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pharm: coagulation

Drugs affecting coagulation

DrugIndicationMechanism of actionAdverse effectsContraindicationsBaseline testsPatient EducationAntidote
Heparin Anticoagulant. Prevents the extension of blood clots in patients with PE or DVT. Has no effect on existing clots. Rapidly promotes the inactivation of factor X, which prevents the conversion of prothrombin to thrombin and fibrinogen to fibrin. This limits clot formation. Prolongs bleeding time. Bleeding and heparin induced thrombocytopenia (HIT) Hypersensitivity (beef or pork), bleeding disorders, active bleeding, thrombocytopenia, use during or after surgery. aPTT and platelet count and PLT Monitor for signs of bleeding. Use soft toothbrush or electric razor to mimimize bleeding. Safe for pregnant women. protomine sulfate
Ateplase, recombinant (Activase) Breaking down already formed blood clots which pose acute medical emergencies (MI, PE, ischemic stroke) tPA synthesized by recombinant DNA technology. Binds to fibrin in the clot then converts plasminogen to plamin. Fibrinolysis occurs. Internal or superficial bleeding. Hypersensitivity,active internal bleeding, hemorrhagic stroke, severe HTN and recent surgeries. Increased risk of bleeding with anticoagulants. platelet count aPTT, PT, Hgb and Hct
Lovastatin (Mevacor) Primary hyperlipidemia. Secondary prevention of coronary events (MI and stroke) Completely inhibits HMG-CoA reductase, which is the enzyme that catalyzes the early rate limiting step in cholesterol biosynthesis Increased HDL, decreased LDL, decreased cholesterol, decreased VLDL and decreased triglycerides. Muscle and joint aches, weakness, cramps, rhabdomyolysis, myopathy and elevated liver enzyme levels. Active liver disease and pregnacy (category X). Grapefruit juice decreases CYP3A4 and increases drug levels. (risk for myopathy). cholesterol, LDL, HDL, triglycerides, LFT's, CPK's and grapefruit juice intake/output. photosensitivity.Following a low- cholesterol and low-saturated fat diet.
Gemfibrozil (Lopid) Management of hyperlipidemia decreased triglyceride production by the liver, decreased VLDL, increased HDL. gallbladder stones, myopathy, abnormal liver enzyme levels. gallbladder disease, liver and renal disease HDL, LDL, triglyceride levels, renal and liver function tests. Take 30 min before breakfast and dinner.
Ezetimide (Zetia) Management of hyperlipidemia. Decreased absorption of cholesterol from food, decreased LDL. decreased absorption of cholesterol from food, decreased LDL diarrhea and myalgia liver and renal disease HDL, LDL, triglyceride levels, renal and liver function tests. Take without regard to food
Cholestyramine (Questran) Management of hyperlipidemia binds bile acids in the GI, increased clearance of cholesterol, decreased LDL constipation, vitamin K deficiency, increased triglycerides biliary disease, elevated triglycerides and VLDL HDL, LDL, triglyceride levels. Take before meals
LMWH (Lovenox) and (Arixtra) derived from standard heparin. Less bleeding and less HIT Black box warning regarding the use of epidural/spinal anesthesia or spinal puncture. Increased risk of epidural or spinal hematoma. Teach patients how to self inject
Warfarin (Coumadin) Anticoagulant. Used after heparin therapy. Used in patients with a high risk for thrombus formation. Completely blocks vitamin K at its action sites. Prevents activation of factor X and prothrombin. Bleeding, hemmorhage, NVD Active bleeding, PUD or bleeding disorders (hemophilia), thrombocytopenia, use during or after surgery. PT and INR Vitamin K (green leafy vegetables) decrease the effects. Pregnancy category X. Discontinue 7 days before surgery. Give in the evening after 6pm to allow morning blood draws. Vitamin K (phytonadione)
Clopidogrel (Plavix) Used to reduce the occurrence of atherosclerotic events in patients who have had MI or stroke or who are at high risk (PAD). PRODRUG: requiring activation by CVP2C19 Inhibits binding of adenosine diphosphate (ADP) to its platelet receptor and the subsequent ADP- mediated activation of the glycoprotein IIb/IIIa complex and inhibits platelet aggregation. Prolongs bleeding time. Bleeding, GI distress, neutropenia Hypersensitivity and active bleeding disorders (PUD). Anticoagulants increase risk of bleeding. CBC, platelet function, LFT, CV exam Lab tests are needed on a regular basis. Discontinue 7 days before surgery. Take with food to decrease GI problems. Heart healthy diet.
Aspirin Low dose is used for prophylaxis against MI and stroke. Provides reduction in the risk for MI and stroke.TXA2 is a vasoconstrictor that promotes platelet aggregation. Inhibits platelet aggregation by inhibiting COX and the synthesis of throboxane and A2. bleeding (GI bleeding and ulceration) and neutropenia. Take with food to avoid GI distress.
Created by: lehasler



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