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CoagulationModifiers
| Question | Answer |
|---|---|
| What is the extrinsic pathway? | A pathway that triggers the clotting process |
| What is the final result of the extrinsic pathway, and why is it important? | Factor X. This factor is converted to Factor Xa, which converts prothrombin to thrombin. Thrombin then converts fibrinogen to fibrin. Clots are composed of fibrin and aggregation of platelets. |
| What is the Fibrinolytic System? | A system that prevents the coagulation system from going out of control. It converts plasinogen to plasmin, which helps dissolve clots. |
| How Does Unfractionated Heparin Work? | Heparin enhances the function of antithrombin III (substance that inactivates thrombin) by binding to it, thus giving AT III a configuration that picks up thrombin more efficiently. |
| Does Unfractionated Heparin stop clotting, dissolve existing clots, or reduce clotting? | Heparin reduces clotting |
| How long does it take for Unfractionated Heparin to start working? | once it reaches the blood, less than 1 minute |
| What are the routes of administration for Unfractionated Heparin? | SQ or IV. Heparin is not given PO b/c it cannot cross the GI mucosa, and it is not given IM b/c hematomas can occur |
| Name a specific condition for which Unfractionated Heparin is prescribed prophylactically. | Deep Venous Thrombosis (DVT) |
| List two causes of DVT. | immobility, postoperative clotting |
| What is a DVT?? | A clot that forms in the deep veins of the legs |
| What are some situations in which Unfractionated Heparin is given IV? | Post IM, Treatment of a DVT, Stroke, Atrial fibrillation, machines that circulate blood outside the body, to keep central venous catheter clot free |
| The amount of Unfractionated Heparin a patient receives in an infusion is based on what information? | Body Weight |
| IV's in what body parts should not be flushed with Unfractionated Heparin? | hands and arms |
| How much (range) of Unfractionated Heparin is used to flush a port into to prevent it from clotting off? | 10-100 units |
| List Side Effects associated with Unfractionated Heparin. | Bleeding, Alopecia (hair loss), Osteoporosis (with long term use), and Heparin-Induced Thrombocytopenia (HIT) |
| What the heck is Heparin-Induced Thrombocytopenia (HIT)? | an immune-mediated reaction that usually occurs after 4 days of treatment that causes the platelet count to drop below 100,000. This causes clotting and damage to organs and tissues...sometimes resultingin limb loss or even death. |
| How does HIT occur? | Heparin binds to platelets which activate the immune system, causing antibodies to form. The antibodies then activate platelets, inducing clotting. |
| Name some symptoms of HIT. | chills, fever, rash w/ itching (urticaria) |
| What drug can be taken in place of Unfractionated Heparin? | Refludan (lepirudin) |
| What is the antidote for Unfractionated Heparin? | Protamine sulfate (for every 100 units of heparin, give 1mg of P.S.) |
| What substances and drugs cause interactions with Unfractionated Heparin? | alcohol (increases bleeding risk), Aspirin (increases bleeding risk, and decreases platelet aggregation), Antibiotics that interfere with vitamin K, CYP450 Enzyme Inducers (increase heparin metabolism, dose will need to be increased) |
| Polly Pocket is taking Unfractionated Heparin via infusion. Suddenly Polly Pocket begins violently vomiting blood. What do you do!? | contact the physician |
| When should Partial Thromboplastin Time (PTT) be monitored for patients on heparin? | prior to heparin administration (to determine baseline PTT), 6 hours after infusion is started, every morning with normal labs |
| What is the normal PTT range, and the range when on heparin? | normal = 30-40 seconds, on heparin = 60-80 seconds |
| Your patient Sponge Bob Square Pants is currently receiving Heparin and Dilantin via IV. Is it cool to use the same line for both of these medications? | No, not cool, the line for Heparin cannot be used for other drugs |
| Dolly Parton requires SQ heparin for a DVT. Where do you inject this? | Into the abdominal fat, two inches away from the umbilicus |
| List three specific drugs that are composed of low molecular weight heparin (fractionated heparin) | Lovenox (enoxaparin), Fragmin (daltaparin), Arixtra (fondaparinux) |
| How does low molecular weight heparin work? | Inhibits factor Xa |
| How are all dose of fractionated heparin administered? | SQ |
| List the benefits of Fractionated heparin over Unfractionated heparin. | Fractionated heparin has a longer half-life, and therefore only needs to be given 1-2 times/day and does not require a constant infusion. In addition fractionated heparin requires fewer PTTs |
| How does coumadin (Warfarin) work? | prevents the formation of new clots by inhibiting vitamin K dependent clotting factors such as prothrombin |
| What is the only route of administration for coumadin? | PO |
| You have just given your patient, Eddie Murphy, his first dose of coumadin. How long do you expect the onset of the drug to take? | 3-5 days because coumadin inhibits the creation of new factors, therefore old factors must be used up before the effects are seen |
| Why does coumadin have so many gosh darn drug interactions? | b/c it is 99% plasma protein bound, and usually has a weaker affinity for albumin than other drugs |
| What is coumadin used for? | DVT, Atrial fibrillation, Clotting Disorders (protein C deficiency) |
| What is Protein C deficiency? | a condition in which protein C production is insufficient. Protein C prevents excessive clotting. Therefore decreased levels of protein C leads to increased clotting. |
| Your patient, Chuck Norris, has just received his first dose of coumadin. He is also receiving heparin. Is this kosher? | Yes, often times heparin is given concurrently with coumadin until the coumadin reaches a therapuatic level |
| Name some side effects of Warfarin. | Ecchymosis (bruising), Agranulocytosis, Hypersensitivity (chills, rash, itching), Warfarin-Induced Skin Necrosis, GI Distress |
| Is Warfarin fetus-friendly? | NO. |
| What can cause Warfarin-Induced Skin Necrosis? How often does it occur? | A loading dose that is too high, or if coumadin and heparin are started at the same time. Occurs in less than 0.1% of cases |
| List four drugs/drug classes than increase the level of Warfarin | aspirin, sulfonamide, antibiotics, loop diuretics |
| List two drugs that increase the metabolism and decrease the effectiveness of Warfarin | estrogens, barbiturates |
| List two drugs that decrease absorption and effectiveness of Warfarin | Bile Acid Squestrants, Antacids |
| Contraindications for Warfarin | pregnancy, hemorrhagic conditions |
| What is the antidote for Warfarin Toxicity? | Vitamin K |
| Is Vitamin K usually given IV? Why or Why not? Is this always true? | No, it is usually given PO, because IV vitamin K commonly causes anaphylaxis. However, if the INR is greater than 20, vitamin K is given IV, |
| What are symptoms of Warfarin Toxicity? | The first sign is usually minor bleeding. Skin necrosis is a severe symptom. |
| As the nurse of a patient who is on Warfarin, what should you be monitoring? | PT/INR |
| What is INR? | "Internation normalized ratio" A ratio of PT to PT control. The control is how long it took to clot before anticoagulants, and PT is the time after anticoagulants were started. |
| What is the goal range for INR? | 2-3 |
| Your patient, who is on Warfarin, has an INR of 17, what do you do?? | contact the provider, who will decide is vitamin K is required |
| As an awesome nurse, what do you teach your patient about Warfarin? | That an injury can cause severe bleeding, to report increased bruising, to wear a medic alert bracelet, to limit their intake of aspirin, that alcohol increases INR, to use and electric razor, and hold pressureon IM injections for 5 min |
| What foods should you tell your patient to limit while on Warfarin? | Foods high in potassium such as: green veggies, canola oil, olive oil, mayo, soybeans, beef liver (eweee...), green tea Foods that increase INR: grape fruit juice, cranberrries |
| How does aspirin function as an antiplatelet drug? | It causes irreversible inhibition of platelet aggregation, that is, the aggregation is decreased for the platelet's lifespan (7-10 days) |
| What is a relatively common hypersensitivity to aspirin? What happens? | Aspirin Sensitive Asthma (10-30% of asthma patients), causes an acute asthma flare |
| What are Thrombolytics? | Drugs that break up existing fibrin clots |
| List specific Thrombolytics. | Retevase, tPA |
| List two conditions that Thrombolytics are used to treat. | MI, Stroke |
| What are the side effects of thrombolytics? | Hemorrhage, GI bleeding, Bleeding in the brain |
| Contraindications for Thrombolytics | intracranial pathology, GI bleeding, uncontrolled Hypertension |
| Prior to thrombolytic therapy, what should be monitored? | PT/INR, PTT, CBC |
Created by:
littlejohnson
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