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What are three ways anticoagulants work?
- 1. Prevent fibrin deposits
- 2. Prevent extension (growing) of a blood clot
- 3. Prevent thromboEMBOLIC complications (prevent blood clot from moving)
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What are the two main groups of anticoagulant medications?
- 1. Oral - Coumadin
- 2. Parenteral- Heparin
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What is the action of anticoagulant drugs?
Prevents clot development
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When is heparin used?
- (parenteral anticoagulant)
- - when rapid anticoagulant therapy is needed
- - Surgery on heart or blood vessels, Desseminated Intravascular Coagulation, Hemodialysis, Prolonged bed rest
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When is heparin flush used?
To keep IV lines patent
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What is the preferred anticoagulant during pregnancy?
Heparin
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When is coumadin used?
- Long-term maintanence
- - prevent DVT, PE, thromboembolism ass with afib/flutter
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What are the lab values used to regulate heparin?
- Target heparin assay: .3-.69 units/mL
- aPTT: 1.5-2.5 x control
- ACT: 2-3 x control
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What is the mechanism of action for heparin?
Prevents conversion of Prothrombin to thrombin and fibrinogen to fibrin
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What is the mechanism of action for coumadin?
Interferes with liver synthesis of vitamin K dependent clotting factors
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What are the lab values used to regulate coumadin?
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How can patients taking oral anticoagulant therapy prevent risk of bleeding and how is it treated if it occurs?
- Warfaran (Coumadin)-
- Px: Diet high in vitamin K- green leafy veges, milk, meat
- Tx: vitamin K or FFP is given
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When is Protamine Sulfate used?
Antidote to both heparin and coumadin
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What should you do before administering heparin?
Always check vial with another RN and have them tell you how much is in it
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LMWH =
- low molecular weight heparin
- Enoxaparin (Lovenox)
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What is the advantage to using lovenox over heparin?
- Fewer hemorrhagic complications
- No need for monotoring blood work daily
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1. Argatroban
2. Bivalirudin-Angiomax
3. Lepirudin-Refludan
What type of drugs are these and what are they primarily used for?
HIT -- Heparin Induced Thrombocytopenia
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1. Alteplase- Activase
2. Streptokinase-Streptase
3. Unokinase- Abbokinase
What type of drugs are these and what are they primarily used for?
- Thrombolytic Agents
- -- Acute thromboembolic events
ALL: treat thrombosis associated with MI, and open occlusions of shunts and catheters
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What are Streptokinase and Urokinease indicated for...
PE
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What is the only drug approved for the TREATMENT of DVTs?
Streptokinase
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How do antiplatelet drugs work?
Affect initial step of coagulation, platelet adhesion. Prevents clots.
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1. Aspirin
2. Clopidogrel- Plavix
3. Ticlopidine- Ticlid
What type of drugs are these?
Antiplatelets
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1. Abciximab-Reopro
2. Eptif ibatide- Integrilin
3. Tibrofiban- Aggrastat
What type of drugs are these?
GP IIb/IIIa inhibitors
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1. Clopidogrel- Plavex
2. Ticlopidine- Ticlid
What type of drugs are these and how do they work?
- Antiplatelets.
- ADP Inhibitor
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