pharm: 4

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Author:
itzlinds
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270575
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pharm: 4
Updated:
2014-04-14 22:48:22
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coagulation
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coagulation
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  1. thwhat type of med will be used if a clot forms and must be dissolved quickly:
    thrombolytics

    after the clot is dissolved, anti coagulants are usually given IV or SQ afterwards
  2. after a clot has been dissolved, list the (2) anti coagulants that are usually given either IV or SQ:
    • heparin
    • low molecular weight heparin
  3. anti coagulants primarily prevent:
    venous thrombosis
  4. drugs that inhibit some of the clotting factors, and prevent clot formation are called:
    anti-coagulants
  5. drugs that prevent clots by inhibiting platelet aggregation are called:
    anti-platelets
  6. name one common anti-platelet drug:
    aspirin
  7. what is heparin overdose tx'ed with:
    protamine sulfate
  8. what are the (2) uses of protamine sulfate:

    what is it's onset of action:
    • to tx heparin overdose
    • to reverse any hemorrhage from a normal dose of heparin

    onset: 5 minutes
  9. what is the antidote for excess warfarin:
    vitamin K
  10. why should pt. care of anti coagulation include frequent checks for excess bleeding:
    because anti coagulatants dont just decrease dangerous clots, pts. on them are at high risk of bleeding
  11. list (10) signs and symtoms of excess bleeding to frequently check for during the pt. care on anti coagulants
    • brusing
    • nose bleeds
    • menorrheria
    • black/tarry stools
    • coffe ground appearing emesis
    • red or red brown urine
    • dizziness
    • fatigue
    • new onset of pain
    • pallor
  12. pt. care for anti coagulants should include checking stoosl frequently for:
    blood
  13. what (2) changes in VS would suggest that there is internal bleeding:
    increased HR and decreased BP
  14. what type of lab test is done to confirm whether there is internal bleeding:
    hemoglobin & hematocrit

    serial H&H are often done
  15. what is the lab test that is done to monitor heparin tx's:

    how often is this lab test checked:
    PTT (partial thromboplastin time) test that measures how long it takes blood to clot

    checked: every day and every 8 hours after dose changes
  16. what is the lab test that is done to monitor the effect of warfarin:

    how often is this lab test checked:
    PT/INR (prothrombin time/international normalized ration - results)

    checked: daily and then every 2 weeks once the level stabilizes
  17. when changing from heparin to coumadin, how long is the usual overlap:

    what is the reason for the overlap
    usually a 2 day overlap

    why: heparin has a short 1/2 life and coumadin generally takes a few days to reach the PT (lab test) desired
  18. when changing from heparin to coumadin, heparin must be continue until the coumadin has reached its full therapeutic effect, what is the potential risk during this time:
    increased bleeding risk

    depeding on the cause of increased clotting, the PT (lab test) with coumadin is geared towards a certain range
  19. what is the fxn of heaprin: (2)
    • to prevent clot formation
    • prevent the expansion of existing clots
  20. what is the MOA of heaparin:
    when it binds to anti- throbmin III, several clotting factors are inactivated and that inhibits blood clotting.
  21. what is the onset of action for IV heparin:

    what is the onset of action for SQ heparin doses:
    • IV: almost immediately for therapeutic effect
    • SQ: up to 1 hour for therapeutic effect
  22. what is the pregnancy category of heparin:
    pregnancy category C

    • due to the maternal risk of increased bleeding
    • also, it doesnt cross the palcenta as its too big
  23. modified heparin molecules that inhibit active clotting factor X are called:
    low molecular weight heparins
  24. why are low molecular weight heparins given less often than heparin:
    the duration of action of low molecular weight heparins is longer than with heparin
  25. what is the reason that low molecular weight heparins are possible to discharge pts. eariler and teach them to give themselves SQ heparin at home:
    they are less likely to decrease platelets than is heparine and the response is more consistent that when heparin
  26. what are the doses of low molecular weight heparin's doses based on:
    the pts. weight
  27. what are (2) things not to do at the injection site of heparins, or there could be excess tissue injury and bleeding:
    • injection sites should never be massaged
    • aspirate the injection site (pulling back the plunger after the needle is inserted)
  28. list (2) rx-rx interactions can increasing bleeding during concurrent use with heparins:
    • oral anti coagulants
    • drugs that inhibit platelet aggregation
  29. list the (4)rx-rx interactions that can inhibit anti coagulation during concurrent use with heparins:
    • nicotine
    • digoxin
    • tetracyclines
    • anit histamines
  30. list the (4) herbal interactions during concurrent use with heparins:
    • arnica
    • ginger
    • garlic
    • ginkgo
  31. what is the most common adverse effect of heparin:
    excess bleeding

    with IV heparin, stopping the IV will decrease the excess bleeding within a few hours
  32. the adverse effect of excess bleeding is common with which (4) groups or situtaions
    • elderly
    • menstruation
    • PUD (peptic ulcer disease)
    • renal or liver disease
  33. list the (6) contraindications of herparins:
    • active internal bleeding
    • bleeding disorders
    • severe HTN
    • recent trauma
    • intercranial bleeding
    • bacteral endocarditis (inflammation of the inner tissues of the heart, rare)
  34. what is the MOA of coumadin (warfarin):
    the inhibition of vitamin K, and thus the production of clotting factors 2,7,9 & 10 is decreased
  35. what is the onset of action for coumadin (warfarin):

    describe why:
    2-7 days

    why: it takes a few days to work as existing clotting factors are used up (factors 2,7,9,&10)
  36. what is the antidote of coumadin (warfarin):

    how long does the antidote take if given IV:
    vitamin K, either SQ or IV

    if give IV: starts reversing the effect in 6 hours
  37. what is the pregnancy category for coumadin (warfarin):
    pregnancy category C
  38. what is the half life of coumadin (warfarin):

    what is the duration:
    • half life: 0.5 - 3 days
    • duration: 3-5 days
  39. what is the adverse effect of coumadin (warfarin):

    how long does this effect last:
    increase bleeding

    the decreased clotting effect it causes may last up to 10 days as clotting factors are slowly replenished
  40. list the (7) contraindications of coumadin (warfarin):
    • recent trauma
    • active internal bleeding
    • bleeding disorders
    • intracranial bleeding
    • severe HTN
    • bacteral endocarditis
    • severe liver or renal impairment
  41. list (8) rx-rx interactions of coumadin (warfarin):

    what are most of the interactions due to:
    • NSAIDs
    • alcohol
    • diurectics
    • many anti depressants
    • steroids
    • anti biotics
    • vaccines
    • some vitamins



    due to: protein binding
  42. list the (6) herbal interactions of coumadin (warfarin) that can increase bleeding
    • feverfew
    • arnica
    • garlic
    • ginseng
    • gingko biloda
    • ginger
  43. what is a good option to alert med. staff they are on blood thinner:
    pts. should wear an ID bracelet stating they're on a blood thinner
  44. list the (8) s/sx that should be reported immediately when the pt. is on coumadin (warfarin):
    • chest pain
    • sudden dyspnea (SOB)
    • increased HR
    • excess bleeding
    • hemoptysis (coughing/spitting up blood)
    • hematemesis
    • black or bloody stools
    • wound bleeding
  45. pts. on coumadin (warfarin) should also report the (7) following s/sx:
    • prolonged nose bleeds
    • menorrhagia (heavy/prolonged peroid)
    • increased weakness
    • dizziness
    • chills
    • gum bleeding
    • excess bruising
  46. if a pt. is on coumadin (warfarin) they should avoid food that are high in:

    name some food high in this:
    avoid food in: K+

    • cabbage
    • cauliflower
    • broccoli
    • asparagus
    • lettuce
    • turnips
    • greens
    • kale
    • spinach
    • onions
    • fish or liver
    • they should avoid garlic, also
  47. when should warfarin be taken:
    at the same time every day
  48. pts. on warfarin should protect their foot from injury, and:
    check foot pulses daily
  49. pts. on warfarin should seek care for all injuries that are anything more than minor cuts and that dont stop bleeding within:
    10 minutes
  50. what is the MOA for aspirin:
    irreversibly binding to cyclooxygenase on platelets thus preventing formation of throboxane A2 - a chief platelet aggregation inducer
  51. how long dose one dose of aspirin's anti platelet effect last for:
    one does of aspirins anti platelet effects: lasts up to 7 days

    because it binds irreversibly
  52. what is usually the 1st choice anti-platelet:
    aspirin

    other anti platelet drugs are only given if asprin is contraindicated
  53. if an overdose of anti-platelet occurs what is given:
    platelet transfusions are given
  54. how soon before surgery are anti-platelet drugs discontinuned:
    D/C'ed 1 week before surgery
  55. what is the MOA of thrombolytics:
    they increase the conversion of plasminogen to plasmin - an enzyme that digests fibrin and breaks down fibrinogen and prothrobmin, thus enhancing fibrinolysis/clot breakdown.
  56. because thrombolytics actively breakdown clots and restore blood flow to an area, if they are given __________  hours after a clot forms, the chances of salvaging tissues the occluded vessel served is:
    because thrombolytics actively breakdown clots and restore blood flow to an area, if they are given more than 4  hours after a clot forms, the chances of salvaging tissues the occluded vessel served is greatly decreased
  57. when are thrombolytics usually administered:
    only in the ICU or ER
  58. if excess bleeding develops while on thrombolytics, what will D/C'ing the tx do:
    D/C' ing the thrombolytic quickly restores the normal clotting , as these drugs have a short 1/2 life
  59. after thrombolytics have dissolved the clots, what is the next tx:
    anti- coagulants are started to prevent further clots
  60. what was the 1st thrombolyic developed:
    streptokinase (kabikanase)
  61. name the thrombolytic that acts faster, lasts longer, and has fewer side effects including less frequent allergic rxn:
    tenecteplase (TNKase)
  62. list (2) commonly used thrombolytics:
    • alteplase (activase, TPA)
    • reteplase (retavase)
  63. what is the pregnancy cagetgory for thrombolytics:
    pregnancy category c
  64. what is the adverse effect of thrombolytics:
    bleeding including intracrainal bleeding
  65. list the (8) contraindications of thrombolytics:
    • active internal bleeding
    • recent bleeding - within 2 months
    • CVA
    • recent trauma
    • surgery
    • severe HTN
    • brain tumor
    • AV malformation (abnormal connection between arteries and veins)

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