Pharmacology
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| What are the two steps of hemostasis? | Platelet plug formation and coagulation
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| What are the two pathways of coagulation? | Intrinsic and extrinsic
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| What is the action of anticoagulants? | Reduce the formation of fibrin
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| What are the three major groups of thromboembolic drugs? | Anticoagulants, antiplateletes, and thrombolytics
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| Is the half-life of heparin short or long? | Short
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| How can heparin be administered? | Only by IV or subQ injection
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| Where is the optimal site for subQ heparin injection? | In the abdomen, two inches from the umbilicus
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| What are the adverse effects of heparin? | Hemorrhage, spinal/epidural hematoma, and heparin-induced thrombocytopenia
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| What is the primary treatment for heparin induced thrombocytopenia? | Stopping the use of heparin
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| When is heparin contraindicated? | In patients with thrombocytopenia; uncontrollable bleeding; immediately after brain, eye, or spinal cord surgery
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| What are the labs that must be monitored with heparin use? | aPTT and INR
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| What is the normal range for aPTT? | 25-38 seconds
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| What is the normal INR range? | 2-3 seconds
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| Does heparin increase or decrease aPTT time? | Increases to 60-80 seconds
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| How often should the aPTT be monitored in a patient on heparin? | Every 4-6 hours
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| What should you assess for in patients on heparin? | S/S of blood loss: Hypotension, tachycardia, bruises, hematomas, headache or syncope, discolored urine. Also assess mental status and mucous membranes
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| What is the antidote for heparin overdose? | Protamine sulfate
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| Describe the action of protamine sulfate. | Has immediate action and last 2 hours.
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| How is protamine sulfate administered? | Usually by IV
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| What are the advantages of Lovenox? | It can be given at home, while heparin cannot..
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| What patient should never receive Lovenox? | Patient in kidney failure (assess creatinine and BUN levels).
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| True or False: Warfarin has a delayed onset. | True
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| How is warfarin administered? | PO
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| What are the therapeutic uses of warfarin? | Prevention of thrombus in atrial fibrillation and as prophylaxis in patients with prosthetic heart valves.
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| What is the antidote for warfarin overdose? | Vitamin K
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| What should be included in patient teaching for warfarin? | Use a soft bristled toothbrush
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| What labs should be monitored with warfarin? | PT and INR
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| What is a normal PT range? | 11-14 seconds
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| Does warfarin increase or decrease PT range? | Increase
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| Should warfarin be used during pregnancy? | No
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| What are the advantages of direct thrombin inhibitors? | No anticoagulation monitoring and usually the same dose is used for all patients
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| Do the direct thrombin inhibitors have a reversal agent? | No
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| What is the therapeutic use for eliquis? | Prevention of stroke and systemic embolism in patient with nonvalvular atrial fibrillation
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| What is an example of an antiplatelet drug? | Aspirin
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| What are the thrombolytic drugs used for? | Acute MI, acute ischemic stroke, and acute massive PE
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| What drugs are also known as clot busters? | Thrombolytic drugs
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| What are the 3 thrombolytic drugs available in the US? | Alteplase, Reteplase, and Tenecteplase
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