12/7/23,g6:37gA NR293gPharmacologygforgNursinggPracticegWeekg4gEd
M apt
Weekg 4g Concepts:g Clotting
Coagulationg Modifiers
Prepare:g Coagulationg Modifiers
Coagulation gModifiers
Coagulationgmodifiersgaregaggroupgofg medicationsgthatgbothgpromotegandgpreventgclotgformationgasgwellgasglysing
gagpreformedgclotgandgreversinggthegactiongofganticoagulants.
Warfarin
Warfaringisganganticoagulantgmedicationgwhosegmechanismgofgactiongisgtog preventg clotgformationgbyginhibitinggparti
culargclottinggfactors.
Coagulation gModifiergDrugs
Coagulation gmodifiergdrugsgisga gclassgofgmedicationgthatgincludesgmedications?
heparin
gaspirin
acetaminophen
gwarfarin
SelfgCheck:gHemostasisg Review
Coagulationg Cascadeg System
Thegcoagulationgcascadegsystemgisgtriggeredgbyganginjurygtogagbloodgvessel,gwhichgthengtriggersgeithergangintrin
sicgorgangextrinsicgpathwaygofgintricategsteps,geachgstepgtriggeringgtheg nextgwhengclottinggfactorsgare/isgactivated.
gThegultimategresultgofgthisgsystemgisgaglargegconcentrationgofgfibrin.
Reverseg ofg theg Coagulationg Process
Thegreversegofgthegcoagulationgprocessgisgthegfibrinolyticgsystem.gFibrinolysisgisgthegbreakdowngofg thrombi.gThisgis
gangimportantgpartgofghemostasisgingordergtogpreventgexcessivegcoagulation,gblockedgbloodgvessels,gorgmobilizedgth
rombigcalledgangembolus.
Selfg Check:g Coagulationg Modifierg Drugs
Coagulation gModifiers
The gcoagulation gmodifier gdrugs garegbrokengdown gintogseveralgsubclassesgorgcategories gbased gongtheir g
hemostasis greversalgorgpromotion gaction.gWhich gitems garegmechanisms gofgaction gforgthisgclassgofgdrug?
gSelectgallgthatgapply.
Thrombusgprevention
Thrombusgmobilization
Lysinggofgagpreformedgthrom
busgAnticoagulationgreversalg
ThrombusgpromotiongAntiplate
letgreversal
Selfg Check:g Mechanismg ofgAction
Mechanismg ofg Action
Which gonegofgthesegcoagulation gmodifier gdrugs ghas gagmechanism gofgaction gthatgis gto glysegagthro
mbus gthatghas galready gformed? gMatchgitgtogitsgsubclass.
Medication Subclass
MechanismgofgAction Alteplase Thrombolytic
Reversalg Drug
Which gofgthese gmedications gis gagcoagulationgmodifier gwhose gsubclass gisgagreversalgdrug?gSelectgallgthatga
pply.
aminocaproicgaci
dgapixaban
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M apt
protaminegsulfat
egvitamingK
Reflect:g Coagulationg Modifiers
Antifibrinolytics
Whatgis ganother gtermgforgantifibrinolytics?
Antithrombotics
gAntiplateletsg
Hemorheologics
gHemostatics
PromotinggCoagulation
Agcoagulationgmodifier gdruggwhose gmechanismgofgaction gisgtogpromote gcoagulation gofgthegblood gisgcalled g
a(n)
g andg isg usedg to
.gantifibrinolytic,gmanagegexcessivegbl
eedingganticoagulant,gpreventgclotgformationg
thrombolytic,glysegclotsgthatghavegalreadygfor
medgantiplatelet,ginterferegwithgplateletgfuncti
on
Anticoagulants
Whatgisganothergtermgforganticoagulant?
HemostaticsgAn
tiplateletsgHem
orheologicsgAnti
thromboticsgAnt
ifibrinolytics
Coagulationg Modifierg Drugsg andg Subclasses
Match gthegcoagulation gmodifier gdrug’sgsubclass gtogthegcorrectgmedications.gNote:gSeveralgofgthegsubcl
assesghave gmoregthangonegmedicationglistedgas gcorrectgchoices.
Anticoagulants ●gg Enoxaparin
● Heparin
● Warfarin
● Dabigatran
● etexilateapixaban
Antiplatelets ●gg clopidogrelgbisulfate
● abciximab
Thrombolytics
●galteplase gAntifibri
nolytics
●gaminocaproic gaci
dgHemorheologics ●g pentoxifylline
Reversalg Drugs ●gggg coagulationg factorg Xag (recombinant)
● idarucizumab
● protamine gsulfate
● phytonadione
Reversalg andg Coagulationg Modifierg Drugs
Choosegthegcorrectgword(s)gfromgthegdrop-
downglistgtogcomplete gthegfollowing gstatementsgregarding greversalgdrugs.
Protaminegsulfategisgthegreversalgdruggforgheparin.g
Phytonadionegisgthegreversalgdruggforg warfarin.
Idarucizumabgisgthegreversalgdruggforg dabigatrangetexilate.
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M apt
Coagulationgfactorg Xag(recombinant)gisgthegreversalgdruggforgrivaroxaban.
Indications gforgUse
Match gthegindicationsgforgusegofgcoagulationgmodifyinggdrugsgbygdragginggthegclassgongthegrightgt
ogthe gcorrectgdescription.
Antiplateletgdrugsginhibitgplateletgaggregationgandgformationgofgplateletgplugs,g whichgareghelpfulgingpreventinggheart
gattacksgandgstrokes.
Hemorrhagicgdrugsgaltergplateletgfunctiongwithoutginterferinggwithgnormalgplateletgactivity.
Thrombolyticgdrugsgaregagclassificationgofgdrugsgthatgaregusedgtogbreakgdowngclotsgorgthrombi gthatg
havegformed.gAntifibrinolyticgdrugsgareg hemostaticgdrugsgthatgpromotegbloodgcoagulationgforgconditions
gofgexcessivegbleeding.
Hemostasisg Vocabulary
From gthegdrop-down gmenu,gselectgthegtermgthatgbestgfits gthegdefinition.
Theg processg ofg thrombig formationg –g Coagulation
Agclotgforminggsubstanceg thatgisgthegresultgofgthegcoagulationgsystem,gwhichgalsog triggersgthegfibrinolysisgsyst
emg–g FibringThegprocessgofgthrombigbreakdowng–g Fibrinolysis
Agrareg geneticg disorderg ing whichg certaingfactorsg neededg forg coagulationg andg hemostasisg areg inadequateg orgnonexiste
ntg –
Hemophilia
Anyg processg thatg stopsg bleedingg –g Hemostasis
Useg ofg compressiong tog achieveg hemostasisg –g xxxMechanicalg meansg ofg hemostasis
Useg ofg clampingg org cauterizationg tog achieveg hemostasisg –g xxxSurgicalg meansg ofg hemostasis
Useg ofg coagulationg modifierg drugsg tog achieveg hemostasisg –
g xxxPharmacologicg meansg ofg hemostasisgAgmobilized gthrombusg–g Embolus
Bloodgclotg–g Thrombus
Subclasses
Match gthegcoagulation gmodifier gdrug’sgsubclassgtogits gmechanism gofgaction.
Preventgclotgformationgbyginhibitinggparticulargclottinggfactorsggggg Antic
oagulantsgPreventgclotgformationgbyginterferinggwithgplateletgfunction
Antiplateletsg
Lysegclotsgthatghavegalreadygformed Thrombolytics
Promotegthegcoagulationgofgblood Antifibrinolytics
Reducegbloodgviscosity Hemorheologics
Actgasgantagonistsgtogthegothergmedications Reversalgdrugs
Anticoagulantsg (warfarin;g heparin)
Prepare:g Anticoagulants
ActionsgofgAnticoagulants
Anticoagulantsgperformgwhich gofgthegfollowing gactions?
Actgdirectlygongplateletgaggregat
iongPreventgthrombosis
Breakdowngfibrin
Lysegpre-formedgclots
AnticoagulantgSubclasses
Which gofgthese ganticoagulantsgbelongsgtogthegsubclassgheparins?
clopidogrel
gwarfaringri
varoxabang
enoxaparin
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M apt
Coumarins
Howgdogcoumarinsgpreventgthrombusgformation?
Workinggwithgothergdruggclassesgtogdecreasegthegthicknessg o
fgbloodgInhibitinggvitamingK-dependentgclottinggfactors
Directlygimpactinggplateletgaggregati
ongBreakinggdowngthegfibringingclot
s
Selfg Check:g Thromboembolicg Event
Whichgofgthegfollowing gpatients gis gleastgatgriskgofgagthromboembolic gevent?
SomeonegongagdirectgflightgfromgDetroit,gMichigangtogSydney,gA
ustraliagSomeonegwhoghasgbeengingagcomagforgagweekgfollowin
ggagstroke
Someonegwhog hasgagbrokengfootgandgisglearninggtogwalkgwithgangorthopedicgboot
Someonegwhog hasgag mechanicalgheartgvalve
Someonegrecoveringgfromgagbilateralgkneegreplacement
SelfgCheck:gHeparin
HeparingToxicity
Which gofgthegfollowing gstatements garegcorrectgregardinggheparin gtoxicity?gSelectgallgthatgapply.
Heparingtoxicitygmaygbegtreatedgintravenouslygwithgthegreversalgdruggprotaminegsulfategingseveregcas
esgBecausegofgheparin’sglongghalfglife,gthegtoxicgeffectsgofgheparingcannotgreversedgbygdiscontinuing
gheparingalonegThegheparingmustgbegstoppedgimmediately
Thegtoxicgeffectsgofgheparingmaygbegreversedgbygdiscontinuinggheparingalone
Increasedg Anticoagulants
Whichgofgthegfollowing gmedications gwhengtaken gwithgheparins,gcangcausegangincreased ganticoagulantgeffec
tg(bleeding grisk)?
Aspiringandgotherg NSAIDs,g oralganticoagulants,gantiplatelets,gandgthrombolytics
Antithrombotics,goralgantibiotics,gandgprothrombinsgAcetam
inophen,goralganticoagulants,gandgantithromboticsgAspiring
andgothergNSAIDs,goralgantibiotics,gandgantithrombotics
SelfgCheck:gWarfaring(Coumandin)
Warfarin
Whichgofgthegfollowing gstatementsgregarding gwarfarin garegaccurate?gSelectgallgthatgapply.
Itgtakesgseveralgdaysgtogreachg therapeuticglevels
Itgisgthegmostgcommonlygprescribedgparenteralganticoagulant
Theregisgagblackgboxgwarninggregardinggbleedinggriskgspecificgtogwarfarin
Togtreatgwarfaringtoxicity,ghighgdosesgofgdilutedgvitamingKgintravenouslygcangreversegthegeffectsgwithing6ghours
Selfg Check:g Blackg Boxg Warnings
Match gthegfollowing ganticoagulants gwithgits gblack gbox gwarnin
g.
dabigatran
Premature gdiscontinuation gofgthe gmedication gbecause gitgcangl
eadgto gincreased gthrombi
Forg patientsg withg ang epiduralg catheterg (mayg causeg spinalg hematomas) Apixabang/gRivaroxabang/gEnoxaparin
Seriousgbleeding grisk warfarin
Reflect:g Anticoagulants
AdversegEffects
Which gofgthegfollowing garegmedicationsgused gforgtreatmentgofgadversegeffects gassociated gwithgheparin? gSel
ectgallgthat
about:blank 4/46
M apt
Weekg 4g Concepts:g Clotting
Coagulationg Modifiers
Prepare:g Coagulationg Modifiers
Coagulation gModifiers
Coagulationgmodifiersgaregaggroupgofg medicationsgthatgbothgpromotegandgpreventgclotgformationgasgwellgasglysing
gagpreformedgclotgandgreversinggthegactiongofganticoagulants.
Warfarin
Warfaringisganganticoagulantgmedicationgwhosegmechanismgofgactiongisgtog preventg clotgformationgbyginhibitinggparti
culargclottinggfactors.
Coagulation gModifiergDrugs
Coagulation gmodifiergdrugsgisga gclassgofgmedicationgthatgincludesgmedications?
heparin
gaspirin
acetaminophen
gwarfarin
SelfgCheck:gHemostasisg Review
Coagulationg Cascadeg System
Thegcoagulationgcascadegsystemgisgtriggeredgbyganginjurygtogagbloodgvessel,gwhichgthengtriggersgeithergangintrin
sicgorgangextrinsicgpathwaygofgintricategsteps,geachgstepgtriggeringgtheg nextgwhengclottinggfactorsgare/isgactivated.
gThegultimategresultgofgthisgsystemgisgaglargegconcentrationgofgfibrin.
Reverseg ofg theg Coagulationg Process
Thegreversegofgthegcoagulationgprocessgisgthegfibrinolyticgsystem.gFibrinolysisgisgthegbreakdowngofg thrombi.gThisgis
gangimportantgpartgofghemostasisgingordergtogpreventgexcessivegcoagulation,gblockedgbloodgvessels,gorgmobilizedgth
rombigcalledgangembolus.
Selfg Check:g Coagulationg Modifierg Drugs
Coagulation gModifiers
The gcoagulation gmodifier gdrugs garegbrokengdown gintogseveralgsubclassesgorgcategories gbased gongtheir g
hemostasis greversalgorgpromotion gaction.gWhich gitems garegmechanisms gofgaction gforgthisgclassgofgdrug?
gSelectgallgthatgapply.
Thrombusgprevention
Thrombusgmobilization
Lysinggofgagpreformedgthrom
busgAnticoagulationgreversalg
ThrombusgpromotiongAntiplate
letgreversal
Selfg Check:g Mechanismg ofgAction
Mechanismg ofg Action
Which gonegofgthesegcoagulation gmodifier gdrugs ghas gagmechanism gofgaction gthatgis gto glysegagthro
mbus gthatghas galready gformed? gMatchgitgtogitsgsubclass.
Medication Subclass
MechanismgofgAction Alteplase Thrombolytic
Reversalg Drug
Which gofgthese gmedications gis gagcoagulationgmodifier gwhose gsubclass gisgagreversalgdrug?gSelectgallgthatga
pply.
aminocaproicgaci
dgapixaban
about:blank 1/46
,12/7/23,g6:37gA NR293gPharmacologygforgNursinggPracticegWeekg4gEd
M apt
protaminegsulfat
egvitamingK
Reflect:g Coagulationg Modifiers
Antifibrinolytics
Whatgis ganother gtermgforgantifibrinolytics?
Antithrombotics
gAntiplateletsg
Hemorheologics
gHemostatics
PromotinggCoagulation
Agcoagulationgmodifier gdruggwhose gmechanismgofgaction gisgtogpromote gcoagulation gofgthegblood gisgcalled g
a(n)
g andg isg usedg to
.gantifibrinolytic,gmanagegexcessivegbl
eedingganticoagulant,gpreventgclotgformationg
thrombolytic,glysegclotsgthatghavegalreadygfor
medgantiplatelet,ginterferegwithgplateletgfuncti
on
Anticoagulants
Whatgisganothergtermgforganticoagulant?
HemostaticsgAn
tiplateletsgHem
orheologicsgAnti
thromboticsgAnt
ifibrinolytics
Coagulationg Modifierg Drugsg andg Subclasses
Match gthegcoagulation gmodifier gdrug’sgsubclass gtogthegcorrectgmedications.gNote:gSeveralgofgthegsubcl
assesghave gmoregthangonegmedicationglistedgas gcorrectgchoices.
Anticoagulants ●gg Enoxaparin
● Heparin
● Warfarin
● Dabigatran
● etexilateapixaban
Antiplatelets ●gg clopidogrelgbisulfate
● abciximab
Thrombolytics
●galteplase gAntifibri
nolytics
●gaminocaproic gaci
dgHemorheologics ●g pentoxifylline
Reversalg Drugs ●gggg coagulationg factorg Xag (recombinant)
● idarucizumab
● protamine gsulfate
● phytonadione
Reversalg andg Coagulationg Modifierg Drugs
Choosegthegcorrectgword(s)gfromgthegdrop-
downglistgtogcomplete gthegfollowing gstatementsgregarding greversalgdrugs.
Protaminegsulfategisgthegreversalgdruggforgheparin.g
Phytonadionegisgthegreversalgdruggforg warfarin.
Idarucizumabgisgthegreversalgdruggforg dabigatrangetexilate.
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M apt
Coagulationgfactorg Xag(recombinant)gisgthegreversalgdruggforgrivaroxaban.
Indications gforgUse
Match gthegindicationsgforgusegofgcoagulationgmodifyinggdrugsgbygdragginggthegclassgongthegrightgt
ogthe gcorrectgdescription.
Antiplateletgdrugsginhibitgplateletgaggregationgandgformationgofgplateletgplugs,g whichgareghelpfulgingpreventinggheart
gattacksgandgstrokes.
Hemorrhagicgdrugsgaltergplateletgfunctiongwithoutginterferinggwithgnormalgplateletgactivity.
Thrombolyticgdrugsgaregagclassificationgofgdrugsgthatgaregusedgtogbreakgdowngclotsgorgthrombi gthatg
havegformed.gAntifibrinolyticgdrugsgareg hemostaticgdrugsgthatgpromotegbloodgcoagulationgforgconditions
gofgexcessivegbleeding.
Hemostasisg Vocabulary
From gthegdrop-down gmenu,gselectgthegtermgthatgbestgfits gthegdefinition.
Theg processg ofg thrombig formationg –g Coagulation
Agclotgforminggsubstanceg thatgisgthegresultgofgthegcoagulationgsystem,gwhichgalsog triggersgthegfibrinolysisgsyst
emg–g FibringThegprocessgofgthrombigbreakdowng–g Fibrinolysis
Agrareg geneticg disorderg ing whichg certaingfactorsg neededg forg coagulationg andg hemostasisg areg inadequateg orgnonexiste
ntg –
Hemophilia
Anyg processg thatg stopsg bleedingg –g Hemostasis
Useg ofg compressiong tog achieveg hemostasisg –g xxxMechanicalg meansg ofg hemostasis
Useg ofg clampingg org cauterizationg tog achieveg hemostasisg –g xxxSurgicalg meansg ofg hemostasis
Useg ofg coagulationg modifierg drugsg tog achieveg hemostasisg –
g xxxPharmacologicg meansg ofg hemostasisgAgmobilized gthrombusg–g Embolus
Bloodgclotg–g Thrombus
Subclasses
Match gthegcoagulation gmodifier gdrug’sgsubclassgtogits gmechanism gofgaction.
Preventgclotgformationgbyginhibitinggparticulargclottinggfactorsggggg Antic
oagulantsgPreventgclotgformationgbyginterferinggwithgplateletgfunction
Antiplateletsg
Lysegclotsgthatghavegalreadygformed Thrombolytics
Promotegthegcoagulationgofgblood Antifibrinolytics
Reducegbloodgviscosity Hemorheologics
Actgasgantagonistsgtogthegothergmedications Reversalgdrugs
Anticoagulantsg (warfarin;g heparin)
Prepare:g Anticoagulants
ActionsgofgAnticoagulants
Anticoagulantsgperformgwhich gofgthegfollowing gactions?
Actgdirectlygongplateletgaggregat
iongPreventgthrombosis
Breakdowngfibrin
Lysegpre-formedgclots
AnticoagulantgSubclasses
Which gofgthese ganticoagulantsgbelongsgtogthegsubclassgheparins?
clopidogrel
gwarfaringri
varoxabang
enoxaparin
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M apt
Coumarins
Howgdogcoumarinsgpreventgthrombusgformation?
Workinggwithgothergdruggclassesgtogdecreasegthegthicknessg o
fgbloodgInhibitinggvitamingK-dependentgclottinggfactors
Directlygimpactinggplateletgaggregati
ongBreakinggdowngthegfibringingclot
s
Selfg Check:g Thromboembolicg Event
Whichgofgthegfollowing gpatients gis gleastgatgriskgofgagthromboembolic gevent?
SomeonegongagdirectgflightgfromgDetroit,gMichigangtogSydney,gA
ustraliagSomeonegwhoghasgbeengingagcomagforgagweekgfollowin
ggagstroke
Someonegwhog hasgagbrokengfootgandgisglearninggtogwalkgwithgangorthopedicgboot
Someonegwhog hasgag mechanicalgheartgvalve
Someonegrecoveringgfromgagbilateralgkneegreplacement
SelfgCheck:gHeparin
HeparingToxicity
Which gofgthegfollowing gstatements garegcorrectgregardinggheparin gtoxicity?gSelectgallgthatgapply.
Heparingtoxicitygmaygbegtreatedgintravenouslygwithgthegreversalgdruggprotaminegsulfategingseveregcas
esgBecausegofgheparin’sglongghalfglife,gthegtoxicgeffectsgofgheparingcannotgreversedgbygdiscontinuing
gheparingalonegThegheparingmustgbegstoppedgimmediately
Thegtoxicgeffectsgofgheparingmaygbegreversedgbygdiscontinuinggheparingalone
Increasedg Anticoagulants
Whichgofgthegfollowing gmedications gwhengtaken gwithgheparins,gcangcausegangincreased ganticoagulantgeffec
tg(bleeding grisk)?
Aspiringandgotherg NSAIDs,g oralganticoagulants,gantiplatelets,gandgthrombolytics
Antithrombotics,goralgantibiotics,gandgprothrombinsgAcetam
inophen,goralganticoagulants,gandgantithromboticsgAspiring
andgothergNSAIDs,goralgantibiotics,gandgantithrombotics
SelfgCheck:gWarfaring(Coumandin)
Warfarin
Whichgofgthegfollowing gstatementsgregarding gwarfarin garegaccurate?gSelectgallgthatgapply.
Itgtakesgseveralgdaysgtogreachg therapeuticglevels
Itgisgthegmostgcommonlygprescribedgparenteralganticoagulant
Theregisgagblackgboxgwarninggregardinggbleedinggriskgspecificgtogwarfarin
Togtreatgwarfaringtoxicity,ghighgdosesgofgdilutedgvitamingKgintravenouslygcangreversegthegeffectsgwithing6ghours
Selfg Check:g Blackg Boxg Warnings
Match gthegfollowing ganticoagulants gwithgits gblack gbox gwarnin
g.
dabigatran
Premature gdiscontinuation gofgthe gmedication gbecause gitgcangl
eadgto gincreased gthrombi
Forg patientsg withg ang epiduralg catheterg (mayg causeg spinalg hematomas) Apixabang/gRivaroxabang/gEnoxaparin
Seriousgbleeding grisk warfarin
Reflect:g Anticoagulants
AdversegEffects
Which gofgthegfollowing garegmedicationsgused gforgtreatmentgofgadversegeffects gassociated gwithgheparin? gSel
ectgallgthat
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