Chapter 26 Coagulation Modifier Drugs

Front 1

What does Hemostatsis mean?

Back 1

-Any process that stops bleeding

-Coagulation is hemostasis that occurs due to physiologic clotting of blood

-Complex relationship between substances that promote clot formation and either inhibit coagulation or dissolve a formed clot

Front 2

What are the three coagulation cascade pathways?

Back 2

-Extrinsic pathway

-Intrinsic Pathway

Front 3

What is Extrinsic pathway?

Back 3

-Triggered by external trauma

-Activated when blood leaks into tissue spaces

-Factor 7 makes pathway quicker

Front 4

What is Intrinsic Pathway?

Back 4

-Slower pathway

-Activated in response to injury

-Involves factors 6,7,8,9

-Expose epithelial and collagen

Front 5

What do Intrinsic or extrinsic pathways lead to?

Back 5

-Formation of Fibrin clot

-Injured cells release prothrombin activator

-Prothrombin activator changes prothrombin to thrombin

-Thrombin changes fibrinogen to fibrin

-Fibrin forms insoluble web over injured area to stop blood flow (Normal clotting takes about 6 min)

Front 6

What is Fibrinolysis?

Back 6

Clot removal

Front 7

Fibrinolysis usually beings _____ to _____ hours after clot formation.

Back 7

24 to 48 hours

Front 8

Fibrinolysis is initiated by the release of _______.

Back 8

Tissue plasminogen activator (tPA)

-tPA converts plasminogen to plasmin

-Plasmin digest fibrin strands, thus circulation is restored

-Regulated so unwanted clots are removed and fibrin is left in wounds

Front 9

Drug class that are coagulation modifiers?

Back 9

-Anticoagulants

-Antiplatelet drugs

-Hemorheologic drugs

-Thrombolytic drugs

-Antifibrinolytic or hemostatic

Front 10

What does an Anticoagulant drug class do?

Back 10

-Inhibit the action or formation of clotting factors

-Prevent clot formation

Front 11

What does an Antiplatelet drug class do?

Back 11

-Inhibit platelet aggregation

-Prevent platelet plugs

Front 12

What does an Hemorheologic drugs class do?

Back 12

-Alter platelet function

Front 13

What does an Thrombolytic drugs class do?

Back 13

-Break down existing clots

*Only drug to break down clot*

Front 14

What does an Antifibrinolytic or hemostatic drug class do?

Back 14

-Promote blood coagulation

Front 15

Anticoagulants are also known as ____________.

Back 15

-Antithrombotic drugs

Front 16

What effect does Anticoagulants drugs have on blood clots?

Back 16

They have no effects on blood clots that already formed.

Front 17

Anticoagulants are used to prevent __________ and ___________.

Back 17

- Used prophylactically to prevent:

*clot formation (thrombus)

*an embolus (dislodged clot)

Front 18

What are Anticoagulant drugs?

Back 18

-Warfarin Sodium

-Enoxaparin

-Heparin

-Dabigatran

-Fondaparinux

-Argatroban

Front 19

What does Warfarin Sodium inhibit?

Back 19

-Hepatic synthesis of factors 2(II), 7(VII), 9(IX), 10(X)

-Blood thinner

Front 20

What factor is Enozaparin more specific too?

Back 20

Factor X(10), LMWH (low molecular weight heparin)

Front 21

What does Heparin enhance?

Back 21

Enhances that action of Antithromnin III

Front 22

Dabigatran is a _______ thrombin inhibitor.

Back 22

Direct

Front 23

How do Anticoagulants work?

Back 23

-Vary depending on drug

-Work on different point of the clotting cascade; depends because they work on different factors

-Do not lyse existing clots

*Blood thinners, DO NOT break down clots

Front 24

What are indications to use Anticoagulants?

Back 24

-Used to precent clot formation in certain setting: *Myocardial infarction

*Unstable angina

*Atrial fibrillation

*Indwelling devices (mechanical heart valves)

*Major orthopedic surgery

Front 25

Adverse effects that happen with anticoagulants?

Back 25

-Bleeding (increase risk with increased dosage)

-Heparin-induced thrombocytopenia (HIT)

-Nausea/Vomiting

-Abdominal cramps

-Thrombocytopenia (low platelet count)

Front 26

Heparin-induced thrombocytopenia(HIT) reduces _______, and has two different types _______ and _______.

Back 26

1. Platelets

2.Gradual fall

3. Acute fall

Front 27

Heparin enhances the actions of ________________.

Back 27

Antithrombin III

Front 28

Heparin is monitored by ________________, which is the _______ _______.

Back 28

1. Activated partial thromboplastin times (aPTT)

2. Length

3. Time

Front 29

Heparin is given by _______ route, never _____ because it causes _______.

Back 29

1. Parenteral (subcutaneous, fatty tissue)

2. Rub

3. Bruising

Front 30

Heparin has a _____ half life of ____ to _____ hours.

Back 30

1. Short

2. 1

3. 2

Front 31

If the person is bleeding due to Heparin the antidote is ________ ________.

Back 31

1. Protamine Sulfate

Front 32

Protamine Sulfate reverses the effects of _________.

Back 32

Heparin

Front 33

Heparin provides anticoagulation until therapeutic levels of _______ are reached, because it takes a while for ________ to get into the blood system, then is discontinued.

Back 33

1. Warfin

2. Warfin

Front 34

Monthly blood checks are necessary when taking ________ to make sure you maintain therapeutic level.

Back 34

Warfin

Front 35

Heparin blood coagulation time is monitored by __________ _______ ______ _________ (aPTT).

Back 35

Activated Partial Thromboplastin times (aPTTs)

Front 36

Warfarin blood coagulation time is monitored by _________ _______ and __________ ________ (PT-INR).

Back 36

Prothrombin time and International rate

*Amount of time it takes while on anticoagulant for blood to clot*

Front 37

Low-molecular-weight heparins are specific to which factor?

Back 37

Factor X

Front 38

___________ and ________ are LMWH.

Back 38

Enoxaparin and Dalteparin

Front 39

LMWH have more predictable anticoagulant __________, do not require _______ monitoring, they are given ___________, and you should not _______ after administration.

Back 39

1. Response

2. Lab

3. Subcutaneously

4. Rub

Front 40

_________ inhibits hepatic synthesis of factors _____, ______, _____, ______.

Back 40

1. Warfin

2. II (2)

3. VII (7)

4. IX (9)

5. X (10)

Front 41

Warfarin is given ______ and the normal INR is _____, therapeutic INR is ______ to _____.

Back 41

1. Orally ONLY

2. 1.0

3. 2 - 3.5

Front 42

Vitamin K is given if _______ toxicity occurs, and is used to make ______.

Back 42

1. Warfarin

2. Factors

Front 43

People that are on _______ therapy are ask not to eat green leafy veggies, because it causes ____ to form, stopping the thearpy.

Back 43

1. Warfarin

2. Clots

Front 44

Antiplatelet Drugs prevents _________ from ________.

Back 44

1. Clots

2. Forming

Front 45

The antiplatelet drugs that are used are the following, ___(6 drugs)__.

Back 45

-Aspirin

-Dipyridamole

-Clopidogrel

-Tirofiban

-Eptifibatide

-Abciximab

Front 46

Patient taking ______ should take it with H20 and food to prevent ________ issues.

Back 46

1. Aspirin

2. G.I.

Front 47

_________ is often used as an adjuvant to help Warfarin, in preventing post op thromboembolic complications.

Back 47

Dipyridamole

Front 48

________ and _________ are similar to Clopidogrel.

Back 48

1. Prasugrel

2. Tricagrelor

Front 49

_______, _______ and _______ are Glycoprotein IIb/IIIa inhibitors, which is inhibiting the protein that prepares fibrin for clot formation.

Back 49

1. Triofiban

2. Eptifibatide

3. Abcixmab

Front 50

Antiplatelet drugs are used to reduce risk of fatal and nonfatal ______, and acute unstable _____ and _____.

Back 50

1. Strokes

2. Angina

3. MI

Front 51

__________ drugs break down clots that are formed.

Back 51

Thrombolytic

Front 52

Older thrombolytic drugs are ______ and ______, all drugs end in "____".

Back 52

1.Streptokinase

2. Urokinase

Front 53

Current Thrombolytic drugs are as follows, (4 drugs).

Back 53

1. Anistreplase

2. Alteplase

3. Reteplase

4. Tenecteplase

Front 54

__________ drugs activate the ______ system to break down the ____ in the blood vessel quickly. Also, they activate _____ and convert it to _____, which can digest fibrin. As well as reestablishing blood flow to the heart muscle via ______ arteries, preventing tissues destruction.

Back 54

1. Thrombolytic

2. Fibrinolytic

3. Clots

4. Plasminogen

5. Plasmin

6. Coronary

Front 55

Thrombolytic drugs should be used in the following cases: (6)

Back 55

-Acute MI

-Arterial thrombolysis

-DVT

-Occulsion of shunts or catherters

-Pulmonary embolus

-Acute ischemic stroke

Front 56

Thrombolytic drugs cause what adverse effects?

Back 56

-Bleeding *most common

-N/V

-Hypotension

-Anaphylactoid reactions

-Cardiac dysrhythmias *can be dangerous

Front 57

________ drugs promote clot formation by preventing the lysis of _____. Used to treat the following bleeding disorders: ___________ and _________ _______ disease.

Back 57

1. Antifibrinolytic

2. Fibrin

3. Hemophilia *from factor 8-9

4. Von Willebrand

Front 58

What are Antifibrinolytic drugs?

Back 58

-Aminocaproic acid

-Desmorpressin (Similar to ADH, used in treatment of diabetes insipidus)

Front 59

What adverse effects come from antifibrinolytic drugs?

Back 59

-Uncommon and mild

- Rare reports of thrombotic events

- Dysrhythmia

-Orthostatic hypotetsion

-Bradycardia

-Headache

-Dizziness

-N/V/D

-Fatigue

-Abdominal cramps

Front 60

When dealing with Heparin a nurse needs to ______ check IV doses with another nurse, ensure that subcutaneous doses are given subcut. not _______, and do not ______ site.

Back 60

1. Double

2. IM

3. Rub

Front 61

Do not give Heparin within _______ inches of areas that can bleed out, and do not ________ subcut. injections.

Back 61

1. 2

2. Aspirate

Front 62

Lab values for Heparin are done daily to monitor coagulation effects with ________ testing. Anticoagulant effects are seen _______________.

Back 62

1. aPPT

2. Immediately

Front 63

Anticogulation has an antidote in case of excessive antiocogulation, which is __________.

Back 63

Protamine sulfate

Front 64

LMWH should be given ___________ in the ________, and _________ sites.

Back 64

1. Subcut

2. Ab

3. Rotate

Front 65

While still on Heparin, ________ may be started until ___________ levels indicate adequate anticoagulation, full therapeutic effect takes several days.

Back 65

1. Warfarin

2. PT-INR

Front 66

Warfarin's antidote is ______________, which can be found in green leafy veggies and tomatoes.

Back 66

Vitamin K

Front 67

Drugs and herbal products that have potential interactions to increase bleeding are:

Back 67

-NSAID

-Aspirin

-Capsicum pepper

-Garlic

-Ginger

-Ginkgo

-St. John's wort

-Feverfew

Front 68

Teach the patient that anticoagulants require regular _________ testing, taking measures to prevent ________, _________, or ________ injury, and understanding abnormal signs of _________.

Back 68

1. Lab

2. Bruising

3. Bleeding

4. Tissue

5. Bleeding

Front 69

Patients should also wear ___________ alert ______, avoid foods high in __________.

Back 69

1. Medical

2. Bracelet

3. Vitamin K

Front 70

While using thrombolytic drugs follow strict _______________ guidelines for ____________ and __________. Monitor IV sites for ______, ________, and _________. Monitor for bleeding from _______, ____________, ________, and___________.

Back 70

1. Manufacturer

2. Preparation

3. Administration

4. Bleeding

5. Redness

6. Pain

7. Gums

8. Mucous membranes

9. Nose

10. Injection sites

Front 71

While using thrombolytic drugs observe for signs of internal _________, shown by decreased _______, ___________, and increased ________.

Back 71

1. Bleeding

2. BP

3. Restlessness

4. Pulse