Patho Test 5 Drugs

Front 1

Homeostasis

Back 1

process that stops bleeding

Front 2

Stage 1 Homeostasis Platelet Plug is formed by

Back 2

platelet aggregation

Front 3

Stage 2 Homeostasis Coagulation formed through

Back 3

Intrinsic and Extrinsic coagulation pathways

Front 4

Keeping homeostasis under control involves

Back 4

physiologic removal of clots

Front 5

Thrombosis reflect pathology (two types)

Back 5

Arterial and venous thrombosis

Front 6

blood vessel injury results in

Back 6

vasocontriction

Front 7

Platelet Aggregation (sticking together)

Back 7

Activated platelets aggregating a process related in part by prostaglandins (cox2) Following injury to a blood vessel wall platelets pink & purple develop a sticky outer surface and adhere to each other.

Front 8

Three Major groups of drugs for Thomboembolic Disorders

Back 8

AntiCoagulants
Antiplatelets
Thrombolytics

Front 9

Anticoagulants work by

Back 9

reducing the formation of fibrin (web of clot)
MOA: inhibit the synthesis and activity of clotting factors

Front 10

Heparin and Heparin derivatives

Back 10

enhance antithrombin
rapid acting anticoagulant
admin by injection only (deep SubQ or IV)

Front 11

Therapeutic uses of Heparin

Back 11

preferred during pregnancy and when rapid anticoag needed.
PE
evolving stroke
Massive DVT
open heart surgery
renal dialysis
low dose tx postoperatively
DIC
Adjunct Thrombolytic tx

Front 12

Adverse Effects of Heparin

Back 12

hemorrhage
Heparin induced thrombocytopenia (decrease platelets, increase probable clotting)
Hypersensitivity reactions

Front 13

Contraindicated with heparin

Back 13

thrombocytopenia
uncontrollable bleeding
during and immediately after surgery of the eye, brain or spinal cord

Front 14

Antidote for Heparin

Back 14

Protamine Sulfate

Front 15

test ordered with heparin

Back 15

aPTT -activated partial thromboplastin time

Front 16

Low molecular weight heparin

Back 16

preparation composed of molecules that are shorter than those found in unfractionated heparin.

Front 17

Therapeutic uses for LMW Heparin

Back 17

prevention of DVT following surgery
tx of established DVT
Prevention of ischemic complications (unstable angina, non-Q wave MI and STEMI)

Front 18

How to administer LMW heparin

Back 18

SUB Q (absorbed faster than IM)
can be given at home, does not require monitoring
Antidote Protamine Sulfate
costs more than unfractionated Heparin

Front 19

Adverse effects of LMW heparin

Back 19

bleeding (but less than with UF hep)
Immune-mediated thrombocytopenia (decrease platelets)Severe neurologic injury for pts undergoing spinal puncture or spinal epidural anesthesia

Front 20

How are all heparins delivered?

Back 20

SUB Q or IV (NOT oral)

Front 21

What labs need to monitored for Heparins?

Back 21

aPTT

Front 22

Where can Unfractionated Heparin be used?

Where can LMW heparin be used?

Back 22

Hospital Only

Hospital or Home

Front 23

Warfarin

Back 23

Oral Anticoagulant
Vitamin K antagonist

Front 24

Warfarin used as

Back 24

-rat poison
-delayed onset anticoag
-vitamin K antagonist
-blocks the biosynthesis of factors VII, IX, X and prothrombin

Front 25

True or False
Warfarin is useful in emergencies

Back 25

false. NOT useful in emergencies. delayed onset.

Front 26

Warfarin is used for longterm prophylaxis of

Back 26

thrombosis (clots)
- prevention of venous thrombosis and associated PE
- prevention of thromboembolism (in pts with prosthetic heart valves
- Prevention of thrombosis during atrial fibrillation

Front 27

Test used to monitor Warfarin (oral anticoag)

Back 27

PT- Prothrombin time, INR

Front 28

Adverse effects of warfarin

Back 28

hemorrhage (vit K for toxicity)
fetal hemorrhage and teratogenesis from use during pregnancy
use during lactation

Front 29

Drug interactions for warfarin

Back 29

Drugs that increase anticoag effects
drugs that promote bleeding
drugs that decrease anticoag effects
Heparin
Aspirin
Acetaminophen

Front 30

Warfarin overdose

Back 30

Vitamin K overdose

Front 31

Major classes of Antiplatelet drugs

Back 31

Aspirin, Plavix, Aggrastat

Front 32

What do antiplatelet drugs do?

Back 32

Prevent stickiness of platelets

Front 33

Aspirin (ASA)

Back 33

inhibit cyclooxygenase
Adverse effect: increase risk for GI bleeding

Front 34

Clopidogrel (Plavix)

Back 34

Adenosine diphosphate (ADP) receptor antagonist

Front 35

Aspirin (ASA) therapeutic uses

Back 35

Ischemic stroke
TIA
Chronic stable angina
unstable angina
coronary stenting
acute MI
Previous MI
Primary prevention of MI

Front 36

Aspirin (ASA) Adverse Effects

Back 36

Bleeding
GI Bleeding and hemorrhagic stroke
Enteric coated tablets may not reduce the risk for GI bleed

Front 37

Clopidogrel (Plavix) therapeutic uses

*antiplatelet drug

Back 37

-prevents blockage of coronary artery stents
-reduces thrombotic events in patients with acute coronary syndromes (MI, Ischemic stroke, vasc death)
*similar adverse effects of aspirin
*use with caution with other drugs that promote bleeding

Front 38

Glycoprotein (GP) IIb/IIIa receptor antagonist

Back 38

-most effective antiplatelet drug
-"super aspirins"
-reversible blockade of platelet GP IIb/IIIa receptors

Front 39

Properties of Thrombolytic Drugs

Back 39

convert plasminogen to plasmin, an enzyme that degrades the fibrin matrix of thrombi. (web of the clot)

Front 40

Thrombolytic drugs

Back 40

streptokinase (streptase)
Alteplase (tPa)

Front 41

Major adverse effects of thrombolytics?

Back 41

bleeding (minor oozing to life threatening amount)
**likely sites would include: recent wounds, needle puncture sites, invasive procedure sites
-anticoags increase the risk for hemorrhage
-blood replacement may need to be considered

Front 42

Streptokinase (Streptase)

Back 42

thrombolytic
binds to plasminogen to form active complex
***Adverse effects: bleeding-excessive fibrinolysis can be reversed with IV aminocarproic acid (Amicar)

Front 43

Alteplase (tPa)

Back 43

-converts plasminogen to plasmin
-slightly better than streptokinase for tx MI but much more expensive
*given in an accelerated schedule
* therapeutic uses: MI, Ischemic stroke, Massive PE

Front 44

Other Thrombolytic drugs

Back 44

tenecteplase
reteplase
urokinase