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chapter 45
pharmacology fscj 2011
53
Nursing
Undergraduate 3
10/12/2011

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Term
Various drugs are used to maintain or restore circulation. The three major groups of these drugs are
Definition
1) anticoagulants, (2) antiplatelets (antithrombotics), and (3) thrombolytics.
Term
antiplatelets
Definition
prevent platelet aggregation (clumping together of platelets to form a clot)
Term
antiplatelets
Definition
prevent platelet aggregation (clumping together of platelets to form a clot)
Term
antiplatelets
Definition
prevent platelet aggregation (clumping together of platelets to form a clot)
Term
thrombolytics are popularly called
Definition
clot busters
Term
thrombolytics etiology
Definition
attack and dissolve blood clots that have already formed.
Term
Thrombosis
Definition
s the formation of a clot in an arterial or venous vessel.
Term
The formation of an arterial thrombus could be caused by
Definition
blood stasis (because of decreased circulation),platelet aggregation on the blood vessel wall, or blood coagulation.
Term
Arterial clots are usually made up of both _____ and _____ clots with the _____ clots (platelets) initiating the process, followed by fibrin formation and the trapping of ______ cells in the fibrin mesh.
Definition
white, red, white, red blood
Term
thrombus can be dislodged from the vessel and become an
Definition
embolus (blood clot moving through the blood stream).
Term
When platelets adhere to the broken surface of an endothelial lining, they synthesize _________ which is a product of prostaglandins and a potent stimulus for platelet aggregation (clumping of platelet cells)
Definition
thromboxane A2
Term
Anticoagulants
Definition
inhibit clot formation
Term
TRUE OR FALSE

ANTICOAGULANTS DISSOLVE CLOTS
Definition
FALSE!!

they do not dissolve clots that have already formed, but rather act prophylactically to prevent new clots from forming
Term
Anticoagulants are used in clients with venous and arterial disorders that put them at high risk for clot formation. Venous problems include:
Definition
deep vein thrombosis (DVT) and pulmonary embolism, and arterial problems include coronary thrombosis (myocardial infarction), presence of artificial heart valves, and cerebrovascular accidents (CVAs, or stroke).
Term
Heparin
Definition
is a natural substance in the liver that prevents clot formation.
Term
disseminated intravascular coagulation:
Definition
DIC occurs when fibrin clots form within the vascular system. These clots consume proteins and platelets, depleting clotting factors and causing excess bleeding.
Term
the primary use of heparin is to
Definition
prevent venous thrombosis, which can lead to pulmonary embolism or stroke.
Term
Heparin combines with _______ which accelerates the anticoagulant cascade of reactions that prevents thrombosis formation.
Definition
antithrombin III,
Term
Because heparin is poorly absorbed orally, it is given ____for prophylaxis or ____ to treat acute thrombosis.
Definition
SUB Q, IV
Term
HEPARIN LAB TESTS
Definition
Partial thromboplastin time (PTT) and activated partial thromboplastin time (aPTT)
Term
HEPARIN ANTIDOTE
Definition
protamine sulfate
Term
___ ____ ___ heparins (LMWHs) produce more stable responses at recommended doses.
Definition
Low–molecular-weight
Term
TRUE OR FALSE:
Low–molecular-weight heparins do not need to have aPTT tests done in the patient
Definition
TRUE
Low–molecular-weight heparins (LMWHs) produce more stable responses at recommended doses. As a result, frequent laboratory monitoring of aPTT is not required,
Term
___ ____ ____ ___ inactivates the Xa factor, but it is less able to inactivate thrombin.
Definition
Low–molecular-weight heparin
Term
TRUE OR FALSE:

you can be prescribed heparin to use at home.
Definition
FALSE
it needs to be monitored by PTT/aPTT testing
Term
TRUE OR FALSE

LMW Heparin can be administered at home
Definition
TRUE

The drugs can be administered at home, because aPTT monitoring is not necessary,
Term
The half-life of LMWHs is_______ times longer than that of heparin.
Definition
2 TO 4 TIMES
Term
TRUE OR FALSE

Warfarin (Coumadin), from the coumarin drug family, is the only oral anticoagulant prescribed today
Definition
TRUE
Term
Oral anticoagulants prolong clotting time and are monitored by the
Definition
prothrombin time (PT), a laboratory test that measures the time it takes blood to clot in the presence of certain clotting factors
Term
the laboratory test most frequently used to report PT results.
Definition
international normalized ratio (INR)
Term
LMWHs CONTRANDICATIONS
Definition
trokes, peptic ulcers, and blood anomalies. These drugs should not be given to clients having eye, brain, or spinal surgery.
Term
Antidote for warfarin overdose
Definition
phytonadione
Term
Intravenous heparin has a _____ onset; its peak time of action is reached in ______, and its duration of action is _____
Definition
short, minutes, short
Term
warfarin adverse effects
Definition
Bleeding (hemorrhage)
Term
TRUE OR FALSE

Because warfarin is highly protein-bound, it is not affected by drug interactions.
Definition
FALSE
because its protein bound, its very affected by drug interactions.
Term
________ should be used instead of aspirin by clients taking warfarin to prevent drug interactions
Definition
Acetaminophen (Tylenol)
Term
Antiplatelet drug therapy is mainly for prophylactic use in the prevention of:
Definition
(1) prevention of myocardial infarction or stroke for clients with familial history, (2) prevention of a repeat myocardial infarction or stroke, and (3) prevention of a stroke for clients having transient ischemic attacks (TIAs).
Term
Thromboembolism
Definition
(occlusion of an artery or vein caused by a thrombus or embolus)
Term
ischemia
Definition
(deficient blood flow) t
Term
necrosis
Definition
death
Term
he thrombus, or blood clot, disintegrates when a thrombolytic drug is administered within _____ after an acute myocardial infarction (AMI)
Definition
4 hours
Term
Anaphylaxis
Definition
vascular collapse
Term
thrombolytic Adverse Reactions
Definition
Anaphylaxis (vascular collapse) and hemorrhage
Term
1. When a newly admitted client is placed on heparin, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.)

a. Coronary thrombosis

b. Acute myocardial infarction

c. Deep vein thrombosis (DVT)

d. Cerebrovascular accident (CVA) (stroke)

e. Venous disorders
Definition
A B C D E
Term
2. A client who received heparin begins to bleed, and the physician calls for the antidote. The nurse knows that which is the antidote for heparin?

a. protamine sulfate

b. vitamin K

c. aminocaproic acid

d. vitamin C
Definition
A
Term
3. A client is prescribed enoxaparin (Lovenox). The nurse knows that low–molecular-weight heparin (LMWH) has what kind of half-life?

a. A longer half-life than heparin

b. A shorter half-life than heparin

c. The same half-life as heparin

d. A four-times shorter half-life than heparin
Definition
A
Term
4. The nurse is teaching a client about clopidogrel (Plavix). What is important information to include?

a. Constipation may occur.

b. Hypotension may occur.

c. Bleeding may increase when taken with aspirin.

d. Normal dose is 25 mg tablet per day.
Definition
C
Term
5. A client is prescribed dalteparin (Fragmin). LMWH is administered via which route?

a. Intravenously

b. Intramuscularly

c. Intradermally

d. Subcutaneously
Definition
D
Term
6. A client is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally?

a. enoxaparin sodium (Lovenox)

b. warfarin (Coumadin)

c. bivalirudin (Angiomax)

d. lepirudin (Refludan)
Definition
B
Term
7. A client is taking warfarin 5 mg/day for atrial fibrillation. The client's international normalized ratio (INR) is 3.8. The nurse would consider the INR to be what?

a. Within normal range

b. Elevated INR range

c. Low INR range

d. Low average INR range
Definition
B
Term
8. Cilostazol (Pletal) is being prescribed for a client with coronary artery disease. The nurse knows that which is the major purpose for antiplatelet drug therapy?

a. To dissolve the blood clot

b. To decrease tissue necrosis

c. To inhibit hepatic synthesis of vitamin K

d. To suppress platelet aggregation
Definition
D
Term
9. A client is to undergo a coronary angioplasty. The nurse acknowledges that which drug is used primarily for preventing reocclusion of coronary arteries following a coronary angioplasty?

a. clopidogrel (Plavix)

b. abciximab (ReoPro)

c. warfarin (Coumadin)

d. streptokinase
Definition
B
Term
10. A client is admitted to the emergency department with an acute myocardial infarction. Which drug category does the nurse expect to be given to the client early for the prevention of tissue necrosis following blood clot blockage in a coronary or cerebral artery?

a. Anticoagulant agent

b. Antiplatelet agent

c. Thrombolytic agent

d. Low–molecular-weight heparin (LMWH)
Definition
C
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