Anticoagulants

Front 1

What is Venous thrombi?

Back 1

begin with formation of fibrin, which enmeshes platelets & RBCs - Anticoagulants

Front 2

What is Arterial thrombi?

Back 2

begin with formation of platelet plug which is reinforced with fibrin Antiplatelet

Front 3

What are Anticoagulants?

Back 3

Anticoagulants are drugs that interfere with the clotting cascade and prolong clotting time. They do not dissolve or break up existing clots & they are not “blood thinners;” they prevent venous clots from forming or enlarging

Front 4

What effects do these drugs have?

Back 4

Prevent venous thrombi formation or prevent existing thrombi from enlarging

Front 5

What are the indications for anticoagulants?

Back 5

Prevention of post-op DVT (deep vein thrombosis) and PE (pulmonary embolism)
Prevention of thrombus associated with a-fib (atrial fibrillation) & heart valve replacement
Prevention of CVA (stroke) & MI (Myocardial Infarction)

Front 6

Name 3 anticoagulant drugs.

Back 6

Coumadin (warfarin)
Heparin
Low Molecular Weight Heparin (LMWH)

Front 7

Anticoagulants DO NOT?

Back 7

LYSE CLOTS AND ARE NOT BLOOD THINNERS!!!!!!!!!

Front 8

MOA of coumadin?

Back 8

Inhibits synthesis of Vit. K dependent clotting factors in the liver

Front 9

Onset Route

Back 9

2 to 3 days

Front 10

Route of coumadin?

Back 10

PO

Front 11

Onset of coumadin?

Back 11

2-3 days

Front 12

Duration of Coumadin?

Back 12

2-5 days

Front 13

Dosage of Coumadin?

Back 13

milligrams (varies)

Front 14

What laboratory test can be used to monitor Coumadin so that the patient is correctly ant-coaged?

Back 14

INR= International Normalization Ratio

Front 15

What is the normal value? (i.e. w/o coumadin)

Back 15

1.0-1.5

Front 16

What is the therapeutic INR? (i.e. w/ coumadin)

Back 16

2.0-3.5

Front 17

What is another lab test that can be used to monitor Coumadin so that the pt is correctly ant-coaged?

Back 17

PT= Prothombin Time

Front 18

What is the normal value for PT w/o coumadin?

Back 18

12-15 sec

Front 19

What is the Therapeutic PT?

Back 19

1.5-2x baseline PT

Front 20

Antagonist for Coumadin?

Back 20

Vitamin K;
crisis situation requires plasma

Front 21

***FYI****

Back 21

Warfarin (the generic name for Coumadin Therapy) is administered to prevent clots from forming on the mechanical valves. Coumadin acts as an anticoagulant. That said, Coumadin therapy is the primary medication used to slow down the body's clotting system.

Front 22

****MORE FYI****

Back 22

However, too much use of this medicine can lead to serious bleeding complications from ulcers, injuries, or even spontaneous bleeding in the brain, kidneys or other internal structures.
Coumadin Blood Tests And Coumadin Therapy Monitoring

Front 23

What does the PT test for?

Back 23

The PT predicts how long it takes your blood to clot. Your doctor uses the PT to determine your Coumadin dose.

Front 24

What happens if the PT level is less than the therapeutic range?

Back 24

The blood may clot too quickly. This would increase the chance of blood clots forming on your mechanical valve. If this happens, there is a risk that your valve will not work correctly. There is also a possibility that small clots will break off and cause a stroke.

Front 25

What happens If the PT level is greater than the therapeutic range?

Back 25

The blood will take too long to clot. This will increase the chance of unusual bleeding. Contact sports or activities, such as skiing, that risk blunt trauma, can be dangerous.

Front 26

Why do they need to consume consistent amounts of Vitamin K?

Back 26

Because Coumadin inhibits synthesis of Vitamin K dependent clotting factors in the liver.

Front 27

What foods are rich in Vitamin K?

Back 27

Green leafy vegetables, such as asparagus, broccoli, brussel sprouts, kale, cabbage and also vitamin D enriched milk and yoghurt, etc.

Front 28

Heparin & LMWH are both given to post-op patients at risk for DVT & PE, & they are both given SQ. What are the advantages of low molecular weight heparin, such as Lovenox (enoxaparin), over heparin?

Back 28

LMWH is:
A. Less likely to have an incidence of bleeding and low platelets
B. More stable response than heparin
C. Safe for pregnant women

Front 29

Nursing considerations R/T anticoagulants?

Back 29

•Administer at same time every day
•Assess for bleeding – Increased dose is an increased risk
•Monitor lab work (CBC (which one all??), PT (Coumadin), PTT (heparin) , INR (coumadin)
•Apply pressure to venipuncture sites
•Be aware that when patient is being converted from heparin to Coumadin, the two medications are taken simultaneously for 2-3 days during which time there is an increased risk of bleeding.

Front 30

Patient teaching R/T anticoagulant therapy?

Back 30

A. Avoid OTC meds containing ASA & NSAIDS
B. Avoid risk of injury
C. May need to stop medication before dental work
D. Take medication at same time every day
E. Report S&S of bleeding

Front 31

Contraindications for Coumadin?

Back 31

Uncontrolled bleeding
recent surgery
Bleeding d/o
Severe HTN
Vit K def.( to therapeutic)

Front 32

A/E of Coumadin?

Back 32

Bleeding

Front 33

Interactions w/ Coumadin?

Back 33

Many drug-to-drug interactions
Antibiotics very common watch INR

Front 34

Patient teaching specifically R/T Coumadin?

Back 34

A. Inform MD of other meds, OTCs, herbals
B. Do not start or stop any medication w/o contacting MD
C. Avoid ETOH
D. Wear Medic-Alert ID (Long-term use)
E. Get lab work as directed
F. Consume consistent amounts of vitamin K

Front 35

Antiplatelets prevent platelet aggregation and are effective in the arterial circulation where anticoagulants have little effect. What are two classes of antiplatelets?

Back 35

ASA – Aspirin
ADP receptor blockers

Front 36

What are the indications for antiplatelets?

Back 36

Decrease risk for MI & CVA
Maintain CABG patency
Aspirin (ASA) – reduces death rate & complications in pts with S&S of MI – chew 325 mg

Front 37

Adverse effects of ADP receptor blockers (Plavix).

Back 37

•Common: bleeding, GI bleed
•Serious:: Thrombotic thrombocytopenia purpura (TTP)

Front 38

MOA w/ Heparin?

Back 38

Low Doses: Prevents conversion of prothrombin to thrombin
High Doses: Blocks conversion of fibrinogen to fibrin

Front 39

Onset of Heparin?

Back 39

SQ Onset 20-60 min
Duration 8 – 12 hours or IV infusion – immediate & duration is 2 to 6 hours

Front 40

Route of Heparin?

Dosage is in:

Back 40

SQ – Onset 20-60 min
Duration 8-12 hours

IV infusion: onset is immediate & duration is 2-6 hours

Dosage in units

Front 41

Labs to Monitor &
Therapeutic Level for Heparin?

Back 41

PTT
Normal: 25-40 seconds
Therapeutic: 1.5-2.5
Critical valve greater than 100 sec spontaneous bleeding

Front 42

Antagonist for Heparin? AKA antidote?

Back 42

Protamine sulfate

Front 43

•What drug-drug interactions (concurrent administration) are potentially fatal and should be avoided?

Back 43

Coumadin – MANY drugs and antibiotics!! ETOH, herbals also. No Plavix.
Antiplatelet (Plavix) – no Coumadin, NSAIDS, or heparin.

Front 44

•What would determine whether a patient was prescribed an anti-coagulant versus an anti-platelet?

Back 44

If a patient was at risk for a clot or a clot they already had from getting larger, they would be prescribed anticoagulants. Anticoagulant drugs are used primarily to prevent thrombosis in veins. Antiplatelet drugs are used to prevent clot formation in arteries.

Front 45

What are the 3 major anti-coagulants? What are their antagonists

Back 45

Coumadin (Vitamin K), Heparin (Protamine sulfate) and LMWH (Protamine sulfate).

Front 46

What is the major side effect of these medications? How will the nurse monitor the patient for this side effect?

Back 46

The most serious side effect of anticoagulants is bleeding. Asses the client for signs of bleeding, including bruising, nosebleeds, excessive menstrual flow, “coffee-grounds” emesis, tarry stools, tea-colored urine, bright red bleeding from the rectum, tea-colored urine, bright red bleeding from the rectum, dizziness, fatigue, or pale pasty-looking skin. The major side effect of Heparin is HIT (heparin-induced thrombocytopenia) a dangerously low platelet count, which patients would be at risk for major clotting problems.

Front 47

Explain the difference between the half-life, onset, & duration of Coumadin & heparin.

Back 47

Heparin has a brief half-life (90 minutes) whereas Coumadin has a half-life of 1-3 days.
Coumadin’s onset is 2 to 3 days. Heparin’s onset is immediate by IV (duration is 2 to 6 hours) and 20 to 60 minutes by SQ (duration is 8 to 12 hours).

Front 48

How will the nurse monitor the patient for HIT?

Back 48

Nurse needs to check platelet level along with a full blood count. This is an immune response to heparin that destroys platelets. Watch for signs and symptoms of a possible DVT or swelling in legs. In those receiving heparin through an intravenous infusion, a complex of symptoms ("systemic reaction") may occur when the infusion is commenced: fever, chills, high blood pressure, a fast heart rate, shortness of breath and chest pain. This happens in about a quarter of people with HIT. Others may develop a skin rash consisting of red spots.

Front 49

Why might a patient be prescribed a LMWH versus heparin?

Back 49

1. Less incidence of bleeding and low platelets
2. More stable response than heparin
3. Safe for pregnant women

Front 50

How will a CBC monitor for side effects of Plavix (clopidogrel)?

Back 50

To check for platelets which will increase the risk of bleeding. Also a CBC will check for WBC, which could be a side effect of Plavix ----- low WBC could cause TTP (Thrombotic thrombocytopenia purpura).

Front 51

What is HIT?

Back 51

Heparin Induced Thrombocytopenia. It is an immune response to heparin that destroys platlets

Front 52

Nursing implications for heparin?

Back 52

Low dose (100 units/ml) used to maintain IV patency
Subcut injection
Continious IV infusions

Front 53

T/F Is heparin given IM?

Back 53

FALSE

Front 54

Laboratory's for heparin?

Back 54

CBC (RBC, hemoglobin, hemocrat)
aPTT
Monitor platlets for HIT

Front 55

Lovenox (enoxaparin) is what?

Back 55

Low molecular weight heparin
suffix= arin

Front 56

Indications for Lovenox?

Back 56

Given to pt's post op and those at risk for DVT and PE

Front 57

Contraindications for Lovenox?

Back 57

Concurrent administration of heparin

Front 58

Antagonist, dose and lab's for Lovenox?

Back 58

Promatine sulfate
mg (subcut injections)
Lab's are unnecessary

Front 59

Nursing Implications for ALL Anticoag's

Back 59

Administer same time everyday
Assess for bleeding
Monitor lab wrk
Apply pressure to venipucture site
When pt is being changed from heparin to coumadin the 2 meds are taken simultaneously for 2-3 days
at this time INCREASE risk of bleeding

Front 60

What are 2 antiplatelet medications?

Back 60

ASA & ADP receptor blockers (PLAVIX)

Front 61

Indications for antiplatelet medications?

Back 61

Decrease r/f MI & CVA
Maintain CABG patency
ASA= reduces death rate & complications in pts w/ S&S of MI

Front 62

MOA for Antiplatelets?

Back 62

Prevent platelet aggregation do NOT decrease # of platelets

Front 63

Antiplat are Effective in the ?

Back 63

Arterial circulation where anticoagulants have little effect

Front 64

What dose of ASA should you give?

Back 64

81,160, or 325mg enteric coated

Front 65

MOA of ASA?

Back 65

Prevents platelet aggregation by inhibiting formation of thromboxane A2

Front 66

A/E of ASA

Back 66

GI distress, bleeding, or ulcers
Contraindicated: bleeding d/o decrease platelet count

Front 67

N/I & P/T for ASA?

Back 67

Anti-plat effect may last a week
Avoid NSAIDS & other anti coags
Avoid etoh
MAY NEED TO WITHHOLD 7-10 DAYS B4 SURGERY

Front 68

MOA for Plavix?

Back 68

Prevents platelet aggregation by alltering the cell membrane of platelets

Front 69

Contraindications for Plavix?

Back 69

Active bleeding and breastfeeding

Front 70

Plavix is cautioned in?

Back 70

HX of PUD & current etoh abuse
Concurrent use w/ NSAIDS, heparin, & Coumadin= increase risk of bleeding

Front 71

N/I for Plavix?

Back 71

Monitor bleeding
Monitor CBC

Front 72

P/T for Plavix?

Back 72

Stop taking b4 surgery
Avoid taking ASA & NSAIDS
Report fever, chills & sore throat ASAP!!!

Front 73

S/S for bleeding?

Back 73

Brusing, nose bleeds, increase menstral flow, coffee ground tarry stool, tea colored urine, rectal bleeding, dizziness, fatigue, pale pasty skin, increase HR, decrease BP, back pain, H/A, decrease RBC, hemoglobin and hemocrat

Front 74

What is a traveling clot?

Back 74

Embolus

Front 75

Deprives an area of blood flow causing ischemia?

Back 75

Arterial Thrombus

Front 76

The process of formation of an insoluble clot to form?

Back 76

Coagulation

Front 77

AKA Thrombocyte?

Back 77

Platelet

Front 78

Cell w/o a nucleous?

Back 78

Platelet

Front 79

A protein made from fibrinogen, made by the liver, insoluble web?

Back 79

Fibrin

Front 80

Deficency of platelets caused by a any condition that supresses bone marrow?

Back 80

Thrombocytopenia

Front 81

Measure the ability of the blood to clot properly?

Back 81

PT

Front 82

Measures the effectiveness of blood thinning?

Back 82

INR

Front 83

Evaluates how long it takes for blood to clot?

Back 83

aPTT

Front 84

Prevention of clot formation; Inhibits specific clotting factors?

Back 84

Anticoagulants

Front 85

Prevention of clot formation; Inhibits platelet action?

Back 85

Antiplatelets

Front 86

Removal of existing clot; Breaks up the already formed clot?

Back 86

Thrombolytics

Front 87

What stick together to form a clot?

Back 87

Platelets & Fibrin

Front 88

What lab test is used to monitor Heparin?

Back 88

aPTT

Front 89

What is the normal value? i.e w/o Heparin?

Back 89

25-40 sec

Front 90

What is a Therapeutic aPTT?

Back 90

1.5-2.5
baseline aPTT= 60-100