426 EXAM 1
3 Things that happen due to lack of coagulation factors
Slower coagulation cascade
Less fibrin
Risk for bleeding
Coagulation cascade usually happens...
Locally
What happens if there is a lot of coagulation happening
Will start to run low on clotting factors which could lead to a bleeding problem
General Nursing Considerations for ALL anticoagulants, thrombolytics, and anti-platelet
drugs (3)
Give any of these drugs together or give two of the same type of drug= increased risk
for bleeding
Monitor for signs of bleeding
does this patient already have a risk of bleeding?
Medications to avoid when taking anticoagulants, thrombolytics, antiplatelet (2)
NSAID
Asprin
Labs to monitor for intrinsic pathway
PTT/aPTT
,Labs to monitor for extrinsic pathway
INR
Heparin works by
Deactivate factors that are already in the bloodstream (works quickly)
Warfarin works by
does nothing to factors already in the blood stream- but prevents the body from making
future specific factors (works slowly)
What happens if heparin or warfarin works to quickly or if you take too much? (3)
Patient will be LOW on factors
Less able to go through the coagulation cascade
Bleeding time would be LONGER
heparin is an anticoagulant that specifically affects
anti thrombin
What does anti-thrombin do
Deactivates specific factors in the coagulation cascade
How does heparin affect antithrombin (3)
Heparins boost/activate anti thrombin function
slows down the coagulation cascade
less fibrin
Labs to monitor with heparin
PTT
,aPTT
Adverse reaction for heparin (besides bleeding)
Thrombocytopenia
When giving SQ or IV heparin aPTT should be...
1.5x the baseline value
Where is heparin given
only at the hospital
Heparin reversal agent
Protamine
Enoxaparin/lovenox works similar to heparin, however the difference is...
Enoxaparin can be given at home and no need to monitor aPTT
Anticoagulants Affecting SYNTHESIS of clotting factors
Warfarin (coumadin)
Lab to monitor with warfarin
INR
How does warfarin affect existing clotting factors?
Only prevents synthesis of clotting factors that useVitamin K (VII, IX, X,II)
Therefore, takes longer to take effect
Reversal agent of warfarin
Vitamin K
, When does warfarin start to work (2)
8-12 hrs
full effect in 3-5 days
3 contraindications for warfarin
Pregnancy
Thrombocytopenia
Alcoholism
Patient education for warfarin (3)
Use soft toothbrush
Electric razor
Keep vitamin K consumption consistent (leafy greens, broccoli, soybean oils, Brussel
sprouts,)
phenobarbital, oral contraceptives, Phenytoin, Vitamin K have what effect on warfarin
Decrease effects
Aspirin, Acetaminophen, glucocorticoids, sulfonamides, cephalosporins have what
effect on warfarin
Increase effect
Clopidogrel (plavix) is an anti platelet and works by
P2Y12 ADP receptor antagonist (prevents platelet aggregation)
Is there an antidote to clopidogrel?
No its irreversible and last 7-10 days
3 Things that happen due to lack of coagulation factors
Slower coagulation cascade
Less fibrin
Risk for bleeding
Coagulation cascade usually happens...
Locally
What happens if there is a lot of coagulation happening
Will start to run low on clotting factors which could lead to a bleeding problem
General Nursing Considerations for ALL anticoagulants, thrombolytics, and anti-platelet
drugs (3)
Give any of these drugs together or give two of the same type of drug= increased risk
for bleeding
Monitor for signs of bleeding
does this patient already have a risk of bleeding?
Medications to avoid when taking anticoagulants, thrombolytics, antiplatelet (2)
NSAID
Asprin
Labs to monitor for intrinsic pathway
PTT/aPTT
,Labs to monitor for extrinsic pathway
INR
Heparin works by
Deactivate factors that are already in the bloodstream (works quickly)
Warfarin works by
does nothing to factors already in the blood stream- but prevents the body from making
future specific factors (works slowly)
What happens if heparin or warfarin works to quickly or if you take too much? (3)
Patient will be LOW on factors
Less able to go through the coagulation cascade
Bleeding time would be LONGER
heparin is an anticoagulant that specifically affects
anti thrombin
What does anti-thrombin do
Deactivates specific factors in the coagulation cascade
How does heparin affect antithrombin (3)
Heparins boost/activate anti thrombin function
slows down the coagulation cascade
less fibrin
Labs to monitor with heparin
PTT
,aPTT
Adverse reaction for heparin (besides bleeding)
Thrombocytopenia
When giving SQ or IV heparin aPTT should be...
1.5x the baseline value
Where is heparin given
only at the hospital
Heparin reversal agent
Protamine
Enoxaparin/lovenox works similar to heparin, however the difference is...
Enoxaparin can be given at home and no need to monitor aPTT
Anticoagulants Affecting SYNTHESIS of clotting factors
Warfarin (coumadin)
Lab to monitor with warfarin
INR
How does warfarin affect existing clotting factors?
Only prevents synthesis of clotting factors that useVitamin K (VII, IX, X,II)
Therefore, takes longer to take effect
Reversal agent of warfarin
Vitamin K
, When does warfarin start to work (2)
8-12 hrs
full effect in 3-5 days
3 contraindications for warfarin
Pregnancy
Thrombocytopenia
Alcoholism
Patient education for warfarin (3)
Use soft toothbrush
Electric razor
Keep vitamin K consumption consistent (leafy greens, broccoli, soybean oils, Brussel
sprouts,)
phenobarbital, oral contraceptives, Phenytoin, Vitamin K have what effect on warfarin
Decrease effects
Aspirin, Acetaminophen, glucocorticoids, sulfonamides, cephalosporins have what
effect on warfarin
Increase effect
Clopidogrel (plavix) is an anti platelet and works by
P2Y12 ADP receptor antagonist (prevents platelet aggregation)
Is there an antidote to clopidogrel?
No its irreversible and last 7-10 days
