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Nur210 Clotting

Pharmacology clotting

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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