Chapter 55 Flashcards by Fatima Avila

HEMOSTASIS
-What is the purpose of this?

To stop bleeding

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HEMOSTASIS
-What is Stage 1?
-What occurs?

-Formation of a platelet plug
-The platelets stick together (platelet aggregation)

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HEMOSTASIS
-What is Stage 2?

-Coagulation –> fibrin is produced to reinforce the clot

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OVERVIEW OF DRUGS
-What are the 3 drug classes?

Anticoagulants
Antiplatelets
Thrombolytics

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OVERVIEW OF DRUGS
-What do anticoagulants do?
-Example?

-They disrupt the coagulation cascade (stage 2) –> they suppress fibrin production
-Heparin & warfarin

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OVERVIEW OF DRUGS
-What do antiplatelets do?
-Example?

-Inhibit platelet aggregation (Stage 1) –> platelets DO NOT stick together
-Aspirin

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OVERVIEW OF DRUGS
-What do thrombolytics do?
-Examples?

-Promote fibrin lysis, causing dissolution of thrombi (break up the existing clot)
-Alteplase, tPA

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HEPARIN
-What is the drug class?
-Is this fractionated or unfractionated?

-anticoagulantd
-Unfractionate

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HEPARIN: Therapeutic Use
-When do you use heparin?
-Examples? (6)

-In emergency situations, wehn RAPID coagulation is needed
1. PE
2. Massive DVT
3. open heart surgery
4. Renal dialysis
5. Low-dose therapy postop
6. DIC

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HEPARIN: Therapeutic Use
-This is used as an adjunct to what?

Thrombolytic therapy

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HEPARIN: Mechanism of Action
-What does heparin enhance?
-What does this do?

-antithrombin
-It BLOCKS thrombin & Factor 10a (Xa)

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HEPARIN: Mechanism of Action
-Does heparin break up existing clots?

NO; it suppresses coagulation to PREVENT the formation new blood clots

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HEPARIN: Pharmokinetics
-What is the route?

SubQ or IV (high alert when IV!!)

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HEPARIN: Pharmokinetics
-During the initial phase of treatment, what will you be checking?
-How often?

-Activated partial thromboplastin time (aPTT)/PTT
-Every 6 hours; adjust infusion rate accordingly

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HEPARIN: Pharmokinetics
-Can this be used during pregnancy?

YES! –> it does NOT cross the placenta

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HEPARIN: Adverse Effects
-What are the 2 adverse effects?

Hemorrhage (excessive bleeding)
Heparin-induced thrombocytopenia (HIT)

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HEPARIN: Adverse Effects
-In terms of hemorrhage, what will you be looking for/monitoring?? (2)

S/S of bleeding –> HYPOtension
Montior PTT levels

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HEPARIN: Adverse Effects
-What is HIT?
-Notify provider if ______ are low

-Fatal immune-mediated disorder from the administration of heparin
-platelets

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HEPARIN: CONTRAINDICATIONS
-Who should you NEVER use this in? (3)

Someone who is actively bleeding
Someone with thrombocytopenia (low platelet count)
Surgery with a high risk of hemorrhage (brain or spinal cord injury)

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HEPARIN
-What is the antidote for overdose of heparin?

Protamine sulfate

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ENOXAPRIN (LOVENOX)
-What is the drug class?

Low-molecular weight heparin (LMWH)

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ENOXAPRIN (LOVENOX)
-How are these medications in comparison to unfractionated heparin?
-Why?

-They are easier
-They have a fixed dosage in adults & do NOT require constant aPTT monitoring

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ENOXAPRIN (LOVENOX)
-What is this used for? (3)

Prevention of DVT after surgery
Treatment of established DVT
Prevention of ischemic complications

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ENOXAPRIN (LOVENOX)
-This is (harder/easier) to use in outpatient settings than unfractionated heparin

Easier

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**ENOXAPRIN (LOVENOX)**: *Mechanism of Action* -It enhances _____ -It inhibits _____, meaning ???

-antithrombin III -factor Xa --> stops clot formation

**ENOXAPRIN (LOVENOX)**: *Pharmacokinetics* -What is the route? -Is it well absorbed PO?

-SubQ -No

**ENOXAPRIN (LOVENOX)**: *Adverse Effects* -What are the two adverse effects?

1. Bleeding (less than unfractionated heparin) 2. HIT (less common)

**ENOXAPRIN (LOVENOX)**: *Drug Interactions* -What can this cause in patients undergoing a spinal puncture or spinal epidural anesthesia?

Severe neurologic injury --> AVOID

**WARFARIN** -Drug class? -Examples?

-Oral anticoagulant -Coumadin, Jantoven

**WARFARIN** -Warfarin is a ______ antagonist

Vitamin K

**WARFARIN** -What is the difference between warfarin & heparin?

-**Warfarin** has a *delayed onset* & is taken PO -**Heparin** has a *rapid* onset & is an injection

**WARFARIN**: *Therapeutic Uses* -What are 2 uses?

1. Long-term prophylaxis of thrombosis 2. Treatment/prevention of DVT/PE

**WARFARIN**: *Therapeutic Uses* -What are the 3 types of thrombosis that this is used to prevent?

1. Venous thrombosis associated with PE 2. Thromboembolism in pts with prosthetic heart valves 3. Thrombosis during atrial fibrillation

**WARFARIN**: *Mechanism of Action* -What does it inhibit? -What does it block?

-Vitamin K epoxide reductase -production of factors VII, IX, & X and prothrombin

**WARFARIN**: *Monitoring Treatment* -What two lab values will you monitor during administration?

Prothrombin time (PT) & international normalized ration (INR)

**WARFARIN**: *Monitoring Treatment* -What is PT?

How long it takes for blood to clot

**WARFARIN**: *Monitoring Treatment* -What is INR normal range? -It is most commonly used to monitor _____ -HIGHER INR = ?

-2-3.5 -Coumadin -Risk for bleeding

**WARFARIN**: *Monitoring Treatment* -Because the INR range in so small, what do you need?

A specific dose to maintain that range

**WARFARIN**: *Adverse Effects* -What is the main adverse effect? -What should you ask the patient?

-Hemorrhage -If they are bleeding at any site --> nose, gums, pee, or poop

**WARFARIN**: *Adverse Effects* -What is the antidote for bleeding?

Vitamin K

**WARFARIN**: *Adverse Effects* -Can this be used during pregnancy? -Why? -What can you use instead?

-NO; it crosses the placenta & can cause fetal hemorrhage & teratogenesis -Heparin

**WARFARIN**: *Adverse Effects* -Can this be used during lactation?

Yes

**WARFARIN**: *Drug Interactions* -What 5 drugs does this interact with?

1. Drugs that increase or decrease anticoagulant effects 2. Drugs that promote bleeding 3. Heparin 4. Aspirin 5. Acetaminophen

**WARFARIN** -What is the antidote for warfarin overdose?

Vitamin K

**WARFARIN** -What are dietary foods that contain Vitamin K? -What is important to keep in mind?

-Mayonnaise, canola oil, soybean oil, & green leafy vegetables -Keep this consumption consistent so you don't mess with INR levels

**DABIGATRAN ETEXILATE** -What is the brand name?

Pradaxa

**DABIGATRAN ETEXILATE** -What is the drug class?

Direct thrombin inhibitor

**DABIGATRAN ETEXILATE** -How is it compared to warfarin?

It is similar, BUT it has a **RAPID** onset & doesn't require frequent monitoring

**DABIGATRAN ETEXILATE** -What are the benefits of this? (3)

1. Lower risk of major bleeding (can cause GI bleeds) 2. Lower risk of adverse effects 3. Same dose for ALL patients!

**DABIGATRAN ETEXILATE** -In what two situations is this used in?

1. Atrial fibrillation (stroke prevention) 2. Treatment of DVT & PE after knee or hip surgery

**DABIGATRAN ETEXILATE**: *Mechanism of Action* -Direct inhibition of ______ -Prevents....

-thrombin (factor 10A) -formation of fibrin & conversion to fibrinogen

**DABIGATRAN ETEXILATE**: *Adverse Effects* -What are the 3?

1. Bleeding (hemorrhage) 2. GI disturbances 3. Anemia (due to blood loss)

**DABIGATRAN ETEXILATE**: *Adverse Effects* -What are the GI disturbances?

GI bleeds, ulcers, gastritis, stomach upset

**DABIGATRAN ETEXILATE** -Pradaxa should be stopped before _____ -Why?

-surgery -Due to bleeding risk!!!

**DABIGATRAN ETEXILATE** -Is there a specific antidote to reverse dabigatran etexilate bleeding?

**ASPIRIN (ASA)** -What is the drug class?

Antiplatelet --> it stops platelets from sticking

**ASPIRIN (ASA)**: *Therapeutic Use* -What are the 5 uses of ASA?

1. Ischemic stroke 2. Transient ischemic attack (TIA) 3. Chronic stable angina OR unstable angina 4. Coronary stenting 5. Primary prevention of MI --> acute MI or previous MI

**ASPIRIN (ASA)**: *Mechanism of Action* -What does it inhibit? -What does this do? -What is the end result?

-Cyclooxygenase (COX) -stops platelets from making thromboxine, so the platelets CANNOT stick together -prevents clot formation

**ASPIRIN (ASA)**: *Pharmacokinetics* -What is the route?

**ASPIRIN (ASA)**: *Adverse Effects* -What are the 3?

1. Bleeding, even in low doses 2. GI bleeding 3. Hemorrhagic stroke

**ASPIRIN (ASA)**: *Adverse Effects* -Enteric-coated tablets always reduce the risk of GI bleeding (T/F)

FALSE; they MAY not reduce it

**ALTEPLASE (tPA)** -What is the drug class? -What does it function as?

-Thrombolytic drug -tissue plasminogen activator (tPA)

**ALTEPLASE (tPA)**: *Therapeutic Uses* -What are the uses of this? MIMP

1. MI 2. Ischemic stroke 3. Massive PE 4. Pts with indwelling catheters --> PICC lines, central venous catheters

**ALTEPLASE (tPA)**: *Mechanism of Action* -What does this function as? -What does it do?

-Clot buster -Breaks blood clot by converting plasminogen into plasmin & dissolving the fibrin network of existing clots

**ALTEPLASE (tPA)**: *Pharmacokinetics* -What is the route?

IV ONLY

**ALTEPLASE (tPA)**: *Pharmacokinetics* -Describe absorption & distribution -How is it excreted?

-Rapid -in urine

**ALTEPLASE (tPA)**: *Adverse Effect* -What is the primary one?

Bleeding

Chapter 55 Flashcards

Anticoagulant, Antiplatelet, and Thrombolytic Drugs (67 cards)