PathoPharm: Exam #2 - Hemo & Blood MEDS

What are examples of antiplatelets?

- aspirin

- clopidogrel

- dipyridamole

- prasugrel

What is the action of antiplatelets?

- stop step #1 (suppress platelet aggregation)

- glycoprotein Ilb/Illa receptor agonists

What are examples of glycoprotein Ilb/Illa receptor agonists?

Abiximab (IV), eptifibates, & tirofiban

Why are antiplatelets used?

- prevent thrombus in arteries

- prevention of MI or stroke

- prevent repeat MI or stroke

- prevention of transient ischemic attacks

What is the reversal of antiplatelets?

platelets

when using antiplatelets you should monitor for ______.

bleeding

What is the action of direct thrombin inhibitors?

- stop step #2

- directly inhibit thrombin from converting fibrinogen to fibrin

- non-K antagonist oral anticoagulants (NOAC’s)

What are examples of direct thrombin inhibitors?

dabigatran, desirudin, bivalirudin, & argatroban

What are the common routes of direct thrombin inhibitors?

- oral

- subcutaneous

- IV

What is the reversal of direct thrombin inhibitors?

Idarucizumab (praxbind) & fresh frozen plasma (FFP)

What are the therapeutic uses of direct thrombin inhibitors?

prevent & treat thromboembolic disorders such as heparin induced thrombocytopenia, venous thromboembolism, & A fib

Antithrombin?

...

What is the action of anticoagulants?

- stops step #2

- activating antithrombin

- inactivating thrombin and Xa

- inhibits fibrin formation

What are examples of anticoagulants?

heparin

What are the uses of heparin?

- evolving stroke & PE

- massive DVT

- low dose therapy after ortho surgery

What are common routes of heparin admin?

subcutaneous or IV

true or false: frequent lab monitoring is needed for heparin

true

What are the side effects of anticoagulants?

- bleeding

- heparin induced thrombocytopenia (HIT)

- low platelets

What is the antidote for anticoagulants?

proamatine sulfate

What are thrombolytics action?

Reverse the clotting process, disintegrate the clot

What are examples of thrombolytics?

Tenecteplase & Alteplase (tPA)

What are side effects/adverse effects of thrombolytics?

- Bleeding & hemorrhage

- Anaphylaxis

- Dysrhythmias

What is the antidote of thrombolytics?

aminocaproic acid (amicar)

What is the action of Low molecular weight heparin (LMWH)?

- STOP STEPS 2&3

- Inhibit thrombin

- Inactivates Xa factor

What are the examples of Low molecular weight heparin (LMWH)?

dalteparin & enoxaparin

What are the uses of Low molecular weight heparin (LMWH)?

- prevent DVT & acute PE after orthopedic or abdominal surgery

- thin blood until therapeutic levels of warfarin obtained

What is the reversal for Low molecular weight heparin (LMWH)?

Andexanet alfa (factor Xa) & protamine sulfate

What is the action of Xa inhibitors?

- STOP STEP #3

- Selectively & reversibly blocking the activity of clotting factor Xa (ten A)

What are examples of Xa inhibitors?

Rivaroxaban, apixaban, & fondaparinux

What are the uses of Xa inhibitors?

- treatment & prevention of DVT and acute PE

- reduce the risk of stroke & embolism in people with nonvalvular atrial fibrillation

What is the administration & monitoring needed for Xa inhibitors?

- oral

- no routine coagulation labs needed

What is the reversal of Xa inhibitors?

Andexanet alfa (factor Xa)

What is the action of vitamin K antagonist?

- STEP #3

- Inhibit hepatic synthesis of vitamin K, thus affecting the clotting factors II, VII, IX, and X

What are examples of vitamin K antagonists?

warfarin

What are the uses of vitamin K antagonists?

- prevent thromboembolic conditions of thrombophlebitis

- prevent PE & embolism formation for patients with a fib or prosthetics

true or false: you should monitor the therapeutic range for vitamin K antagonists

true

What is the reversal for vitamin K antagonists?

- vitamin K for warfarin overdose

- 24 to 48 hours to be effective

- acute bleeding: fresh frozen plasma or whole blood is indicated

What are nursing considerations for anticoagulants?

GI tract is one of the first places to experience bleeding when someone is on a blood thinner because it is highly vascularized (rich in blood vessels)

What should you avoid while taking anticoagulants?

- spicy foods

- acidic foods

- caffeine

- alcohol

What should you encourage to help protect the GI tract?

- Whole grains

- non-acidic fruits & vegetables

- Probiotics: yogurt, fermented foods

Ginger (can thin)

What should you monitor when taking warfarin? Ex?

- vitamin K intake

- beef liver

- DGLV

- soybeans

- spinach

What are foods that may increase bleeding?

- vitamin E

- fish oil

- ginger

- garlic

- ginko bilboa

- dong quia

- feverfew

list herbal supplements that must be considered when caring for clients taking anti clotting medications

.....