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Week 7

Interfere with the clotting cascade and thrombin formation Anticoagulants: Warfarin (Coumadin) and Heparin
Alter the formation of the platelet plug Antiplatelets: Aspirin, clopidogrel (Plavix)
Break down the thrombus that has been formed by stimulating the plasmin system. Thrombolytic Drugs: alteplase (Activase)
Inhibit platelet adhesion and aggregation by blocking receptor sites on the platelet membrane, preventing platelet-platelet interaction or the interaction of platelets with other clotting chemicals. Antiplatelets - Aspirin
What are eptifibatide and clopidogrel? antiplatelets - eptifibatide is an IV agent clopidogrel - PO agent
adverse effect of Aspirin- _____________: Monitor for hearing loss. Withhold dose if manifestation occur. Tinnitus
What is the eventual effect of warfarin? depletion of clotting factors and prolongation of clotting times
It is used to maintain a state of anticoagulation in situations in which the patient is susceptible to potentially dangerous clot formation. Anticoagulants - Warfarin
- Reduce the risk of stroke in AF -Patients undergoing knee or hip replacement. - Treatment/prevention: DVT, PE, TIA, recurrent MI Anticoagulants Warfarin
What are the contraindications/ cautions of aspirin? - Caution with TIA, Closed head injury, recent surgery, - Contraindicated in pregnancy/lactation.
T or F - Warfarin should be taken following surgery of brain, spinal cord, lumbar puncture. False
What drug should you be cautioned about taking with Low platelet count (Thrombocytopenia) and peptic ulcers. Warfarin (Coumadin)
T or F - Because of the time of effect delay, warfarin is not the drug of choice in an acute situation.; however it is convenient and useful for prolonged effects. True
What drug - patient reports orange-yellow discoloration of urine, this can be frightening, but may be an effect of the drug. Warfarin
What are the adverse effects of Warfarin? Hemorrhage (bleeding gums with tooth brushing to internal hemorrhage. Obtain baseline PT & INR GI upset Alopecia, bone marrow depression, Orange-yellow discoloration od the urine. Avoid herbal agents. Risk for hepatitis- Monitor liver enzymes
T or F - Herbal Therapies are good to take with Warfarin because they have a therapeutic effect. False!
Vitamin K promotes the liver synthesis of several clotting factors. When these pathways have been inhibited by warfarin, clotting time is increased. How can you decrease clotting time? If an increased level of vitamin K is provided, more of these factors are produced, and the clotting time can be brought back within a normal range.
Because of the way in which vitamin K exerts its effects on clotting, there is a delay of at least ____ from the time the drug is given until some change can be seen. Why does this happent? 24 hrs. --- This occurs because there is no direct effect on the warfarin, rather an increased stimulation of the liver, which must then produce the clotting factors.
Do these drugs increase or decrease the effect of Warfarin? Heparin and oral anticoagulants, salicylates, penicillins, or cephalosporins, glucocorticoids, acetaminophen- Increase
How do you reverse the effect of warfarin? Vitamin K- Antidote Usual dose for anticoagulant-induced prothrombin deficiency is: 0.5 to 1 mg IV or 2.5 mg PO
Foods high in vitamin K, such as__________ can decrease anticoagulant effects with excessive intake. Patient should maintain a consistent intake of vitamin K to avoid certain fluctuations that could affect the action of warfarin. green leafy vegetables
What are the two thing you want to monitor with Warfarin? What are the normal therapeutic levels? Monitor PT level Antidote: Vitamin K Therapeutic level is 18 to 24 seconds. Monitor INR level Therapeutic level is 2-3 seconds.
INR of __________ for treatment of acute MI, AF, PE, venous thrombosis, tissue heart valves. INR of _____ for mechanical heart valve, recurrent systemic embolism. 2 to 3, 3 to 4.5
Blocks the formation of thrombin from prothrombin. Anticoagulants: Heparin
-Treatment/prevention of venous thrombosis, stroke, -Treatment/prevention of pulmonary embolism - Treatment of AF, prevention of clotting in blood samples, venous tubing, dialysis, & DIC. Therapeutic use of heparin
DIC treatment of choice is Heparin. Why? Heparin prevents the clotting phase from being completed, thus inhibiting the breakdown of fibrinogen. It may also help avoid hemorrhage by preventing the body from depleting its entire store of coagulation factors.
In the case of Heparin Overdose administer __________ and avoid _______. Protamine and avoid aspirin
What do you want to monitor with Heparin and what is the baseline? Monitor partial thromboplastin time (aPTT) Keep value at 1.5 to 2 times the baseline.
T or F - give Heparin if there Low platelet count, peptic ulcer disease, following surgery of the eye, brain, spinal cord, lumbar puncture, or severe HTN. False
T or F - Do not take Heparin with antiplatelet agents such as Aspirin, NSAIDs or other anticoagulants because it can increase risk for bleeding True
-Prevents deep-vein thrombosis (DVT) in postoperative clients. -Treats DVT in PE Low-Molecular-Weight Heparins - Enoxaparin Does not greatly affect thrombin, clotting, or prothrombin times; therefore causes fewer systemic adverse effects.
Prevents clotting by activating antithrombin, thus inactivating both thrombin and factor Xa. Inhibits fibrin formation. Low-Molecular-Weight Heparins - Enoxaparin
Thrombocytopenia evidenced by low platelet count, less than _______ 100,000.
Break down the thrombus that has been formed by stimulating the plasmin system. Thrombolytic Agents - Alteplase and Urokinase
Action: Dissolve clots that have already formed. Convert plasminogen to plasmin. This destroys fibrinogen and other clotting factors. Thrombolytic Agents - Alteplase and Urokinase
What are the therapeutic uses for Thrombolytic Agents - Alteplase and Urokinase? -Treatment for acute MI (Both medications) -Acute ischemic stroke- tPA only -Massive PE- tPA only -Restore patency to central IV catheters- Cath Flow (tPA)
What are the adverse effects of Thrombolytic Agents - Alteplase? Internal bleeding (GI or GU tracts, Cerebral bleeding. Superficial bleeding, wounds, IV catheter site.
What are the nursing interventions for Alteplase -tPA (Thromolytic)? -Limit venipunctures and injections. -Apply pressure dressings to recent wounds. -Monitor for changes in VS, alterations in level of consciousness, weakness, & indication of intracranial bleeding. -Monitor aPTT and PT, Hgb, & Hct, fibrinogen.
T or F - With Alteplase - Concurrent use with other drugs that enhance bleeding (aspirin, NSAIDs, heparin, warfarin, thrombolytics, other antiplatelets, increases risk of bleeding. True
The pharmacology instructor is talking to the student about low-molecular-weight-heparin medications. What would the instructor indicate as an advantage to these medications? Cause fewer systemic adverse effects --Rationale: Low-molecular-weight-heparins do not greatly affect thrombin, clotting, or prothrombin times; therefore cause fewer systemic adverse effects.
Prevent body wide or systemic clot breakdown, thus preventing blood loss in situations in which serious systemic bleeding could occur, or hyperfibrinolysis. Is the Antidote for Thrombolytics -Systemic Hemostatic Agents= Aminocaproic Acid
T or F - Enoxaparin is available only in SC form. Enoxaparin should never be administered with Alteplase as it would risk further bleeding. True
_________ must be administered as soon as possible after manifestations of MI, PE, CVA, begin. 3 hrs. is often the limit. Client outcomes would be decreased if 8 hrs. elapsed before beginning this drug. Alteplase
You are writing a care plan on a patient who is taking an anticoagulant. What would be an appropriate nursing diagnosis? A. Evaluate pt for PT > 2.5 B. Establish safety precautions C. Notify the health care provider of any pts is receiving this drug B- Patients on anticoagulants are at increased risk for bleeding. usesoft-bristled toothbrushes, using electric , avoiding activities that could easily involve injury,limiting invasive procedures &ensuring adequate compression to stop bleeding.
A nurse is caring for a client who is receiving IV heparin for deep-vein thrombosis. The client begins to vomit blood. After heparin has been stopped, which of the following meds should be given? Vitamin K Atropine Protamine Aminocaproic acid Protamine reverses the anticoagulant effect of heparin.
- ________ reverses the anticoagulant effect of heparin. - Atropine is used to reverse bradycardia. - ________ is used to reverse the effects of warfarin. - ________ is used to reverse the effects of thrombolytics. -Protamine, -Vitamin K -Aminocaproic aid
Created by: sbertelsen



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