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Nur210 Clotting
Pharmacology clotting
| Question | Answer |
|---|---|
| What are triggers for clot formation? | Intravascular - ASHD = arteriosclerotic heart disease Extravascular - trauma |
| What is hemostasis? | The body's ability to clot Have to have platelets to clot Have to be able to make fibrin If you cut an artery, vessels will constrict to cut-off blood loss |
| What is Virchow's triad? | Venous stasis - bad circulation Hypercoaguability - thick blood (diabetes) Endothelial damage - hurt the vessel |
| What are the factors linked to increased risk of thromboembolic events? | Thrombus - clot; Embolic = move Decreased circulation Decreased mobility Disease or disability Obesity Obstruction of venous flow; fat build-up Medications |
| What is an anticoagulant? | Prevent clots in the first place Heparin is the drug of choice Rapid acting Does not dissolve a clot, but prevents one from forming |
| What is an antiplatelet? | Make platelets less sticky (i.e. ASA) |
| What are thrombolytics? | Chomp the clots and break them down (i.e. pac man) Only drugs that break down existing clots i.e. tPA, streptokinase, urokinase |
| Indications for heparin use | DVT PE MI Pregnancy CVA |
| What are mechanisms of action of heparin? | Can only be given parenterally; SubQ or IV Not absorbed in GI tract Very acid solution Large molecule Rapid acting Dosed in units |
| What are some injectable anticoagulants? | Heparin Low molecular weight heparin (LMWH) |
| What are some oral anticoagulants? | Coumadin and pradaxa |
| What is an antiplatelet drug? | ASA |
| What are some thrombolytics? | tPA, Streptokinase, Urokinase |
| What are the pharmokinetics of heparin? | Rapid acting Metabolized by liver Eliminated via kidney Short half-life Highly protein bound - will sit in fat and sometimes cross BBB |
| What are the ADRs of heparin? | Hemorrhage - has systemic-wide impact (gums can bleed, blood in urine, blood at IV site) Osteoporosis HIT - Heparin Induced Thrombocytopenia - lose all platelets = allergic reaction |
| What are nursing indications with heparin? | Need to look for signs of bleeding Respiratory rate up, BP down, HR up, extremities feel cool or look mottled Changes in LOC, agitation IV - do not mix with other meds SubQ - rotate sites, don't massage |
| What are nursing implications of heparin? | Monitor aPTT should be 60 to 80 seconds (1.5 to 2X normal of 40 seconds) Monitor for bleeding Protamine sulfate is antidote |
| What are characteristics of LMWH? | 100% bioavailability SubQ Fragments of unfractionated heparin |
| What are the mechanisms of action of LMWH? | Half-life 6X longer than heparin Minimal protein binding Renal clearance |
| What are some nursing implications with LMWH? | Obtain baseline aPTT, PT, CBC, creatnine Administered SubQ every 12-24 hours Antidote = protamine sulfate |
| What are some characteristics of Warfarin? | Coumadin Oral anticoagulant Inhibits liver synthesis of vitamin K Absorbed rapidly in upper GI tract |
| What are the actions of Warfarin? | Long half-life (42 hours) Highly protein bound Works on what's coming - does not work on what's currently circulating Prevents thrombosis formation - doesn't treat anything |
| What are ADRs of Warfarin? | Multiple drug interactions Hemorrage - major - bleeding in brain possible Cannot use on pregnant women - crosses placental barrier |
| What are nursing implications for warfarin? | Monitor for bleeding - PT level is 1.2 to 1.5X control OR INR level should be 2-3 Patient teaching so they can go home Antagonist vitamin K - higher vitamin K will decrease effectiveness of coumadin |
| What is vitamin K's impact when using coumadin? | Decreases effectiveness of coumadin. High vitamin K = broccoli, cucumber, brussel sprouts Mod vitamin K = green beans, raw cabbage Low vitamin K = apples |
| Pradaxa/Xarelto advantage? | Need regular blood work on coumadin, not on these, though Stroke could be your first sign of issues, though |
| What are some antiplatelet drugs? | ASA |
| Properties of ASA | Inhibits prostaglandin synthesis Dose = 81 to 325 mg/day Adverse effects - upset stomach, will interact with other anticoagulants and increase blood thinning effects |
| Properties of thrombolytic drugs | tPA, streptokinase, urokinase Get rid of existing clots Causes low BP, bleeding, cardiac arrythmias Used for MI, DVT, PE (massive) |
Created by:
ssbourbon
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