Pharmacology Exam #2 > Coagulation Modifiers > Flashcards

Coagulation Modifiers Flashcards

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1
Q

What are the steps in the
Blood Vessel Injury Healing Process?

Blood coagulation/clotting process

A
  • Local vasoconstriction to seal off small injury (makes surface area of injury smaller)
  • Platelet aggregation forms a platelet plug
  • Hageman factor is activated (clotting factor)
  • Intrinsic pathway (inside the vessel) converts prothrombin to thrombin to seal system
  • Extrinsic pathway (outside the vessel) clots the blood that has leaked out of the vascular system
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2
Q

Lifespan Considerations for Coagulation Modifiers
In Children

A
  • Most common: Antihemophiliac agents for children with hemophilia
  • Injury and safety precautions: no contact sports, soft toothbrushes, no flossing
  • Teach what to do if bleeding begins: constant firm pressure, call provider
  • Drugs are based on weight and age
  • Low-molecular weight heparins preferred
  • Monitor closely
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3
Q

Lifespan Considerations for Coagulation Modifiers
In Adults

A
  • Injury prevention: soft bristled toothbrush, no flossing, electric razor, no contact sports
  • What to do if bleeding begins: constant firm pressure, call provider
  • Caution with other meds due to interactions
  • Medic Alert bracelet
  • Extreme caution in pregnancy and lactation; choose alternate feeding method
  • Periodic blood tests (less testing with newer meds)
  • Monitor for signs of bleeding
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4
Q

Lifespan Considerations for Coagulation Modifiers
In Older Adults

A
  • Look closely for drug interactions
  • Impaired liver and kidney function: run liver and kidney function tests
  • Start low, go slow
  • Safety and Injury Prevention: Fall prevention, electric razors, soft toothbrush, no flossing
  • Careful monitoring with additions, deletions, or changes to medication regimen (including dose changes)
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5
Q

Antiplatelet Agents
Mechanism of Action

A

Alters the formation of the platelet plug
* Blocks the receptor site on the platelet membrane which prevents platelets from sticking together and clumping (aggregating)

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6
Q

Antiplatelet Agents
Indications

A
  • CV diseases that are prone to clogged vessels
  • Keep surgical grafts open/patent
  • Prevent cerebrovascular occlusion (strokes and TIAs)
  • Adjunct to thrombolytic therapy after MI and to prevent another MI
  • Aspirin: Antiinflammatory, antipyretic, analgesic
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7
Q

Antiplatelet Agents
Drug Names

A

Aspirin
Clopidogrel
Ticagrelor

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8
Q

Antiplatelet Agents
Contraindications

A

Absolute:
* Allergy

Cautions:
* Bleeding disorder (higher risk of bleeding)
* Recent surgery
* Closed-head injury

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9
Q

Antiplatelet Agents
Adverse Effects

A

🩸 BLEEDING: major effect! Monitor for black stools, bruising, petechiae, epistaxis
🧠 CNS: Headache, dizziness, weakness
🤢 GI: Nausea

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10
Q

Antiplatelet Agents
Drug Interactions

A
  • Another drug that affects blood clotting
  • Herbal supplements
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11
Q

Antiplatelet Agents
Assessment

A

History:
* Allergy, pregnancy, lactation, bleeding disorders, recent surgery, closed head injury

Physical:
* vitals, skin, CNS, perfusion

Labs:
* CBC
* Clotting studies

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12
Q

Antiplatelet Agents
Nursing Diagnoses/Conclusions

A
  • Injury Risk (r/t CNS and bleeding effects)
  • Impaired comfort (r/t GI effects)
  • Knowledge deficit
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13
Q

Antiplatelet Agents
Implementation/Patient Teaching

A
  • Safety precautions: electric razors, soft toothbrush, no flossing, no contact sports
  • Small, frequent meals for GI effects
  • Increased precautions for bleeding during invasive procedures
  • Mark the chart of any patient receiving this drug
  • Ice and pressure can help stop bleeding
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14
Q

Anticoagulant Agents
Mechanism of Action

A
  • Interferes with the normal cascade of events involved in the clotting process
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15
Q

Anticoagulant Agents
Indications

A

Prevent new clot formation
* Atrial fibrilation
* Bed Bound
* Certain surgical patients

Prevent existing clots from getting bigger
* Deep vein thrombosis (DVT)
* Pulmonary Embolism (PE)
* Myocardial Infarction (MI)

Genetic disorders
(missing part of the clotting cascade)

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16
Q

Anticoagulant Agents
Drug Names

A

Warfarin
Heparin
“-xaban”
Rivaroxaban
Apixaban
Dabigatran

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17
Q

Anticoagulant Agents
Contraindications

A

Absolute:
* Allergy

Relative:
* conditions that would be worsened if bleeding occurs (recent trauma, GI ulcers, spinal puncture)

Cautions:
* Renal & hepatic disorders

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18
Q

Anticoagulant Agents
Adverse Effects

A

🩸 Excessive bleeding
* priapism
* Increased menstrual flow
* Black tarry stools
* Epistaxis

Heparin-induced thrombocytopenia (HIT): “allergy” to heparin - can never have heparin again

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19
Q

Anticoagulant Agents
Drug Interactions

A

Any drug that affects bleeding
* NSAIDs/Salicylates
* Antiplatelets
* Thrombolytics

Herbal Supplements (can increase bleeding)

NUMBER of many drug interactions Check drug guide

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20
Q

Anticoagulant Agents
Assessment

A

History:
* Allergy, pregnancy, lactation
* Conditions that would be worsened if bleeding occurs

Physical:
* Vitals, heart sounds, lung sounds, skin, CNS, orientation, perfusion

Labs:
* CBC (Hgb, Hct)
* Clotting studies
* Renal and hepatic function tests
* guaiac test for blood in stool

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21
Q

Anticoagulant Agents
Nursing Diagnoses/Conclusions

A
  • Injury risk (r/t bleeding)
  • Altered tissue perfusion (r/t blood loss)
  • Altered cardiac output (r/t blood loss)
  • Disturbed body image (r/t skin changes… bruising)
  • Knowledge deficit
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22
Q

Anticoagulant Agents
Implementation/Patient Teaching

A
  • Check lab values during treatment
  • Monitor for signs of blood loss (epistaxis, petechiae, neuro status for brain bleed)
  • Establish safety precautions: electric razor, soft toothbrush, no contact sports
  • Increase bleeding precautions during invasive procedures
  • Mark chart of patient receiving this drug
  • Maintain antidotes on standby:
    Warfarin: Vitamin K
    Heparin: Protamine sulfate
  • Monitor patient carefully when change in medication
  • Ice, pressure for bleeding
  • Wear medic alert bracelet
  • Keep follow up appts.
  • Teach patient to report bleeding to provider
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23
Q

Therapeutic value to watch with Warfarin

Study These Flashcards
A

INR: 2-3
(higher than a normal value because of treatment)

24
Q

Therapeutic values to watch with Heparin

Study These Flashcards
A
  • aPTT 60-80
  • anti-Xa (anti-10A)
25
**Low-Molecular-Weight Heparins (LMWH)** Mechanism of action
* Inhibit thrombus and clot formation by **blocking factors Xa and IIa** (10a and 2a) * *Do NOT greatly affect thrombin, clotting, or prothrombin times* = fewer systemic adverse effects * **Block angiogenesis**, the process that allows cancer cells to develop new blood vessels *Longer half-life than other anticoagulants = longer lasting effects*
26
**Low-Molecular-Weight Heparins (LMWH)** Indications
* Specific uses in the prevention of clots and emboli formation after certain surgeries or while on bed rest
27
**Low-Molecular-Weight Heparins (LMWH)** Drug Names
**Dalteparin** **Enoxaparin**
28
**Thrombolytic Agents (AKA: Clot Busters)** Mechanism of Action
**Activates plasminogen to plasmin**, which in turn **breaks down fibrin threads** in a clot to dissolve it
29
**Thrombolytic Agents (AKA: Clot Busters)** Indications
* Acute MI * Pulmonary emboli * Ischemic stroke
30
**Thrombolytic Agents (AKA: Clot Busters)** Drug Names
**"-teplase"** Alteplase Reteplase Tenecteplase
31
**Thrombolytic Agents (AKA: Clot Busters)** Contraindications
**Absolute:** * Allergy **Cautions:** * Any condition worsened by dissolution of clots *(recent surgery, trauma, recent stroke, GI bleed, recent childbirth)* * Liver disease
32
**Thrombolytic Agents (AKA: Clot Busters)** Adverse Effects
🩸 **Bleeding**
33
**Thrombolytic Agents (AKA: Clot Busters)** Drug Interactions
* Anticoagulants * Antiplatelets *(increased bleeding)*
34
**Thrombolytic Agents (AKA: Clot Busters)** Assessment
**History:** * Allergy, pregnancy, lactation * Conditions that would be worsened if bleeding occurs **Physical:** * Baseline: vitals, heart sounds, lung sounds, skin, CNS, perfusion **Labs:** * clotting studies * Renal and hepatic function tests * CBC * guaiac stool test
35
**Thrombolytic Agents (AKA: Clot Busters)** Implementation/Patient Teaching
* Discontinue heparin if it is being given before administering a thrombolytic agent * Check lab values * Monitor for signs of blood loss *(epistaxis, blood in stool, petechiae, surgical sites, IV sites)* * Institute treatment within 6 hours after onset of symptoms of acute MI * Arrange to type and cross-match blood to have on hand * Monitor cardiac rhythm continuously if the drug is being given for acute MI * Increase bleeding precautions during invasive procedures * Mark chart if patient is receiving this drug * Ideally wait 24 hours after thrombolytic admin to do any type of invasive procedure
36
**Hemorrheologic Agent: Pentoxifylline** Mechanism of Action
* Xanthine that decreases platelet aggregation and decreases fibrinogen concentration in the blood ***Helps blood flow in compromised blood vessels***
37
**Hemorrheologic Agent: Pentoxifylline** Indication
Intermittent claudication
38
**Hemorrheologic Agent: Pentoxifylline** Adverse Effects
💓 **Many CV stimulatory effects** * racing heart/palpitations * anxiety * flushing * angina
39
What are bleeding disorders treated with Clotting Factors?
* Hemophilia * Liver Disease * Bone Marrow Disorders
40
**Antihemophilics** Mechanism of Action
* Replace clotting factors that are either genetically missing or low in a particular type of hemophilia
41
**Antihemophilics** Indications
* Prevent blood loss from injury or surgery and to treat bleeding disorders
42
**Antihemophilics** Drug Names
**"factor"** All medications in this category have the word factor in their name
43
**Antihemophilics** Contraindications
**Absolute:** * Anaphylactic Allergy
44
**Antihemophilics** Adverse Effects
**Involve risks associated with the use of blood products** * Infections such as hepatitis * Headache, flushing, fever, chills, lethargy * Stinging, itching, burning at the site of injection
45
**Antihemophilics** Assessment
**History:** * Allergy, pregnancy, lactation **Physical:** * Skin, heart and lung sounds, CNS, perfusion, vital signs **Labs:** * clotting studies
46
**Antihemophilics** Nursing Diagnoses/Conclusions
* Altered tissue perfusion *(r/t changes in coagulation)* * Impaired comfort *(r/t CNS, skin, or injection site)* * Anxiety or fear * Knowledge deficit
47
**Antihemophilics** Implementation/Patient Teaching
* Ensure the appropriate clotting factor is being used for the patient * Administered by IV route ONLY * Check lab values *(clotting studies)* * Monitor pt for any sign of thrombosis *(clots)* * Decrease infusion rate if headache, chills, fever, or tingling occurs * Arrange to type and cross-match blood and have onhand * Mark the chart of any patient receiving this drug
48
**Hemostatic Agents** Mechanism of Action
**Systemic** Prevent systemic clot breakdown to prevent blood loss **Topical** For surface injuries involving so much damage to the small vessels in the area that clotting does not occur and blood is slowly and continually lost
49
**Hemostatic Agents** Indication
Hyperfibrinolysis = hyper clot breakdown
50
**Hemostatic Agents** Drug Names
**Systemic** Aminocaproic Acid *(oral or IV)* **Topical** Absorbable gelatin collagen fibrin thrombin *(sponges, sprays, topical)*
51
**Hemostatic Agents** Contraindications
**Absolute:** Systemic: * Allergy * Acute disseminated intravascular coagulation (DIC) = *clotting and bleeding at the same time* Topical: * Allergy **Cautions:** Systemic: * Cardiac, renal, or hepatic disease Topical: * NONE
52
**Hemostatic Agents** Adverse Effects
**Systemic** * Excessive clotting, CNS, GI, weakness, fatigue, malaise, muscle pain **Topical** * Infection with sponges
53
**Hemostatic Agents** Drug Interactions
**Systemic:** * Heparin, oral contraceptives/estrogen **Topical:** * NONE
54
**Hemostatic Agents** Assessment
**History:** * Allergy, pregnancy, lactation, cardiac, renal or hepatic dysfunction **Physical:** * skin, heart and lung sounds, CNS, perfusion, abdominal assessment, vital signs **Labs:** * clotting studies, renal function tests, hepatic function tests
55
**Hemostatic Agents** Nursing Diagnoses/Conclusions
* Altered sensory perception *(r/t CNS effects)* * Impaired Comfort *(r/t GI, CNS, muscle effects)* * Injury Risk *(r/t CNS, blood clotting)* * Knowledge deficit
56
**Antidote** for **Warfarin**
**Vitamin K**
57
**Antidote** for **He🅿️arin**
**🅿️rotamine sulfate**
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