Term
Anticoagulants
Heparin
Unfractionated Heparin |
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Definition
PREVENTS CLOTS FROM FORMING AND EXTENSION OF NEW CLOTS
Potentiates activity of Antithrombin III on thrombin
Inactivates thrombin
Inactivates Factors 9-12
Biological halflife is dose dependent
The bigger the dose, the longer it lasts. |
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Term
Heparin
Unfractionated
Administration |
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Definition
IV Heparin (Acid) instantaneous onset
IV or SQ only
IV Bolus followed by Infusion
Used for:
DVT (VTE)
PE
ACS-STEMI
Monitor for Hemorrhage
HIT or white clot syndrome
Reversal Agent: Protamine Sulfate (base)
It is an buffer. |
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Term
HEPARIN
UNFRACTIONATED
Monitoring |
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Definition
PTT every 6-8 Hours
Goal: 1.5-2.5 times normal
Contraindications:
hemorrhage
thrombocytopenia
recent CVA
recent surgery or LP
Pericardititis
PTT is intrinsic (in hospital)
PT/INR is extrinsic (out of hospital) Coumadin. |
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Term
Low Molecular Weight Heparin
Lovenox |
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Definition
Lighter weight heparin
Prevents Prothrombin conversion to thrombin
Prevents new clot formation or evolving of existing clot.
Inactivates Factor X-
peaks in 3-5 hours after SQ
DVT and PE Prophylaxis
Weight based
Complications: hemorrhage, thrombocytopenia
fever, anemia, elevated LFT
Treat bleeding issues with Protamine-may work. |
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Term
COUMADIN (WARFARIN)
Anticoagulant |
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Definition
INHIBITS THE CLOTTING FACTORS
Does not do anything with the clot
Inhibits Vitamin K dependent clotting factors
II, VII,IX, X
Treatment
DVT
AFIB
Prosthetic Heart Valves (mitral, aortic)
Takes 5 days to reach Therapeutic Dose.
Must be given with Heparin until therapeutic level achieved. |
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Term
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Definition
Coumadin is 99% protein bound (albumin)
if person has liver problems or decreased albumin will affect coumadin levels.
Food alters absorption
Half Life is 40 hours.
Decrease the dose: elders, heart failure, liver disease,thyroid disease
It is inhibited by : hypothyroid, nephrotic syndrome
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Term
COUMADIN (WARFARIN)
Potentiators |
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Definition
There are several meds that increase effects of Coumadin
Antibiotics
Amiodarone
Cimetidine
Fluconazole
Flagyl
Dilantin
Increases the risk of bleeding: monitor INR for Supratherapeutic Levels.
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Term
COUMADIN (WARFARIN)
Inhibitors |
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Definition
Medications that inhibit the affects of Coumadin
Barbiturates, Griseofulvin, Carbamazepine
Nafcillin, Rifampin, Carafate
Diuretics, Vitamin K
Coating agents decrease absorption of Coumadin |
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Term
COUMADIN (WARFARIN)
Adverse Effects |
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Definition
BLEEDING
inr > 3.0 you are at increased risk
This medication crosses Placenta
so
Pregnancy Category X
DO NOT GIVE IN PREGNANCY |
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Term
COUMADIN (WARAFIN)
Dosing and Management |
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Definition
While still on Heparin or Lovenox, start at 5 mg po at bedtime.
check PT/INR 24-48 hrs after start and adjust dose
by 2-5 mg/day PRN
You want the INR = 2-3
Recheck INR in 2 weeks
Educate patient:
Not to take OTC meds without you knowing about them
No ASA,Cimetidine, Ibuprofen
Only Tylenol
ANTIBIOTICS need to be reported
AVOID Vitamin K rich foods (green leafy)
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Term
COUMADIN (WARFARIN)
Management of Supratherapeutic Levels |
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Definition
INR 2.5-3.0: Reduce dose
INR > 3.0 : Stop dose for 24-48, lower dose
INR 6-10 and NO bleeding: Vitamin K 0.5-1.0 mg
INR 10-20 and NO bleeding: Vitamin K 3-5 mg
INR >20 serious bleeding : Vitamin K 10 mg IV
and 2-4 units FFP
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Term
Pradaxa
Dabigatran
Anticoagulant |
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Definition
Give for Non-valvular AFib,
VTE prevention
DO NOT USE IN PROSTHETIC VALVES
RENAL DISEASE
LIVER DISEASE
Causes Bleeding
High risk for GIB
Dyspepsia
No antecdote
Dialysis to remove
FFP given to reverse
Very expensive.
NO Lab Tests Required. |
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Term
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Definition
Prevention of VTE after HIP surgery or KNEE surgery
Use in Non-valvular Afib |
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Term
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Definition
Direct Thrombin Inhibitor
Used when pt unable to tolerate Heparin
HIT
Very expensive |
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Term
Bivalirudin (Angiomax)
Anticoagulant |
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Definition
Direct Thrombin Inhibitor
Used for PTCA |
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Term
ANTIPLATELET AGENTS
Mechanism of Action |
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Definition
Suppresses platelet aggregation
Makes Platelets slippery; prevents sticking together
Affects every platelet for the life of that platelet (4-6 days)
Prevention thrombus formation
prevents evolution of thrombus
Cox Inhibitor: Blocks Cox (cyclooxygenase) which prevents the synthesis of thromboxane A2 from arachnadonic acid in platelets |
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Term
ANTIPLATELET AGENTS
Indications |
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Definition
Prevention and Management of ACS/MI
Peripheral and Vascular Coronary Artery Disease
Maintain STENT patency
TIA prevention
VTE/DVT prevention
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Term
ANTIPLATELET AGENTS
Aspirin |
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Definition
THE GOLD STANDARD
Prevents Platelet Aggregation
Side effects: GIB
Gastric Irritation-consider Enteric Coated
Causes ringing in the ears: Tinnitis
Dosing: Acute MI, Chest pain 160-325 mo pg
Baby ASA- chew
Maintenance: 81 mg po
DECREASED RISK OF CVA 42%
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Term
Persantine (Dipyridamole)
Antiplatelet |
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Definition
Inhibits ADP and ATP to reduce platelet adhesion
VASODILATION: of coronary artery
Prevents CVA, TIA: Dose 50 mg po TID
Used WITH ASA to prevent TIA and CAB occlusion
Used WITH COUMADIN for prosthetic valves
Risk of Bradycardia
DO NOT USE IF PT ON BETA BLOCKERS |
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Term
TICLID (Ticlopidine)
Antiplatelet Agent |
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Definition
Interferes with platelet ADP binding to fibrinogen
decreases platelet aggregation
Prevents repeated CVA
Prevents STENT patency when used with ASA
Leads to Bone Marrow Suppression
Neutropenia
Monitor LFT, CBC, Lipid Monitoring
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Term
PLAVIX (Clopidogrel)
Antiplatelet Agents
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Definition
Blocks ADP platelet to platelet binding
Inhibits thrombus formation
Given with ASA
Treatment for NSTEMI, ACS, STEMI
Can cause THROMBOCYTOPENIA
ANGIOEDEMA
Avoid with Herbals:
(4G's Garlic,Ginseng,Ginger,Ginko)
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Term
EFFIENT (Prasugrel)
Antiplatelet Agents |
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Definition
Blocks ADP platelet to platelet binding
Inhibits thrombus formation
Used for ACS
Give in conjunction with ASA
No major CYP450 interactions
Side effects: neutropenia, afib, bleeding, liver dysf.
Contraindicated in previous CVA
Complications if older than 75 y.o
Increased risk of Atrial Fibrillation
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Term
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Definition
Plavix
ASA
Coumadin
Patients may develop a mutant genetic variation that develops resistance to this. |
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Term
GLYCOPROTEIN IIB/IIIA inhibitor
Antiplatelet Agent |
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Definition
Inhibits platelet aggregation by preventing binding of IIb/IIIa receptor.
Reopro
Integrilin
Aggrastat
Used for patients actively having MI
NSTEMI
Unstable Angina
PTCA
Side effects
Thrombocytopenia
Bleeding |
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Term
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Definition
"Clot Buster"
Plasminogen is converted to Plasmin
plasmin Lysis Fibrin Clots
They do not prevent new clot formation so you must use it with an anticoagulant.
streptokinase -can only give 1 time due to anaphylaxis.
retevase- used in stemi
tnkase- used in stemi, line declotting |
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Term
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Definition
Clot Buster
used for STEMI,
Ischemic CVA with Negative Head CT
and PE
Must give within 3 hours of onset
TPA ONLY FDA APPROVED DRUG FOR ABOVE USES
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Term
FIBRINOLYTICS
Monitoring and Complications |
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Definition
BIGGEST RISK FOR HEMORRHAGE
Monitor cardiac
mental status
bleeding
CONTRAINDICATED
Aortic dissection
active bleeding
major surgery in last 10 days
CVA
uncontrolled HTN
bleeding disorder
Can lead to reperfusion arrhythmias |
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Term
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Definition
Nitroglycerine
Metabolized to nitrous oxide to nitroglycerine
inhibits Platelet aggregation
Vasodilation: Venous > arterial
increases blood flow to endo/myocardium
Decreases myocardial oxygen demand
Reduces Preload/Afterload
Improves Coronary Perfusion
Causes Venous Pooling |
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Term
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Definition
Indications
Acute Chest Pain
Chronic Chest Pain
hypertension
Side Effects
Headache
postural hypotension
Methemoglobinemia
Reflex Tachycardia
Have a 12 free of NTG
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Term
NITRATES
Nitroglycerine
Sublingual, oral, topical |
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Definition
Isosorbide Dinitrite
Not metabolized
Goes through Hepatic first pass
Lasts 4 - 6 hours
open bottle: 6 mos.
Isosorbide Mononitrate
It is metabolized already
Does not go through Hepatic First pass
Last 6-10 hours
MUST HAVE 12 HOURS FREE OF NITRATES
Pregnancy Category C |
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Term
NITRATE
NITROGLYCERINE
Education |
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Definition
CANNOT TAKE WITH PHOSPHODIASTERASE INHIBITORS
VIAGRA
CIALIS
LIVITRA
Take medication sitting down
Ranexa: take if nitrates do not work and you need pain management for chronic angina
It is NOT a monotherapy
Causes prolonged QT interval
Give it with BB and CaChannel blocker
Pregnancy Category C: DO NOT GIVE IN PREGNANCY |
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