Adenosine diphosphate receptor agonist

38
Q

Clopidogrel MOA

A

Irreversibly blocks adenosine diphosphate (ADP) on the platelet cell surface

Lasts for lifespan of platelets (7-10 days)

39
Q

Clopidogrel uses

A

Reduction of MI, stroke, vascular death in patients with atherosclerosis or after placement of coronary stents

A-fib patients who are unable to take warfarin

Antiplatelet drug for those who cannot tolerate aspirin

40
Q

Special populations considerations for clopidogrel

A

Older adults: higher likelihood of bleeding- used for thrombotic stroke prevention but increases the risk of hemorrhagic stroke

41
Q

Adverse effects of clopidogrel

A

Pruritis, rash purpura, diarrhea

Rare: thrombotic thrombocytopenia, hemorrhage, severe neutropenia

42
Q

Clopidogrel contraindications

A

Hypersensitivity and active bleeding

43
Q

Clopidogrel assessment/monitoring

A

Skin reactions, diarrhea, improvement/absence of vascular ischemic events

Monitor: CBC (for thrombocytopenia, neutropenia 

44
Q

Clopidogrel teaching

A

Take once daily
Risk of bleeding
Safety precautions to prevent injury
May need to take aspirin with this
Hold med 5-7 days before surgery

Report excessive bleeding, bruising, fever, chills, sore throat

45
Q

Aspirin drug class

A

Antiplatelet drugs: Salicylates 

46
Q

Aspirin MOA

A

Inhibits platelet aggregation- Lasts for the life of the platelet

47
Q

Aspirin uses

A

Reduce risk of TIAs and cerebrovascular accidents

Decrease risk of death from MI

48
Q

Adverse effects of aspirin

A

G.I. bleeding

Aspirin toxicity

Nausea, heartburn, dyspepsia

Renal/respiratory failure in high doses

Bruising/Petechiae

49
Q

Contraindications for aspirin

A

Known sensitivity and at risk for bleeding

50
Q

Aspirin assessment

A

Signs of bleeding/bruising, pain, fever
No GI irritation
Resp/skin check for reaction
Cross sensitivity with ibuprofen and aspirin



51
Q

Aspirin monitoring

A

Toxicity
Bleeding/signs of bleeding
Skin reaction

52
Q

Signs of aspirin toxicity

A

Nausea/vomiting
fever, fluid/electrolyte deficiencies
visual changes, drowsiness
hyperventilation
delirium, coma, and seizures

53
Q

Aspirin overdose treatment (mild toxicity)

A

Stop treatment and symptoms improve

54
Q

Severe aspirin toxicity treatment

A

Treat symptoms

Correct fluid, electrolyte, acid-base imbalances

Prevent further absorption in GI tract with activated charcoal/lavage

Alkalinize urine with IVF containing sodium bicarbonate to rapidly excrete salicylates

Hemodialysis if necessary 

55
Q

Aspirin teaching

A

Avoid alcohol, take with food to prevent G.I. irritation

Report bruising or bleeding

May require direct pressure to superficial bleeding 3 to 5 minutes or longer to stop bleeding

Avoid taking two weeks before or after major surgery or dental procedures

If pregnant stop two weeks before estimated due date

keep out of reach of children

56
Q

Alteplase drug class

A

Thrombolytic drugs

57
Q

Alteplase MOA 

A

lyses unwanted fibrin clots

58
Q

Alteplase uses

A

Acute MI

massive pulmonary embolism

Ischemic stroke- within three hours of onset

Restore function of occluded venous catheters

59
Q

Alteplase special populations

A

Children: venous catheter clearance

Older adults- not recommended for pts over 80

60
Q

Alteplase adverse effects

A

Bleeding

Brain hemorrhage- 3% mortality rate, 6-8% risk of symptomatic brain hemorrhage

61
Q

Alteplase contraindications

A

Uncontrolled hypertension, aneurysm, AVM

Known coagulopathy, internal bleeding, intracranial or intraspinal surgery/trauma within three months, intracranial mass, recent surgery, oral anticoagulant use

62
Q

Where is Alteplase given (setting)

A

ICU or ED

63
Q

Alteplase assessment/monitoring

A

Stroke- back to normal mentation, bleeding

Cardiac- back to baseline rhythm, stable

Labs: coags (PTT, INR, platelets)

BP & HR

64
Q

Alteplase teaching

A

Informed consent regarding purpose of drug

Discharge teaching to emphasize management of underlying disease (MI or stroke)

Pharm (9 decks)

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