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Ch. 51 - Anticon
Pharmacology
| Question | Answer |
|---|---|
| Initial phase of hemostasis | limited blood flow to area and vessel constriction at site |
| 2nd phase of hemostasis | thrombin activates platelets, platelet plug |
| 3rd phase of hemostasis | fibrin creates mesh around platelet plug which secures platelet plug |
| 4th phase of hemostasis | plasmin dissolves clot |
| how do clot busters work | form plasmin to break up clots |
| intrinsic pathway | contact activation pathway |
| extrinsic pathway | tissue factor pathway, which is turned on by trauma to vascular wall |
| what med inhibits synthesis of clotting factor | coumadin only. all others inhibit activity of clotting factors |
| what anticoag is safe during pregnancy | heprin |
| what lab test should you monitor for heprin | aPTT |
| will heparin break down a clot | no |
| will heparin prevent a clot from forming | yes |
| heprin route | IV or sub cut only; cannot give IM or orally because it will cause hematomas |
| heprin is an animal byproduct, what must you watch out for | allergies, specifically HIT - heparin induced thrombocytopenia. If platelet levels fall below 100 don't give heprin |
| can heparin be used for rapid therapy | yes |
| uses for heparin | PE, CVA, DVA, proflaxis, renal dyalysis, and low dose proflaxis for post-op |
| side effects of heparin | bleeding, HIT - heparin induced thrombocytopenia (a heparin allergy, if platelet levels fall below 100 don't give heparin), allergy |
| contraindications for heparin | thrombocytopenia, uncontrolled bleeding, surgery in a highly vascular area |
| what do you give for a heparin overdose | Protamine Sulfate. It only lasts for 2 hours, so you may need to repeat |
| how is LMWH dosage determined | by body weight |
| what is the big difference between heparin and LMWH | With LMWH you don't have to monitor aPTT. |
| side effects of LMWH | bleeding and thrombocytopenia |
| what is the direct thrombin inhibitor drug we have to know? | Angiomax = Bivalirodin and Warfin = Coumadin |
| route of Angiomax | IV only and only in hospital |
| will Angiomax dissolve existing clots | No, angiomax is a direct thrombin inhibitor. Only Thrombolytic drugs dissolve existing clots |
| How long is Angiomax's 1/2 life | very short. Therefore, its need to be on a continuous drip |
| What are the side effects of Angiomax? | bleeding, pack pain, nausea, headache, and it is very expensive |
| if a pt is on Angiomax and has back pain, what would you recommend | take tyelenol, but don't' take asprin |
| route for warfrin | oral |
| does warfin work right away | no, it has a delayed onset b/c it does not work on existing clotting factors. |
| when will you see effects of warfin | may see initial effects in 12 hours, but full peak effect is 3-4 days |
| what does warfin work on | vitamin k clotting factors 7,9,10, and prothrombin |
| uses for warfin | proflaxis of thrombosis, |
| dosage frequency of warfin | 1x a day b/c of longer half life. pts will stay on heparin until warfin levels are up |
| lab value for warfin | PT-INR. INR should be 2-3 |
| what to give for OD of warfin | Vitamin k or fresh frozen platelets |
| can you use warfin in pregnancy | no |
| what anti platelet drugs are we responsible for | aprin and Plavix |
| how does aprin work | irreversibly inhibits cyclo-oxygenase and last the life of the platelet which is about 7-10 days |
| side effects of asprin | bleeding, especially GI bleeding |
| when would a pt get plavix | to prevent blockage of a coronary stent post PCI and to reduce risk of thrombolytic evens with pts with angina |
| route of plavix | orally |
| dosage changes in elderly taking plavix | no change for elderly, dosage remains at 75 mg |
| side effects of plavix | diarrha, dyspepsia, rash, abdominal pain, less incidence of GI bleed with aspirin but still a chance, used with caution with other meds, PPI - PROTON PUMP INHIBITORS SUCH AS PRILOSEC WILL DECREASE THE EFFICACY OF PLAVIX |
| what will decrease the efficacy of plavix | proton pump inhibitors such as Prilosec |
| what med causes diarrhea, dyspepsia, rash and abdominal pain and still runs a risk of GI bleeding | PLAVIX |
| super asprin | GP2B3A Inhibitor |
| how do GP2B3A Inhibitor work | inhibit platelet aggregation b/c GP2B3A is a platelet membrane protein used for adhesion and aggregation |
| route for GP2B3A Inhibitor | IV only |
| side effects for GP2B3A Inhibitor | bleeding, not used at home. |
| when is GP2B3A Inhibitor used | acute MI and PCI |
| coumadin | anticoagulate |
| heprin | anticoagulate |
| angiomax | direct thrombin inhibitor |
| warfin | direct thrombin inhibitor |
| asprin | antiplatelet |
| plavix | antiplatelet |
| GP2B3A Inhibitor | antiplatelet |
| streptokinase | thrombolytic drug = clot buster |
| what thrombolytic drug do we need to know | Streptokinase - its a clot buster |
| uses of Streptokinase | MI, DVT, Massive PE |
| is Streptokinase used outpatient | no, b/c it is very dangerous |
| does Streptokinase prevent clots | No, Streptokinase only breaks down existing clots |
| does Streptokinase break down existing clots | yes, it is a thrombolytic drug, that is what they do |
| time from to use thrombolytic drug in MI | should be used within 4-6 hour of symptom onset; NEVER USED if pain has been there more than 12 hours |
| when should you NEVER use a thrombolytic drug such as Streptokinase | after a recent stroke, when there is an active GI bleed, and after recent CPR |
| side effects of Streptokinase | bleeding, which can progress to hemorrhage, antibody production (patients can have an allergy reaction), HPTN, Fever, and cerebral hemmorhage |
| which drug can cause HPTN | Streptokinase, a thrombolytic drug is the only one with a side effect of hptn |
Created by:
cfulton27
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