Week 4 Concepts: Clotting Stuvia.com - The Marketplace to Buy and Sell your Study Material
Coagulation Modifiers Prepare: Coagulation Modifiers
Coagulation Modifiers Coagulation modifiers are a group of medications that both promote and prevent clot formation as well as lysing a preforme clot and reversing the action of anticoagulants.
Warfarin Warfarin is an anticoagulant medication whose mechanism of action is to prevent clot formation by inhibiting particular clott factors. Coagulation Modifier Drugs Coagulation modifier drugs is a class of medication that includes medications? heparin aspirin acetaminophen warfarin
Self Check: Hemostasis Review
Coagulation Cascade System The coagulation cascade system is triggered by an injury to a blood vessel, which then triggers either an intrinsic or an extrinsic pathway of intricate steps, each step triggering the next when clotting factors are/is activated. The ultimate result o this system is a large concentration of fibrin.
Reverse of the Coagulation Process The reverse of the coagulation process is the fibrinolytic system. Fibrinolysis is the breakdown of thrombi. This is an import part of hemostasis in order to prevent excessive coagulation, blocked blood vessels, or mobilized thrombi called an embolu
Self Check: Coagulation Modifier Drugs
Coagulation Modifiers The coagulation modifier drugs are broken down into several subclasses or categories based on their hemostasis reversal or promotion action. Which items are mechanisms of action for this class of drug? Select all that apply. Thrombus prevention Thrombus mobilization Lysing of a preformed thrombus Anticoagulation reversal Thrombus promotion Antiplatelet reversal
Self Check: Mechanism of Action Mechanism of Action Which one of these coagulation modifier drugs has a mechanism of action that is to lyse a thrombus that has already formed? Match it to its subclass.
Mechanism of Action
Medication
Subclass
Alteplase
Thrombolytic
Reversal Drug Which of these medications is a coagulation modifier whose subclass is a reversal drug? Select all that apply. aminocaproic acid apixaban Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal
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protamine sulfate vitamin K
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Reflect: Coagulation Modifiers Antifibrinolytics What is another term for antifibrinolytics? Antithrombotics Antiplatelets Hemorheologics Hemostatics Promoting Coagulation A coagulation modifier drug whose mechanism of action is to promote coagulation of the blood is called a(n) ___________ and is used to _________. antifibrinolytic, manage excessive bleeding anticoagulant, prevent clot formation thrombolytic, lyse clots that have already formed antiplatelet, interfere with platelet function Anticoagulants What is another term for anticoagulant? Hemostatics Antiplatelets Hemorheologics Antithrombotics Antifibrinolytics Coagulation Modifier Drugs and Subclasses Match the coagulation modifier drug’s subclass to the correct medications. Note: Several of the subclasses have more than one medication listed as correct choices.
Anticoagulants
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Enoxaparin Heparin Warfarin Dabigatran etexilateapixaban
Antiplatelets
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clopidogrel bisulfate abciximab
Thrombolytics
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alteplase
Antifibrinolytics
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aminocaproic acid
Hemorheologics
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pentoxifylline
Reversal Drugs
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coagulation factor Xa (recombinant) idarucizumab protamine sulfate phytonadione
Reversal and Coagulation Modifier Drugs Choose the correct word(s) from the drop-down list to complete the following statements regarding reversal drugs Protamine sulfate is the reversal drug for heparin. Phytonadione is the reversal drug for warfarin. Idarucizumab is the reversal drug for dabigatran etexilate. Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal
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Coagulation factor Xa (recombinant) is the reversal drug for rivaroxaban.
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Indications for Use Match the indications for use of coagulation modifying drugs by dragging the class on the right to the correct description. Antiplatelet drugs inhibit platelet aggregation and formation of platelet plugs, which are helpful in preventing heart attacks a strokes. Hemorrhagic drugs alter platelet function without interfering with normal platelet activity. Thrombolytic drugs are a classification of drugs that are used to break down clots or thrombi that have formed. Antifibrinolytic drugs are hemostatic drugs that promote blood coagulation for conditions of excessive bleeding. Hemostasis Vocabulary From the drop-down menu, select the term that best fits the definition. The process of thrombi formation – Coagulation A clot forming substance that is the result of the coagulation system, which also triggers the fibrinolysis system – Fibrin The process of thrombi breakdown – Fibrinolysis A rare genetic disorder in which certain factors needed for coagulation and hemostasis are inadequate or nonexistent – Hemophilia Any process that stops bleeding – Hemostasis Use of compression to achieve hemostasis – xxxMechanical means of hemostasis Use of clamping or cauterization to achieve hemostasis – xxxSurgical means of hemostasis Use of coagulation modifier drugs to achieve hemostasis – xxxPharmacologic means of hemostasis A mobilized thrombus – Embolus Blood clot – Thrombus Subclasses Match the coagulation modifier drug’s subclass to its mechanism of action.
Prevent clot formation by inhibiting particular clotting factors
Anticoagulants
Prevent clot formation by interfering with platelet function
Antiplatelets
Lyse clots that have already formed
Thrombolytics
Promote the coagulation of blood
Antifibrinolytics
Reduce blood viscosity
Hemorheologics
Act as antagonists to the other medications
Reversal drugs
Anticoagulants (warfarin; heparin) Prepare: Anticoagulants Actions of Anticoagulants Anticoagulants perform which of the following actions? Act directly on platelet aggregation Prevent thrombosis Breakdown fibrin Lyse pre-formed clots Anticoagulant Subclasses Which of these anticoagulants belongs to the subclass heparins? clopidogrel warfarin rivaroxaban enoxaparin Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal
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Coumarins How do coumarins prevent thrombus formation? Working with other drug classes to decrease the thickness of blood Inhibiting vitamin K-dependent clotting factors Directly impacting platelet aggregation Breaking down the fibrin in clots
Self Check: Thromboembolic Event Which of the following patients is least at risk of a thromboembolic event? Someone on a direct flight from Detroit, Michigan to Sydney, Australia Someone who has been in a coma for a week following a stroke Someone who has a broken foot and is learning to walk with an orthopedic boot Someone who has a mechanical heart valve Someone recovering from a bilateral knee replacement
Self Check: Heparin Heparin Toxicity Which of the following statements are correct regarding heparin toxicity? Select all that apply. Heparin toxicity may be treated intravenously with the reversal drug protamine sulfate in severe cases Because of heparin’s long half life, the toxic effects of heparin cannot reversed by discontinuing heparin alone The heparin must be stopped immediately The toxic effects of heparin may be reversed by discontinuing heparin alone
Increased Anticoagulants Which of the following medications when taken with heparins, can cause an increased anticoagulant effect (bleedi risk)? Aspirin and other NSAIDs, oral anticoagulants, antiplatelets, and thrombolytics Antithrombotics, oral antibiotics, and prothrombins Acetaminophen, oral anticoagulants, and antithrombotics Aspirin and other NSAIDs, oral antibiotics, and antithrombotics
Self Check: Warfarin (Coumandin) Warfarin Which of the following statements regarding warfarin are accurate? Select all that apply. It takes several days to reach therapeutic levels It is the most commonly prescribed parenteral anticoagulant There is a black box warning regarding bleeding risk specific to warfarin To treat warfarin toxicity, high doses of diluted vitamin K intravenously can reverse the effects within 6 hours
Self Check: Black Box Warnings Match the following anticoagulants with its black box warning.
Premature discontinuation of the medication because it can lead to increased thrombi
dabigatran
For patients with an epidural catheter (may cause spinal hematomas)
Apixaban / Rivaroxaban / Enoxaparin
Serious bleeding risk
warfarin
Reflect: Anticoagulants
Adverse Effects Which of the following are medications used for treatment of adverse effects associated with heparin? Select all th Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal
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idarucizumab vitamin K prothrombin complex concentrate (human) Direct thrombin inhibitors protamine sulfate
About Anticoagulant Medications Match each anticoagulant medication or subclass/category to its true statement. The first oral selective Xa inhibitor to become available
rivaroxaban
Requires frequent monitoring of serum bleeding times (such as aPTT and INR) to determine if therapeutic level has been reached and if toxicity is present
heparin
When taken with warfarin causes a 50% or higher increase in INR
cordarone
Inhibit thrombin (clotting factor IIa)
Direct thrombin inhibitors
When taken with heparins can cause an increased bleeding risk due to decreased platelet activity
Non-steroidal anti-inflammatory (NSAID)
Direct thrombin inhibitor
dabigatran
Do not require frequent monitoring of serum bleeding times due to its more predictable anticoagulant response
Low-molecular-weight heparins (LMWHs)
Adverse Effects What are the most common adverse effects for anticoagulants in general? Select all that apply. Hypokalemia Peripheral edema Bleeding Thrombocytopenia Necrosis of the skin and “purple toes” syndrome Thrombocytosis Abdominal cramps Statements About Heparin Drag the below statements into the correct column, indicating which are true and which are false, regarding the subclass of anticoagulants known as heparins? True Statements
Statements About Heparin
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False Statements
Heparin used therapeutically requires frequent monitoring of serum bleeding times Unfractionated heparin is commonly known as simply “heparin” Enoxaparin has a higher degree of bioavailability and longer elimination half-life than heparin
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●
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Heparin when used as a DVT prophylactic and as a catheter flush require additional monitoring of serum bleeding times Low-molecular weight heparins (LMWHs) require frequent monitoring of serum bleeding times Dalteparin is a type of unfractionated heparin
Selective Xa Inhibitors Which of these medications is an oral selective Xa inhibitor that is used for prevention of strokes in patients with atrial fibrillation (a-fib)? fondaparinux sodium apixapan rivaroxaban
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