Nurs 306 Exam 2 [Anticoags, Antiplatelets, Thrombolytics, Anemia]

Front 1

Identify the 3 anticoagulants discussed in lecture.

Back 1

warfarin (Coumadin)
heparin
enoxaparin (Lovenox)

Front 2

anticoagulant

Back 2

acting to suppress, delay, or nullify blood coagulation

Front 3

coagulation

Back 3

the process by which blood forms clots

Front 4

Identify the mechanism of action(s) for the following drug: heparin.

Back 4

Inactivates thrombin and factor Xa => suppression of fibrin

Note: Stops fibrin

Front 5

Is heparin a maintenance med?

Back 5

No

Front 6

TRUE/FALSE

Blood clot formation is a normal body function.

Back 6

True

Front 7

Identify the routes of administration for heparin.

Back 7

IV
Subcutaneous

Front 8

Identify the half-life of heparin. Is it short or long?

Back 8

1.5 hours, short half-life

Note: Half-life may be longer in patients with kidney or liver disease

Front 9

Where is heparin metabolized?
Where is heparin excreted?

Back 9

Metabolized in liver
Excreted in kidneys

Front 10

Identify 5 therapeutic use(s) for heparin.

Back 10

Massive venous thrombosis (fibrin meshwork of clot) such as DVT (deep vein thrombosis), or post op venous thrombosis

Pulmonary embolism

Acute myocardial infarction (AMI)

Open heart surgery

Renal dialysis

Front 11

Heparin in prescribed in _____.

Back 11

units

For adults, 10,000-20,000 USP units SC or 10,000 units IV initially (loading dose) then 5,000-10,000 units q4-6 hrs

Front 12

Identify the adverse effect(s) of heparin. (4)

Back 12

Heparin Induced Thrombocytopenia
(monitor platelet count)

Hypersensitivity Reactions

Osteoporosis (long term tx)

Hematoma & Irritation, injection site

Front 13

Why do we monitor platelet count?

Back 13

Low platelet count causes bleeding

Front 14

Identify the antidote for heparin.

Back 14

Protamine sulfate

Front 15

Identify the contraindication(s) for heparin. (4)

Back 15

Bleeding disorders (esp uncontrollable bleeding)

Thrombocytopenia

Immediately post-op

After lumbar puncture

Front 16

What lab do you monitor with heparin?

Back 16

Partial thrombloplastin time (PTT)

Front 17

_______ is a low molecular-weight heparin.

Back 17

Enoxaparin (Lovenox)

Front 18

Identify the mechanism of action(s) for the following drug: enoxaprin (Lovenox).

Back 18

Inactivates factor Xa

Front 19

thrombocytopenia

Back 19

low platelet count

Front 20

Do you give heparin to patients with active bleeding or bleeding disorders?

Back 20

No

Front 21

Is enoxaparin (Lovenox) given for maintenance?

Back 21

Yes

Front 22

Is enoxaparin (Lovenox) safe for use during pregnancy?

Back 22

Yes

Front 23

Identify the antidote for enoxparin.

Back 23

Protamine sulfate

Front 24

Identify 2 therapeutic use(s) for enoxaparin.

Back 24

DVT prophylaxis (prevention of DVT)

Prevention of ischemic complications for non-Q wave MI or unstable angina

Front 25

Which has a longer half-life, heparin or enoxaparin?

Back 25

Enoxaparin

Front 26

Why would enoxaprin be used during pregnancy?

Back 26

Pregnancy thickens blood, which then decreases blood supply from mom to baby. Enoxaparin will thin the blood.

Front 27

Identify the adverse effect(s) of enoxaparin.

Back 27

Bleeding
Pain or inflammation at injection site

Front 28

Identify the oral anticoagulant discussed in lecture.

Back 28

Warfarin (Coumadin)

Front 29

Identify the mechanism of action(s) for the following drug: warfarin.

Back 29

prevents biosynthesis of clotting factors VII, IX, X, prothrombin

blocks Vitamin K => prevents coagulation

Front 30

Identify the dietary adjustment that needs to be made for patients taking warfarin. Why?

Back 30

Eat less food items with Vitamin K, such as green, leafy vegetables

This is important because if there is too much Vitamin K, warfarin will be useless and will be toxic to the body.

Front 31

Identify the antidote for warfarin.

Back 31

Vitamin K

Front 32

What labs must be monitored for a patient taking warfarin?

Back 32

INR (international normalized ratio)
Prothrombin time (PT)

Front 33

Identify the half-life of warfarin.

Back 33

6 hours - 2.5 days

Note: Even if the pt stopped taking it 2 days ago, it is still in their system.

Front 34

TRUE/FALSE

A nurse must monitor for signs of bleeding for a few days, even if warfarin has been discontinued.

Back 34

TRUE

Because the drug has a long half-life.

Front 35

Identify the level of INR for a therapeutic dose for atrial fibrillation.

Back 35

2.0-3.0

Front 36

atrial fibrillation

Back 36

muscular twitching of the muscles of the atria of the heart

Front 37

How is vitamin K involved in blood clotting?

Back 37

each form of vitamin K functions as an enzyme that assists in chemically altering proteins involved in the blood clotting

Front 38

thrombolytics

Back 38

Drug used to break up and dissolving clots

Tip: Clot busters

Front 39

Identify some education that may be useful for patients on anticoagulants.

Back 39

Disease process
Reason for taking drug
Adverse effects
Monitoring and follow-up
Avoid vigorous activities (e.g. contact sports)
Brush teeth with soft bristles

Front 40

Identify the 2 antiplatelet drugs discussed in lecture.

Back 40

aspirin and clopidogrel (Plavix)

Front 41

Identify the mechanism of action(s) for the following drug: aspirin.

Back 41

Suppresses platelet aggregation

Front 42

Identify 2 therapeutic use(s) for aspirin.

Back 42

Prevention of MI

Prevention of stroke (pts with hx of TIA)

Front 43

Identify the last step in clot formation.

Back 43

fibrinogen → fibrin

Front 44

Which drug is most effective to prevent venous thrombosis after surgical procedure?

Back 44

Small doses of heparin

Front 45

transient ischemic attack (TIA)

Back 45

when blood flow to a part of the brain stops for a brief period of time. A person will have stroke-like symptoms for up to 24 hours, but in most cases for 1 - 2 hours.

Front 46

Identify the adverse effect(s) of aspirin. (3)

Back 46

- Increase risk of GI bleed, peptic ulcer disease (PUD)
- Increase risk of hemorrhagic stroke
- Bleeding

Front 47

Identify the mechanism of action(s) for the following drug: streptokinase (Streptase).

Back 47

catalyzes conversion of other plasminogen into plasmin

Front 48

Identify the other name for alteplase.

Back 48

tissue plasminogen activator (tPA)

Front 49

Identify the mechanism of action(s) for the following drug: alteplase.

Back 49

promotes plasminogen to plasmin (which digests fibrin matrix of clots)

Front 50

Identify the 2 thrombolytics discussed in lecture.

Back 50

streptokinase (Streptase)
alteplase (tPA)

Front 51

anemia

Back 51

condition in which the body does not have enough healthy red blood cells (decrease in the quantity or quality)

Front 52

Identify the cause(s) for anemia.

Back 52

altered production erythrocytes, blood loss and increased destruction of erythrocytes

Front 53

Identify the most common type of anemia.

Back 53

iron deficiency anemia (IDA)

Front 54

iron deficiency anemia

Back 54

insufficient iron available for erythropoiesis resulting in anemia

Front 55

erythropoiesis

Back 55

formation or production of red blood cells.

Front 56

Identify the 3 cause(s) for IDA.

Back 56

- Blood loss
- Increased iron requirement (birth to 2, adolescents, pregnancy)
- Decreased iron absorption ( gastrectomy, upper small bowel malabsorption issues)

Front 57

Identify the 4 risk factor(s) for IDA.

Back 57

Pregnancy
Poverty
Children/Adolescent
Blood loss

Front 58

Iron is stored in the form of _____ within the body.

Back 58

hemoglobin

Front 59

TRUE/FALSE

Iron (in the body) can be recycled.

Back 59

True

It is in constant use in the body.

Front 60

Identify and describe the 3 stages of IDA.

Back 60

Stage I– body’s iron stores for red cell production and hemoglobin synthesis are depleted

Stage II- insufficient amounts of iron are transported to the marrow and then iron deficient red cells are produced (impaired erythropoiesis)

Stage III- Clinical manifestations of iron deficiency anemia (IDA) appears = insufficient iron supply & diminished HGB synthesis

Front 61

Evaluation of IDA starts with ______.

Back 61

assessment of the labs.

Front 62

What labs need to be assessed for IDA? (5)

Back 62

- CBC (hemoglobin & hematocrit) - Ferritin
- TIBC (total iron binding capacity) - Transferrin saturation
- Stool for occult blood

Front 63

Identify the 2 types of iron replacements available for pts with IDA?

Back 63

Oral replacement is the initial treatment

If severe, IV iron replacement

Front 64

Iron replacement has decreased absorption with _______.

Back 64

Decreased absorption with antacids, milk, eggs, cheese,
coffee, tea

Front 65

What food helps to absorb iron?

Back 65

Orange juice (Vitamin C)

Front 66

Identify the mechanism of action(s) for the following drug: clopidogrel (Plavix).

Back 66

prevent platelet aggregation, antiplatelet; works like aspirin

Front 67

Identify the therapeutic use(s) for the following drug: clopidogrel (Plavix).

Back 67

prevention of ischemic stroke

Front 68

thrombus vs embolus

Back 68

Thrombus is a solid mass of platelets and/or fibrin (and other components of blood) that forms locally in a vessel

Embolus is most often a piece of a thrombus that has broken free and is carried toward the brain by the bloodstream.