U2: Anti-Coagulant Drugs

Question 1

How do anticoagulants function?

Answer 1

Inhibits clog formation and prevents new clots from forming

Question 2

What are the four classes of anticoagulant drugs?

Answer 2

Heparin, warfarin, low molecular weight heparins and factor Xa inhibitors

Question 3

How is heparin dispensed? (What route?)

Answer 3

Sub Q or IV

Question 4

How is warfarin dispensed? (What route?)

Answer 4

Oral

Question 5

Which anticoagulant is used prophylactically to prevent thrombus or to treat acute thrombus, usually in the hospital?

Answer 5

Heparin

Question 6

Which anticoagulant is used for established patients?

Answer 6

Warfarin

Question 7

Which anti-coagulant has a longer half-life?

Answer 7

Warfarin

Question 8

Which anti-coagulant is highly protein bound, which can heighten adverse effects?

Answer 8

Warfarin

Question 9

What are side effects of heparin?

Answer 9

Itching, chills, headache, nosebleeds, vomiting blood, skin redness, hematoma, alopecia, elevated hepatic enzymes, N/V, injection site reaction, priapism

Question 10

What are contraindications for heparin?

Answer 10

Heparin-induced thrombocytopenia, hypersensitivity

Question 11

Patients with which conditions should use caution when taking heparin?

Answer 11

Peptic ulcer, hepatic or renal disease, hemophilia, disseminated intravascular coagulation, diverticulitis, head trauma, asthma, aneurism, endocarditis, thrombocytopenia, pregnancy/breastfeeding, older adults.

Question 12

What are adverse effects of heparin?

Answer 12

Bleeding, intracranial bleeding, ocular hemorrhage, anemia, bone fracture, osteoporosis, hyperkalemia, vitamin d deficiency, GI bleeding, stroke, hyperlipidemia, thrombocytopenia, heparin-induced thrombocytopenia, anaphylaxis

Question 13

Which drugs interact poorly with heparin?

Answer 13

Increased effect: Aspirin, NSAIDs, thrombolytics, probenecid, antibiotics, SSRI
Decreased effect: nitroglycerin, protamine sulfate (antidote)

Question 14

Which lab monitors the effect of heparin and what is the normal range?

Answer 14

PTT (Partial thromboplastin time). 60-70 seconds

Question 15

What is the antidote for heparin?

Answer 15

Protamine sulfate

Question 16

What are the side effects of warfarin?

Answer 16

Headache, alopecia, fever, weakness, priapism, petechiae, ecchymosis (discoloration of the skin)

Question 17

What are adverse effects of warfarin?

Answer 17

Purple toe syndrome, bone fracture, hypotension, angina, hematuria, ocular hemorrhage, intracranial / vaginal / GI bleeding and hemorrhage.

Question 18

What are contraindications for warfarin?

Answer 18

Pregnancy, hematologic disorders, eclampsia, alcohol abuse, stroke, bleeding, head trauma, aneurism

Question 19

Patients with which conditions should use caution when taking warfarin?

Answer 19

Type 2 diabetes (DM), leukemia, anemia, thyroid disease, hepatic and renal impairment, peptic ulcer, atrial fibrillation, heart failure, cerebrovascular disease, breastfeeding

Question 20

What are drug interactions of warfarin?

Answer 20

Increased effects: aspirin, NSAIDs, sulfonamides, thyroid drugs, allopurinol, histamine 2 blockers, oral hypoglycemics, metronidazole, miconazole, methyldopa, diuretics, oral antibiotics, vitamin E

Decreased effects: Barbituates, laxatives, phenytoin, estrogen, vitamin C, vitamin K, oral contraceptives, rifampin

Question 21

Would a smoker get an increased or decreased dose of warfarin?

Answer 21

Increased

Question 22

Which lab monitors the effect of warfarin and what is the normal range?

Answer 22

INR (International Normalized Ratio)
Normal: 1.3 - 2
With anticoagulant: 2-3
With prosthetic heart valves: up to 3.5

Question 23

What is the antidote for warfarin?

Answer 23

Vitamin K (Dietary restriction on leafy greens, etc.)

Question 24

What are the names of low molecular weight heparins?

Answer 24

Enoxaparin (Lovenox) and Dalteparin (Fragmin)

Question 25

Low molecular weight heparins are give via what route?

Answer 25

Sub Q

Question 26

What should you observe for in patients using low molecular weight heparins or Factor Xa inhibitors?

Answer 26

Petechiae, bruising, tarry stools and other signs of bleeding

Question 27

What are contraindications for low molecular weight heparins?

Answer 27

Stroke, peptic ulcers, brain / spinal surgeries

Question 28

What medications should be avoided with low molecular weight heparins?

Answer 28

Aspirin and other NSAIDs

Question 29

Why are low molecular weight heparins or Factor Xa Inhibitors preferable?

Answer 29

Less monitoring than warfarin or heparin, produces more stable results with less bleeding risk

Question 30

What education should you provide for patients using low molecular weight heparins or Factor Xa Inhibitors?

Answer 30

Look for signs of bleeding and use a soft bristle toothbrush

Question 31

What are the names of Factor Xa Inhibitors?

Answer 31

Rivaroxaban (Xarelto) and Apixaban (Eliquis)

Question 32

What is the antidote for Factor Xa inhibitors?

Answer 32

Andexanet Alfa

Question 33

Factor Xa Inhibitors are given via what route?

Answer 33

Oral

Question 34

Should you continue/discontinue Factor Xa Inhibitors for surgery?

Answer 34

Discontinue 1-2 days prior

Question 35

What is the weight limit for Factor Xa Inhibitors?

Answer 35

less than 50 kg